Are we parents yet?

The Clements’ IVF Journey

Insurance games September 30, 2008

Filed under: Financials for IVF — Aria @ 4:25 pm

I don’t get it. We are now being told something else. We are now being told that none of the labs are covered at all with out EPO plan and the surgical center isn’t covered at all, so those expenses we were told two weeks ago to pay and submit for reimbursement we’re now being told are out-of-coverage (they weren’t last week, not according to the two people I spoke to then, and they weren’t when speaking with the clinic’s financial person, and Cody was there and I asked him if I hear it wrong and he heard the same thing I did) and won’t be paid or reimbursed at all. Oooookaaaaaaayyyy. We are tired of all the different stories we’re being told.

Luckily next week is open enrollment, so we can change plans. Unfortunately the only Apple plans that cover IVF are through United. But it looks like the Plus PPO (Choice PPO) (there is also a Basic PPO) plans cover more places and more doctors than the EPO (Choice). The cost difference per year is $477 for us both, which we think will more than pay itself off. Office co-pays will go up to $20 from $15, and to $30 from $20 for specialty visits.

Am I’m reading/understanding this correctly?

The terms say:

Plus PPO

Plan-year deductible
In-Network: $300 Individual, $900 Family
Plan benefits are paid after the satisfaction of plan year deductible.
Out-of-Network: $300 Individual, $900 Family
Plan benefits are paid after the satisfaction of plan year deductible.

Coinsurance
In-network: 100% (Plan pays percentage shown after you pay deductible or copay, if applicable)
Out-of-Network: 70% of the UCR (Plan pays percentage shown after you pay deductible or copay, if applicable)

Annual Out-of-pocket Maximum
In-Network: $2,000 Individual, $6,000 Family (excludes copays)
Out-of-Network: –

Infertility
In-Network and Out-of-Network: Covers diagnosis and treatment of an underlying medical condition that causes infertility, including in vitro fertilization (IVF), gamete intrafallopian transfer (GOFT), and zygote intrafallopian transfer (ZIFT); embryo transport; donor ovum and semen and related costs, including collection, preparation, and storage of; and artificial insemination. Prescription medication limited to a separate $5,000 lifetime maximum.

In-network: $30 copay; 50% after deductible up to a $15,000 lifetime maximum
Out-of-Network: 50% of UCR after deductible up to a $15,000 lifetime maximum

EPO

Plan-year deductible
No deductible

Coinsurance
$15 or $20 (specialaist) copay (Plan pays 100% for most eligible charges after you pay copay, if applicable)

Annual Out-of-pocket Maximum
$1,500 Individual, $3,000 Family

Infertility
Covers diagnosis and treatment of an underlying medical condition that causes infertility, including in vitro fertilization (IVF), gamete intrafallopian transfer (GOFT), and zygote intrafallopian transfer (ZIFT); embryo transport; donor ovum and semen and related costs, including collection, preparation, and storage of; and artificial insemination. Prescription medication limited to a separate $5,000 lifetime maximum.

$20 copay; 50% up to a $15,000 lifetime maximum

This is all word-for-word.

Now I’m confused a bit. With the PPO Plus will this mean we pay the first $300 entirely, and then after that deductible, they’ll cover 50% up to an additional $2,000, which is the out-of-pocket, and then they’ll cover 100%? Or is the deductible part of the put-of-pocket? Something else entirely? What are we looking at as our total out-of-pocket (not including copays), $2,000, $2,300, or something else entirely?

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I feel petty, oh so petty September 29, 2008

Filed under: Random thoughts — Aria @ 6:42 pm

Reading another community made me think about labor and delivery. You’d think just finally being able to get pregnant would be all that’s needed for life to be perfect, but there’s a part of me that’s very sad I won’t get to have a vaginal birth. Nope, not possible. No large intestine and my small is stabled together (meaning I will be high-risk during the third trimester). Due to the staples, there’s concern that the stress of active delivery could cause them to pop, and that would kinda sorta kill me, and I don’t need to be brought back from death a third time. Third time’s a charm and I probably won’t come back the third time.  I always wanted to give my child a start that didn’t involve drugs coursing through her system so I can be cut open.

I feel like I must be some fort of freak for sitting here sometimes trying to imagine what it’s like “knowing that tomorrow is the day,” of trying to imagine what it’s feel like to have a belly “out to here” or to hold a baby, even so far as to hold my arms how I’d hold a baby. Sometimes I swear I can almost feel it. It’s these perhaps-insane thoughts that keep me going. I’ve been called insane here on LJ for admitting I love a baby that has not yet been conceived, and have had pro-choicers tell me I must be anti-woman for loving a future-baby when a baby isn’t a baby until birth (according to them), so definitely can’t be loved before birth.

