Third time’s a……

March 31, 2015April 1, 20151 Comment

Three Times a Charm

I think I am getting the hang of this IUI thing now. I understand exactly what is going to happen each day, what drugs to take, what side effect will happen and when, who to speak to on the phone, who NOT to speak to on phone, how to ask for what I want, how to make myself understood, how to refill my various prescriptions, what bills to expect, even what emotions I am probably going to feel on this roller coaster of a cycle. For example, I am on Cycle Day 4, and having taken two 2.5mg of Letrozole last night at 7pm, I knew at approximately 4pm Today I was going to be mega sleepy. And I was! Where I work, if you have done something more than twice you are considered an expert, so I’m going to declare myself “IUI Subject Matter Expert” on my “CV of life”. I’m feeling quite chilled out about it all, that is except for one, teeny, tiny, annoying thing.

INSURANCE.

The thorn in my side right now. Needles have nothing compared to this pain in the….

You may recall before we started IUI that my insurance company wrongly stated that I did not need pre-approval for IUI treatment. It was only after I started my first cycle all became apparent that we needed pre-approval before any fertility treatment. Since then, we have been trying to get things straight with our insurance company. I am not entirely blaming the insurance company here. I am blaming ‘the system’.

It seemed so simple, our insurance company required copies of our medical records to determine pre-approval for our IUI treatment. Well that’s easy! No? Fertility clinic – please provide our insurance company with our medical records. “No problem, we will get the nurse right on that” they said. Well each week we chased them, they claimed no knowledge of this request, but wait, what is this? …oh there is a note in our records to do this. Hmmmmmm. At our last appointment 2.5 weeks ago, the nurse promised us the request to send the medical files was with their business team and they were going to action it that day. Well it turned out that was all bull. No medical records were ever sent because we had to fill out a release ‘form’. And after the number of people we spoke to try to make this happen, not one person mentioned a form. Things also got complicated when the fertility clinic realised that our insurance’s medical office is located in Belgium. This would be impossible! Sending medical records abroad – there are different laws for this. They were not quite sure how they are going to do it, come on, surely there is a form for that too! How about I google it, I bet google knows the answer.

So after we hit this road block, Chris tried a different approach. He has given the half completed ‘pre-approval’ forms to our insurance company to chase up with our fertility clinic. When my insurance company emailed me this morning to say could I please provide them with a contact number for my doctor, oh, by the way we would need approval for each round of IVF….I flipped! As you can imagine we had dutifully and carefully provided a contact number and address, but most importantly, it clearly stated on the form the treatment was IUI. I even provided them with a breakdown of all the costs for each procedure and medication. Aghhhhhhhhh!

I have no idea what is going on right now, but it is all now in the hands of the insurance company and our fertility clinic to figure our laws, methods of handling medical records, procedures, money and what not. Why couldn’t we have got to this stage two months ago? At this rate we will probably get our “pre-approval” for IUI after we have finished all three rounds of IUI!

Without pre-approval we have paid for our first round of IUI out of our pockets and hoping we will be able to claim some money back. Soon the bills will be coming in for the second round of treatment. It would be nice if they figured it out before then. My worst nightmare is that they deny the claim because there was a small test we had to do or form we had to complete before we started with the IUI. There is little advice the insurance company can provide us on whether we are covered or not until they have our medical records. Similarly, they can’t answer if we are covered for IVF until they see our medical records. This makes financial planning for the future a little challenging. But we are planning for the worst, just to be safe.

I should point out that we do have a rather strange insurance arrangement – because my organisation is international, Allianz, our insurance company, provides coverage for all staff across the various countries. Allianz uses United Healthcare as their service provider in the US to purely deal with admin for claims made in the USA and negotiate in network deals with providers. This makes things complicated for medical providers here in the US when we try to explain that they have to provide medical records to Allianz, not United Healthcare. I hope I didn’t lose you there!

Third time…

So to sum up today’s post – Insurance sucks and starting IUI cycle 3 is going to be a breeze. As the saying goes….third time lucky! Or….third time a charm! Let’s hope it’s not like the other google search term on the list above – third time out :-s

So Letrozzzzzzzzzzzzzzzzzole sleepy…

March 6, 2015March 6, 2015Leave a comment

Wow, these drugs make me sleepy! Letrozole (AKA Femara) comes with a warning on the bottle ‘Do not drive or operate machinery until you know how these drugs affect you’. Well I never saw that on the bottle first time around!

