Thursday, July 11, 2013

I hate you, infertility.

I have been eagerly waiting for today, July 11th, to finally come. July 11th was the date I was given for my insurance company to finally make their decision on our FET preauthorization appeal.

If you recall, it was originally denied stating I first had to prove I was infertile by attempting three IUIs and that I have attempted pregnancy through unprotected sex for at least 12 months. Well, this is just stupid. I've had one IUI, and two more for someone with my level of DOR would be a complete waste of time and money. And as for the latter reason, we tried our first IUI in 2011 and had been trying the natural way long before that! My RE's billing person said she had seen this type of denial before and that a simple physician's letter would take care of it. My RE sent the letter off with the appeal, and even my HR department said our appeal should be approved today, on July 11th.

Well folks, it was denied. I'm still shaking with anger and frustration.

Now, the next logical question would be...Why?

No one can tell me. Not one choose-your-expletive person at my good-for-nothing, wretched, awful insurance company can tell me why it was denied, only that it was. In fact one of the reps I talked to couldn't even pronounce the words embryo, cryopreservation, or in-vitro properly. I know it's a petty thing to mention, but it's just a reminder that most of your average people don't have to deal with infertility therefore they don't know how to say these words.

They said to get an explanation of denial I would need to submit a written letter and they would reply with their rationale in 30 days. But you know how this story ends, right? I send a letter, wait another 30 days and get some bogus stupid reason. I then have to take some other futile step to wait another 30 days to be back where I started. I'm so sick of this.

My last remaining hope at this point is to ask my company's HR benefits rep to go to bat for me. And while this sounds promising in theory, it's not in actuality. I've gone down that road before when my insurance company denied infertility diagnostic tests in 2012. No matter how many times I tried to explain the details to our benefits rep (and it's one single person) I could tell she didn't grasp it, she didn't want to grasp it, and didn't have any kind of drive to help me with it. I imagine her usual benefits questions are simple ones about copays and in-network physicians. But here I am asking about sperm karyotyping, ovarian reserve, and gonadotropins. She stopped responding to my emails and to my calls. I followed up for weeks with no response. I probably should have escalated to her manager, but I just gave up, which is very unlike me! If I get nowhere with her this time, I will take it to her manager but it's just another frustrating layer of complication I really just don't have the time or energy to deal with.

Let me finish this by saying I never had IVF coverage before this calendar year. So trust me, I know all too well how hard it is to be 100% out of pocket. I do not take it for granted for one second and my heart goes out to every woman who suffers from infertility with no coverage at all.

So that leads me to my next thought. If my HR rep doesn't help, I really only have two choices:

1) Give up on the preauthorization altogether. I can pay the $4050 direct to my RE and submit claims after the fact and pray they somehow get processed. I bet some might, but who knows? This is on their radar now as being a denied preauthorization so that might be enough for them to say no way when the claims go through. Has anyone ever done this? Or....

2) Wait some more and fight some more. I could write them a letter and in 30 days they will respond with some lame reason. I'm sure I'll be told I have to do XYZ and wait another 30 days to then be back again where I started.

I am so tired. We really don't have money to be paying out of pocket for this, I'd charge it on a card. We have dumped so much money on our first IVF, attorneys fees, the D&C, etc and now a bunch of money on vet expenses for Nadia's diabetes, we are just drained.

Does anyone have any thoughts or suggestions?

I feel my resolve to fight is almost drained completely, and I just want to surrender and take option number 1. I don't think Kevin will support that though. I don't even know if it's the right thing to do.

Okay so you've now read yet another upset and complaining blog post by me. I am so negative lately, and no one hates it more than I do. I wish I had something puppies and rainbows to post about, but this is what infertility looks like. It sucks. It's frustrating.

EFF YOU, INFERTILITY. I HATE YOU.

17 comments:

  1. Oh, man I hate this for you!! I was so hoping this one thing would work out smoothly. If you decide to continue pursuing the preauth, I'd suggest skipping the benefit rep and go directly to her manager. Just tell them of your past experience with her and how much trouble you've been having with the insurance company. If you do that I'll pray the manager is someone who has previously experienced IF so they'll take a personal interest in your case. ;)

    I can't imagine the level of frustration you are feeling. Huge, huge hugs!!

