Frustration (cont'd)

Friday, June 18, 2010

Even before you wise friends encouraged the clinic switch, I was so bugged out by my clinic's nurse, I called the other place. I had contemplated getting a second opinion before our IVF cycle, even had all my records faxed over there, but I had cancelled the appointment at the last minute when my RE suggested the other protocol. But I am sick of my RE's nurse.

So, I call over to the other place. Good news, they still have my records. At this point, I can't even believe I'm asking for another RE appointment, because it has just been awesome without that stress and worry. And I even think I do a pretty darn good job of not letting the stress and worry take over my life, but now that it's gone, I realize how it crept in here and there.

So they ask if I'm still with my insurance, and then I make sure they plan on just filing the appointments with the insurance first. She puts me on hold to check. (I did not consider this a good sign.)

Then another lady comes on the phone and tells me that since I've already been treated at my current clinic, my insurance considers everything thereafter "treatment", and they will pay nothing.

Um. Excuse me?

I told her that I'm not coming to them for treatment, per se, just a second look at my file and to ask for more testing, which I know is listed as covered on my policy. I'm interested in seeing if they think more detailed thyroid testing is in order or maybe those fancy mutation tests. TESTS, get it??

She said since it is a second opinion and my first appointment there, they will try (TRY?) to code the appointment as testing. Brace yourself, because I asked how much the appointment would be if the insurance didn't pay anything, and it would be THREE TO EIGHT HUNDRED DOLLARS.

Okay, here are my reflections:
1. No wonder people with zero insurance coverage have $100k in infertility debt. God bless them!
2. I am beginning to wonder if my current clinic coded all my ultrasounds (pre-ART and during-ART) as testing. Because they definitely covered the majority of the cost of all the ultrasounds. And bloodwork. If this is the case, and I technically could have been paying $400 a pop for each ultrasound during the entirety of this past year, maybe I should stay with my current place out of homage for all the money they saved us.
3. But, I have serious issues with any clinic coding ultrasounds as treatment. If only!!! If only all we needed was an ultrasound to treat our childlessness. It's not the ultrasound that's the treatment, people! It's the procedures! Which, yes, I know, my insurance doesn't cover.

If there is any possibility that we will have to pay $800 for a stinkin second opinion, I just cannot justify that right now. I haven't even told Mr. A that I made the appointment because I want to call the second clinic back and be sure about their billing procedures before even I decide to even keep the appointment, much less tell him I'm willingly subjecting myself to this circus again. (Even the relatively low-rent clomid circus!) He is so protective of me- he knows how much pressure I put on myself when we were in the throws of it all, and I think he just wants me to kick back for a while. God love him :)

Can you believe that? Two phone calls that my heart passionately willed me not to put myself through, and both of them were nightmares. I almost wonder if because of how they played out, if God really does want us to just be chill for a while, just because I felt so attacked during both of them.

As you may imagine, I haven't given either of the calls much further thought. We are doing a ton of pool entertaining lately that just makes my heart soar. It is so fun to have people over and especially see their kids enjoy our pool. Yesterday, the friends who came over even brought their pup so Banana had someone to hang out with! The weather has been so beautiful that it's all I can do to keep myself inside the bulk of the day working, which is why I love the weekday afternoon vacation-time get togethers! (Yes, I have tried to "work" by the pool, and it's pretty much impossible!!) I am so thankful for the blessings that crowd around us. They definitely encourage me that the best is yet to come!!

9 comments:

the misfit said...

I know I always think this, but - I think threats are in order. Can you upgrade your call to clinic #2 to a nurse (if that wasn't a nurse before) or email the doctor or something and spell out what you want, that a test is a test, and that you will not become a patient there if they cannot find a way to code tests as tests for your insurer? I assume (I make wild assumptions) that RE practices don't actually WANT to lose business.

the misfit said...

And I'm sorry you have to deal with these idiots :(. It's not just you - just the effort to "be in treatment" is so stressful that I hide from these idiots.

Leah said...

How frustrating. :(

Let me tell you my billing/coding story. When I first started seeing my RE, he told me he would code everything as menstrual cycle related so it wouldn't hit my infertility bottom line. I was so grateful and he stuck to his word and did just that. Well you know what? My stupid insurance company STILL billed it as infertility. They said at the end of the day it's up to them, and because this doctor's title was RE, they were going to code as infertility. WHAT????????????????

The cost of infertility is ridiculous, and I guess I should be grateful because I had some coverage, while many have none. But still, It shouldn't put us all into major debt trying to build our family. I believe we all have that right.

Thinking of you.

Katie said...

Oh no. I am so sorry, A. Just another thing you shouldn't have to deal with. I really hope you don't have to pay the money to get a second opinion. It makes no sense! Hugs to you. I hope you get some good news out of this soon.

Ask or Imagine said...

Ugh! That is very stressful - testing and treatments seem so distinct...how can they not see the difference??

Every time you mention your pool, I just wish one would magically appear in our back yard!

Jessica said...

How frustrating!!

Every RE is different when it comes to insurance coding...but I agree with you that they should cover ultrasounds because it is diagnostic!!

Enjoy your weekend!

Trisha said...

I'm so sorry! You know with our insurance they covered nothing so we got that lovely bill all to ourselves :) The one thing that our insurance did cover were the ultrasounds (basically anything you could have at a "normal" ob/gyn--the yearly visit--was covered by our insurance). The infertility meds, testing, and ER and ET were not.

I've been praying that God would give you guys a peace and clarity as to what you need to be doing. I'm glad you're taking it in stride though! Hang in there and enjoy the pool for me too!

HollyT said...

Grrrrrr....that's annoying. Two frustrating phone calls would've thrown me over the edge. You have an amazing attitude, and the pool entertaining sounds like fun.

Jennifer said...

Ugh! I feel your pain. My ins. covered nothing so we paid for it all. Hope you can get it all figured out where it will be covered!

I know just what you mean about the pool. We have been using ours like crazy! We've had friends over several times each week and it's so nice!