Pharmacy Fun Time
Yesterday, I got my ‘refill’ of 10 tablets of Letrozole (2.5mg) from my local pharmacy just in the nick of time. I am supposed to take x2 Letrozole tablets for five days, starting from CD3. Yesterday was CD3, so I when I received an email from my local pharmacy saying I could pick them after 5pm I was relieved. However, there was a note in the email saying that I would have to pay full price because it was so close from ordering to pick up, the insurance had not been calculated yet. That would be $103 full price v $0.26 copay due. Fortunately, when I got to the pharmacy, the insurance had done its thing and I only owed $0.30. An increase from last cycle of $0.04 – weird (My progesterone has gone up by $2.00 as well – has there been a nationwide increase in drug prices? Do drugs fluctuate like oil prices??)

Rahhhhh – Dodgeball is a great place to let off some steam

What time of day do you take your Letrozole?
I have decided to take the Letrozole in the early evening because last time when I took them in the morning, the drugs were affecting me on my drive home from work, dangerously so. They do make me extra sleepy – I guess from using all that energy up to grow those extra follicles. Let’s see how this works out. Last night I slept pretty well for the first time in a while, maybe it was the drugs or maybe its about time I had a good nights sleep after two weeks on the progesterone.

Dodge, Duck, Dip, Dive and Dodge
Right – off to dodge some balls at our social club and let of some steam!! More on dodgeball next week when I will be facing the dilemma of whether to play in the play offs or sit on the side lines…. :-S

A new day, a new cycle and new worries!

March 4, 2015March 4, 20153 Comments

Yesterday sucked. Today sucks still, but not quite as much as yesterday. Cycle Day (CD) 2 and tomorrow is start of Letrozole! Wait – tomorrow??!?! Wow, where is the time to breathe? I don’t even have a prescription yet. The nurse didn’t mention anything about my medication for a new cycle. She just told me that if I was pregnant I was to call in and arrange a blood test and keep taking the progesterone, but if I was not pregnant, to stop the progesterone and my period would come (late, not to worry, that’s normal because of the progesterone) and then we would follow my doctor’s plan. At the time, this all made sense. But my period came full flow three hours after I took my pregnancy test (seriously, what a waste of a test!!!). My period wasn’t late, and suddenly I realised I don’t have my prescription ready for CD 3. In addition I realised that CD11 for my first ultrasound was due the day I was planning on returning from Paris for a work trip. Uhoh. And if all went to plan as the last round of IUI, we would be doing the IUI either the Saturday that my brother is visiting from the UK (sorry bro, you’ve come all this way and we just got to pop to the doctors for half a day) or potentially the day I will be travelling to DC for work (sorry bro, was supposed to be taking you to DC with me for some site seeing). Aghhhhhhh! Too much to think about. How much of my best laid plans could I reschedule?

All of this came quickly. I thought about it yesterday, but was in no state of mind to deal with it. So I dealt with it all today…I decided to still go to Paris, just come back one day early (fingers crossed my flight isn’t delayed by more than 24hrs), we have a plan for when my brother is visiting, and I can delay my DC work trip (My boss has been helpful in this respect).

Today I called the clinic to schedule my CD11 ultrasound, check about medication, how I go about refills and to check the status of them passing on our medical records to our insurance company. It turns out some of my prescriptions were on refill, but not the Letrozole (the nurse asked me if I still wanted to carry on with it – I guess so??). The nurse said she would arrange it immediately. However, when it came to my medical records, there was no note to say that my medical records had in fact been sent to my insurance company. However, there was a note to say that they needed to do it… But not to worry, because I can always check again when I come in for my CD11 ultrasound. Well I do worry because I still do not have approval from my insurance company to have IUI treatment – and there is nothing I can do but let them figure it out together. We can afford the IUI, we have the savings for it, but we would rather know now than later down the road what we do and don’t have to pay for.

On a more positive note, today is our 3 year wedding Anniversary. We celebrated this evening and I enjoyed a lovely big glass of Merlot. Good timing 🙂

Happy Anniversary Mr F!

Is it my British accent that confuses you?