Cody told me the other evening, unexpectedly, that he already loves the baby. That surprised me, maybe because he’s pro-choice and I’m pro-life, so we don’t completely see eye-to-eye on certain things, though he has been starting to see unborn babies as actual people instead of “a blob of cells,” as he really used to believe. Either way, I thought it was very sweet, and I was very touched, when he said this.

Is there any point to this post? I don’t know. Yes. No. I just need to vent so I don’t keep crying. Much of the last two weeks has been spent crying or on the verge of it. Even my “escape,” ballet, isn’t much help and I can’t focus in class and pointed my foot during a frappe, stubbing a toe hella hard. I’ve lost motivation to do much more than sit online and try to distract myself. I’m even feeling pangs when I look at our dogs because they are mom and daughter. So time playing with the animals doesn’t help much.

Yesterday was the day we were going to start this cycle, until United decided to be a bunch of bastards. Everyone we’ve spoken with from Apple, from the store level on up to headquarters (a good part about living here right now is that getting headquarters involved in “small” things is easy because it’s so close, walking distance), everyone has said that this policy is supposed to cover it up front, no other way. MOST of the people I’ve spoken with at United have said the same thing. A couple have tried saying we’re supposed to pay first because payment is due before services are rendered, but the others I’ve spoken with, included one of the managers, said that, as we have an EPO, the rates are contracted, so known up front, so should be directly covered. But somehow still no one knows what’s going on.

And I feel so lost.

 

Just an insurance update September 21, 2008

Filed under: Financials for IVF,Frustrations — Aria @ 10:36 pm

I get so angry sometimes because the cause of mine wasn’t something wrong with my body originally, but rather I as hit by a car when I was 19. A driver in a Lexus (and I will never forget his name, and seeing a Lexus still makes me feel sick) ran a red light and hit me. As in me. Not in a car. Me. My body. I was a pedestrian. One of the many resulting problems led to scar tissue forming that has crushed/blocked my fallopian tubes. When I was 22 and had open-abdominal surgery to finish repairing the intestinal damage, the doctor saw mangling to my left ovary and removed it (damned thing had caused me extreme pain since the accident, and I never mentioned it to this doc, but he saw the damage anyway), and he observed the scar tissue that had formed around both tubes, though it was too much for him to do anything about at the time.

If that idiot driver had watched where he was going, he would have stopped, and I’d be able to have babies normally. It drives me nut to know the thing stopping me isn’t a problem with my uterus or egg production, but that the tubes were damaged beyond repair because of this. Since it was in Massachusetts, the amount I got for pain and suffering was insanely small, not even enough to pay for half of one cycle of IVF, and the amount that was paid toward medical bills was a paltry $8,000 (versus half a million in medical bills on my credit).

Since I still remember his name, Piotr Dimkowsky, I sometimes want to track him down and send him a “nice” little letter telling him how his inattention has effected my life. Since he, the day of the accident, transferred all assets out of his name and into his mom’s to protect himself from judgments (my attorney discovered that, but his own attorney knew loopholes to make it all legal, and that guy was rich), I have a hard time forgiving him for this. I want him to feel bad for what he did. Accident or no, he did what he could to get out of being responsible for the damage he caused to my entire life and for nearly killing me. I wasn’t expected to live! I hate him with venom.

Okay, now that that’s out of my system, tomorrow (well, today, as it’s after midnight) the HR rep at the Apple location where Cody works will be having a teleconference with an HR person at headquarters (funny enough, we live a little over a mile from HQ, yet 15 miles from where he works) about what United is pulling. Brian agrees that United is wrong in trying to tell us to pay nearly $10,000 out of pocket and submit it for some reimbursement later. He agrees that $1,500 oop is just that, not more, even if we may get some back. So hopefully something can be figured out. I have been too depressed over this to even cry, and have destroyed the baby things I had been making out of a feeling of hopelessness.

 

