Insurance Hassles (AGAIN!)

Well, it’s been almost a month since I last wrote to my blog. Needless to say, by now I know my body way too friggin’ well, and AF promptly arrived in her full glory that Sunday morning, kindly enough so I could let the ladies in the monitoring room know that the bloodwork that I had driven down through the pouring rain for was no longer necessary.

As a side note: decided to give acupunture a shot, which I did the day after my last blog. I had an appointment with a group affiliated with my Fertility Center, and I was spurred on by the literature they provided in the waiting room, particularly with regards to the rates of improvement for IUI patients. Had a great session (it did relieve the PMS cramping), had no problem with the needles (who would after sticking themselves as much as IF patients?), and then decided that I wouldn’t pursue any further treatments. Why?, you ask. Because the gentleman that saw me told me that they like to “get their patients ready” by doing a combo of acupuncture, herbs, and other stuff while having the patient take a three-month breather from IF treatments. Thanks, but my clock is ticking and the DH is becoming inpatient with this whole thing, so we’ll have to forge on without Eastern medical assistance.

So, IUI #2 is a bust. They call me later that day to tell me, yes, once again the Insurance Monster has put a note on my file, and I can’t come in the next day for IUI #3’s CD2 u/s and bloodwork. Now I’m pissed. Last month, we went through the same crap. So I leave a voicemail at the center in the general mailbox, telling them I want this solved by noon on Monday and a phone call telling me I’m good to go. Surprise, surprise… no call. 1:30 p.m., I start calling. Because the girl in Insurance that I was referred to is on vacation, I’m going to have to deal with L, which by now stands for “LOSER” in my book. She’s at lunch. Then I get the office manager, S, on the phone. As she tries to put me off, I tell her that last month L dropped the ball, and I shouldn’t be doing her job. Then I call Tufts.

Now we have the “chicken versus egg” dilemma. New regs at Tufts demand FSH levels on CD3 and CD10. Tufts won’t approve the IUI cycle until they have those. The Center won’t let you do a cycle unless you have prior approval or you shell out $2600 upfront (NOT an option in my household right now). The head of the ART office at Tufts is on the phone, somewhat patronizingly telling me where the prior approval form is located on their website, and that, if the Center sends it through as a priority, they may be able to okay it. Much pissing and bitching on my part, and she snaps to attention when I mention that I have not received notice of these changes in my coverage as promised last month, and will be contacting the head of Tufts about their lack of customer service.

Ladies, this is when the Internet proves to be a great, wonderful place full of interesting information. As I look at Tufts’ website, I find the document that I still haven’t received in the mail. On page 21 is the name of the M.D. who is the VP of Medical Affairs, and apparently the jackass that didn’t see that his new regs might be causing some issues. I call Tufts membership line, and some very sweet young rep gives me this guy’s DIRECT LINE! And he answers it himself!!! After totally confusing and scaring this poor man with my tale of woe and talk of being on the 6:00 news, he tells me he will look into this situation and get back to me. Fifteen minutes later, one of his people calls me back, a lovely woman who sympathizes with me and asks for everyone’s names who I’ve spoken with both at Tufts and the Center. She then calls me back twenty minutes later, telling me we’re all set, and “oh, by the way, I know you said you were only doing one more IUI cycle, but I’ve given you approval for two so that if you change your mind, you won’t need to go through this issue with us again”. Hallelujah! We’re on again!

Turns out, after all that, that Tufts had contacted the Center and told them that they would be willing to work out any issues that came up with the new regs (and, yes, I believe Tufts). The best part: the test results that Tufts needed I had had done at the Center in October, and those satisfied their requirements.

The Center calls, and I’m in the next morning for u/s and bloodwork. Then S calls, and patronizingly says “are you doing better today?” Smarmy bitch. So I unload. She states that she’s going into a meeting with L and will bring all my issues up. I tell her great, and I’ll be sure to bring up both L and her attitudes when I speak with my RE, who happens to own the place, as well as speaking with the other partners. I tell her that, while everyone in the medical part of the Center is pulling for every patient, she and L appear oblivious to what a three- or four-day wait can do to an IF treatment cycle, and seem to do their best to be unsupportive and difficult. And oh, I’m sure to let the partners will be interested to hear that I have had to take care of my own insurance clearances for two IUIs in a row. The minute I mention this, she becomes somewhat apologetic. I could care less. I also mention that the VP’s person who gave me the two months worth of approvals told me that she personally spoke with someone at the Center the week before regarding the issues that Tufts patients would be facing, and how Tufts was more than willing to work on these issues with the Center. I thank her again, telling her that I appreciate her addressing these issues with L, and that I’ll be sure to mention that when I speak with my RE.

Now for the real challenge. DH’s agreement with me was that he would do three IUIs. That was IUI #2, so obviously IUI #3 will be in the beginning of September. Now we have permission to do 4 IUIs, and somehow, in the back of my mind, I’m considering the extra cycle a gift. To do any more IUIs would be a total hassle with the Center getting insurance clearance, and honestly, I don’t know if I can emotionally take any more of this. Something for me to think about…