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    1. Thanks so much, DP. I already engaged the rep on the issue, and the whole department is unfortunately terrible so I'm not even that hopeful in her manager. I guess I've already resolved to take this in my own hands. She is supposed to get back to me this morning, if she doesn't I'll probably just be done with her and try her manager. Maybe she will be IF! You never know. :)

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  2. how much is it to do the two IUIs even though it's a waste? Also maybe contact resolve they might have someone that can help fight the insurance company with you. Good luck I'm so sorry! I'm looking for a new job now that covers IVF so I feel your pain. We've fought long and hard with no cover to alittle coverage and if changing jobs is what i have to do to do IVF i will and I won't feel bad having covarge. OK so I got off on a rant sorry! Love ya good luck!!

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    1. Unfortunately, we still have co-insurance so paying for IUIs would be such a slap in the face when I have a better chance of growing an elephant out of my forehead than to get pregnant from an IUI. My doctor wholeheartedly agrees. I really hope you can find a job with coverage. I'd suggest my company, but clearly my insurance company sucks big time! :(

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  3. I doubt HR or your manager will help you - heck insurance companies don't even want to pay for life saving organ transplants! They look to it that you are a complicated case, you don't "have" to do this so why should they pay?
    Sorry to say your best bet is saving up and paying out of pocket. Sucks, but at least you can move on and save yourself the additional stress of fighting the insurance beast. Good luck :(

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    1. Exactly. This is what we have decided to do, but I'm not giving up on the insurance quite yet. I'm just not going to let it hold us back anymore. Thanks for the encouragement!

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  4. Oh crap! I was hoping this would work out for you. I am so sorry, it really sucks.

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    1. Me too! I thought there was a chance....I appreciate the kind words.

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  5. Liz, I'm so sorry to hear this! I'll be praying for you, and that The Lord will give you peace and understanding.

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  6. Liz, I'm so sorry to hear this! I'll be praying for you, and that The Lord will give you peace and understanding.

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  7. I also went through 3 denials and appeals to get my IVF covered. It just takes persistence, persistence, persistence. What finally did it was honestly - getting away from the heart strings and going straight to the pocketbook. I specifically outlined in budget numbers (with attached claims) the cost of me NOT doing IVF. For me, that was continued pregnancy loss, with all the early OB costs and the costs of repeated D&Cs. I also outlined the health risks associated with RPL and D&Cs and the costs that could be associated with those (incompetent cervix, asherman's, etc). I then included the costs of more intense therapy for my mental health well being (I had been going 1-2 month to my therapist and with the m/cs, I was going at least 1/week). I basically used my letter to prove to the insurance company that it was cheaper and easier for them to pay for IVF. I showed them that I would cost them 3 times as much money NOT doing IVF, as well as risk several other complications.

    I know that insurance companies should CARE, that they should take emotional well-being into account. But the reality is - it is a business and they care about the bottom line.

    I tried a heartfelt letter from me, detailing my situation and outlining my necessity, talking about how much I wanted a child. That got me nowhere, just a standard denial letter. But the dollars and cents letter? Combined with a diagnosis letter from my RE - they approved my IVF authorization 3 days later.

    I don't know if that approach will work for you, but I thought I'd share my experience.

    ((HUGS)) Praying that it works out!

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    1. This is so encouraging. I've been thinking about it all weekend. My HR person is talking to our direct rep, and we are a very large world-wide company so I am hoping she has some "pull" so to speak. If nothing else, we should at least be getting a rationale for denial. Fingers crossed. I am going to take your advice and write a letter outlining the cost of NOT approving this. Do to IUIs would cost far more than this FET. It's so silly and stupid, but I can easily tell them it works. I know this is a tall order, but do you think you'd be able to share your letter with me somehow? You can take any specific names or whatever off of it but knowing that it was effective would be the perfect template! If you feel comfortable doing that, let me know at wishingonasnowflake at gmail.com

      THanks so much!

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  8. I'm so sorry.I hate this so much for you. I wish I had some wise words or advice. HUGS!

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  9. OMG so much HATE! So ridiculous! I just detest that insurance companies seem to revel in complicating a process that obviously is already way complicated by nature not to mention horribly frustrating and emotional. I really hope HR comes through for you. I have very little in the way of suggestions, but I'm praying this all shakes out, and soon!

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  10. Omgoodness, this is just so stupid. I'm so sorry they denied it again and that there is so much red tape surrounding all this. I have never had ANY IF coverage at all. I can only imagine the frustration you must be feeling at the tease of having it, but not having it work for you. Hugs.

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