February 17, 2015February 17, 2015Leave a comment

I have concluded that it must be my British accent that confuses people at the other end of a phone line, namely my insurance company, Allianz, and freedom fertility. Or they are just morons. I am sure these big companies wouldn’t hire morons to man their phones, so it must be the former.

You may remember a couple of weeks ago I had a mild panic about whether my insurance company needed a pre-approval before fertility treatment? When I had called my insurance company the nice Irish lady, who held me the line whilst she thoroughly checked the answer to my simple query, concluded I did not need approval for IUI. Turns out she was wrong. The only reason I know this is because my fertility clinic requested to see proof that my insurance covers fertility treatment. So yesterday when I asked my insurance company for an email confirming this, they replied today stating that in fact their representative was incorrect and I needed prior approval. To get the approval I need to send to my insurance: medial records, history, diagnosis and costs of planned treatment. I could easily have collected all this the several times I have been at my clinic in the last few weeks, had the representative supplied me with accurate information in the first place. Is this a normal situation, for insurance companies to request all this? I had thought that insurance companies would usually liaise directly with the healthcare provider?

Who knows what the heck is going on with my insurance. Chris has kindly volunteered to deal with it. I don’t mind if we are not covered, but what annoys me is that this process is not exactly the smoothest of rides as it is. I know people make mistakes, but this mistake is a pain in the backside. At least Allianz apologised and realised their initial mistake, we had a response back from their ‘senior customer sales representative’. So I am not mad at them, but all these coincidences of mess ups on the phone, I’ve decided the only common factor is me. The only obvious explanation is my accent. From now on it’s email all the way, guvn’r…

My what big follicles you have – all the better for inseminating with!

February 14, 20153 Comments

Today is Cycle Day 11 and I attended the first ultrasound for my first ever Intrauterine Insemination (IUI). The clinic were very efficient today, I was in and out within 15 minutes. I sat waiting in the examination room for the doctor to arrive, and there on the wall was a poster explaining the differences between fraternal twins and identical twins – A handy guide or perhaps more of a handy reminder of the increased risk for multiples with IUI. Today, the doctor had a student shadowing her, I had no problem with this, but I think he looked a bit awkward throughout – bless his cotton socks.

The doctor showed the student my good uterine lining – apparently three lines is good. This is all new to me, so I appreciated her explaining everything. I had two follicles in the right ovary (as I had predicted) one 20mm and the other 28mm. I also had a teeny tiny one in the left ovary, only 6mm, but she said it might be nothing. So I am ready to go. They don’t open on a Sunday, so my appointment is on Monday 16th Feb. As a romantic Valentines day gift, I get an injection of Ovidrel at 1130pm. Not looking forward to this given my phobia of needles. I am undecided yet whether I will do it myself or get Chris to poke me in the abdomen.

This is all assuming my medication arrives tomorrow as freedom fertility pharmacy have promised me. Today I called them to check the status of my order with regard to my insurance approval. They had the approval for the Ovidrel, but not yet negotiated the progesterone. I don’t understand how this system works in the background, but from what I understand, it is crazy. So I said I would go ahead and pay full price for them rather than wait for the insurance company to do its thing. If it is covered, then I can just try to claim it back later….but I needed my meds ASAP!

The progesterone was $49 and the Ovidrel was $123 full price, with the insurance agreeing to pay up, my 10% copay made it only $12.30. Not too bad.

Cost of this IUI cycle, full price:

Meds inc. letrozole, ovidrel & progesterone: $311
Ultrasound: $225
Sperm Wash:$140
Insemination:$225

Total: $901

Expensive stuff!! Chances of success? Our doctor told us our chances were about 20%. Advanced Fertility.com breaks down the success rates even further depending on age, sperm mobility and treatment options. Apparently there is a 7.6% chance of success with one follicle, and an increase chance to 26% with two follicles. Wooohooo! But those numbers are still pretty small. there is almost a 4 in 5 chance that we won’t conceive. Putting it like brings you back down to earth.

Fingers crossed for a Valentines baby (Just like Chris is!). Happy Valentine’s day everyone!

Freedom Fertility Pharmacy Fail

February 12, 2015February 12, 2015Leave a comment

My nurse recommended freedom fertility pharmacy rather than my usual pharmacist, Walgreens, because the ovidrel trigger shots and progesterone suppositories are much cheaper if my insurance does not cover it. Sounds great, I said, let’s do it!

