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.