So once my prescription was ready freedom fertility pharmacy dutifully called me via a robot, who then proceeded to tell me there were no free reps available at that time, please call back later. Unfortunately, every time I tried to call them back their lines were busy and I was put on hold for aaaaaages. Usually I don’t mind waiting if I can leave my phone on speaker and wait for a representative to pick up. Unfortunately freedom fertility put in ads and notices over the music. Something I don’t really want my colleagues around me listening to. So I gave up. Then there was the snow storm and they were closed. Eventually when I did get through to them several days after they called me, I arranged delivery of my meds for 11th Feb (Cycle Day 9).

Later that day I had a missed call from freedom fertility. I thought it was probably the robot that kept calling me to say I had to call them, so I ignored this. If it wasn’t the robot I’d get another call. And I did not get another call, so I wrongly assumed all was well. This was until yesterday when I came home expecting my meds to have been delivered. Nothing, nudda had been delivered. I had no missed calls asking me where my house was (a frequent occurrence from delivery people) and no email saying delivery had failed. So first thing this morning I called them up.

‘Oh’, the representative said, ‘your order was cancelled because your insurance card expired.’

My insurance card doesn’t expire! And no one bothered to check with me????!??!?!?!?!?! BAHHHHHHHH!!!!!!

So I re-confirmed the insurance details, which went through correctly this time (why couldn’t the other lady have done that when I was on the phone last time??). I said I needed the delivery ASAP because I will probably need to do the trigger shot this weekend. ‘No problem’, the lady said ‘we will get it to you tomorrow, stay with your phone today in case we need anything else from you’.

As I am driving home this evening I had another missed call from freedom fertility. So I call them back as soon as I could….

‘we are sorry, we are currently experiencing a high caller volume, please hold’ DOUBLE BAHHHHHHHHHHHH!!! Luckily for them someone answered within three rings.

The representative said ‘we have to have authorisation first’….Okaaaaaay….I said ‘sure you have my authorisation!’ I thought this was for payment as I had previously set a limit on my card. Then there was this awkward silence.

‘So we can put the meds on hold then?’ the lady on the phone said. ‘Ummmmmm, wait, what? No? I don’t understand, we may have our wires crossed’ I asked thoroughly confused.

The lady realised she was talking to a bit of an insurance process idiot and explained that the Ovidrel shot required prior authorisation from my insurance company first. I thought to myself, isn’t that what I checked with my insurance company the other day? No – apparently the insurance company have to check with the doctors about something, they will do that within 24 hours. So you are telling me that even though a doctor has prescribed me some medication, they still have to check with them? I am sooooo confused.

So let’s hope that my follicles aren’t quite big enough at tomorrow’s ultrasound and I can wait another day. I am sure the clinic will help me figure it out tomorrow if I do need the shot sooner.

Eeeeeeeeeeek! Why is it all so confusing???!?!

Mild Insurance Panic!

February 5, 2015February 5, 20153 Comments

This evening I was helping Chris with filing his taxes and was searching through our medical paperwork. I pulled out our insurance policy booklet and flicked through it to read about infertility treatment coverage. I already knew we were 100% covered, but what I caught sight of was that we needed prior approval for certain procedures – such as IUI! Whoops…!!

We are learning a lot about medical insurance, policies, bills, coverage, approval, pharmacies – the lot! But there is so much to keep tabs of that I am not used to. This was one of them.

After mildly panicking that I had screwed up, I called up my insurance company, and phew, I discovered that I did not need prior approval for this. Panic over. These insurance booklets can be very confusing. Especially when our insurance is worldwide cover, so depending on which country you are in, depends on the process. Grrrrrrr. However, I am entirely grateful that I do have amazing insurance.

I appreciate the NHS – I really do, particularly when it comes to the complicated billing system we have here. However, if we were in the UK right now things would be different. NHS guidelines used to be that IUI treatment was offered on the NHS if:

a man has mild fertility problems
a woman has mild endometriosis
a couple has unexplained infertility

However, new guidelines released in 2013 state that IUI is no longer offered in these circumstances. Instead, we would probably have been advised to keep trying to conceive through regular unprotected sexual intercourse for a total of two years. Only after this time we may be offered in vitro fertilisation (IVF). So if we were in the UK right now we would be 10 months and counting, then going straight to IVF. That would be pretty scary. I’m kind of glad we are where we are right now in the US!!