More September 18, 2008

Filed under: Financials for IVF — Aria @ 11:37 am

I have spent the morning making calls. What United has claimed is that they don’t pay for services until after they are rendered. However, in all my research and talking with insurance companies and such in the past, for IVF services are always paid for up front, before services start. It’s basically an industry standard, at least in this large geographical area, that fertility facilities collect full payment up front, whether from the patient(s) or the insurance company, and then begin. So I called United again and told them that this is how it goes by industry standard, that the services are pre-paid, and by them saying they won’t pay, but that I can submit a claim and try to get it reimbursed afterward, is in contradiction to the $1,500-OOP max in our contract with them as it’s an additional $8,000 out of pocket we’d have to pay up front, and that if pre-paying is industry standard, then it is their responsibility to know this and have a policy in place to cover it beforehand rather than to tell clients to pay for it and try to get the money later. Since this isn’t cash most people have available, they’re basically turning it into a benefit you can only get if you can afford it to begin with, and that people pick insurance plans based at least partly on what they can afford out of pocket. I emphasized how the contracted agreement we have with them is $1,500-OOP, NOT $8,000+-and-try-to-get-some-back-later, and if this is industry standard, then they’re responsible for not forcing us to pay more out of pocket when there are NO alternatives available. If the only options they will give us that they might reimburse for are places that require payment up front and they won’t pay it up front, it’s basically become a worthless benefit because we just don’t have, and can’t get, $8,000 in cash. I told him truthfully that even Kaiser was only going to have us pay $6,000 and they were going to cover the rest up front, and that we left Kaiser to join United because the benefit from United was presented as greater, that we’d rather pay $6,000 out of pocket we don’t get back to a company that was up front with us than to pay $8,000 more than the $1,500 we agreed on and hope to get it back later. At this point, he repeated a couple time, “Kaiser was going to pay? They were going to pay up front?” and I told him yes, because they knew services are paid up front and what those services for a fairly standard procedure are going to be and how much they cost.

I asked him if there was a local representative I could speak with in person and possibly have my attorney present because what they’re doing is very misleading, and it’s misleading on one of the things most important to most people.

I think that became a ramble, but I think it gets my point across. I nearly cried on the phone talking to him and told him how I’m 27 and have been dealing with this for four years already and finally thought I saw a light at the end of the tunnel as we were going to start IVF in two weeks, only to have it taken away by a misleading policy, and that we’re talking about having children here. At that point, I was trying to strike a cord in his heart, hoping he had kids himself that he loved and would think about what if he wasn’t able to have them.

He said he’d look into this some more and get back to me by tomorrow morning, and I let him know I had an appointment for today at 1:50 and another tomorrow at 2 that we went ahead and canceled since there was no point if United wasn’t going to pay.

There was nothing in any of the contracts we have for them that mentions anything about payment only after services are rendered. If there was, we’d have stayed with Kaiser. Having to come up with $6,000 we wouldn’t get back is a lot better to us than having to come up with $8,000 and hope we can get some of it back later.

Needless to say, I am so deflated of hope I am looking into what therapy is covered. I am so emotionally battered right now I can’t keep food down, so incredible ashamed for having believed something good was going to happen for me, embarrassed that I thought myself worthy of something good for once. We had our hearts set on this. I tore apart the baby afghan I started in frustration. Do I have to accept not having a baby all over again when I never even accepted it fully from the first time?

 

Absolutely devastating blow for us September 17, 2008

Filed under: Financials for IVF — Aria @ 4:41 pm

Cody and I chose the insurance company United. $15 for office visits, $20 for specialty office visits, $1,500 out of pocket max per year (not including office co-pays) with eligible expenses over that covered at 100%. Infertility treatments are covered at 50%. We called, more than once, prior to choosing this company, and were told each time that the treatments for in vitro are eligible expenses. We had our first (now maybe last) appointment today. In fact, we’ve been home all of five minutes. When we were there we found out that for the vast majority of the process, $8,000 worth, United specifically doesn’t contract with any facilities to cover. About $2,300 of it is contracted, but the rest would be up to us.

We feel extremely misled and devastated. From being told 100% over $1,500 is covered to finding out that $2,300 is contracted (we’d pay half, so $1,150, $350 shy of the $1,500OOP) and the rest they don’t contract with anyone for. Is this legal? Is this not a bait and switch? We called more than once to make sure about this! When the first girl, Meghan, said it was, I had her double check, and she said 100% over $1,500. We called the next day to make very sure, and that guy, Adam, said the same thing, and we have him double check, and he said 100% over $1,500. So to find out that insurance will cover $1,150 (half the $2,300) and leave us the remaining $8,000 is like having the rug pulled from under us, the breath knocked out of us. Not only that, they don’t even contract to cover half of those expenses. NOTHING AT ALL.

I don’t know how this can be legal. There were no exclusions, and in vitro SPECIFICALLY is mentioned BY NAME as covered! Can it possibly be legal for a company to have it in writing that 50% of on vitro is covered, with 100% over $1,500, but then to not even actually contract with companies to do the procedures?!

Devastation is really too easy of a word for how we feel right now. IVF is our only chance. We pay taxes to cover the welfare for people who have kids and won’t work (but who can), while we’re trying to find some way to have a family, Cody busted his ass to get into a position with benefits, only to find this out. Something is wrong here.

I feel like an utter fool for thinking something good was going to happen to us, and ashamed that I had hope for this working out.

I’ve got a letter in to an attorney about this. I really feel this is bait and switch, an intentional misleading. Claiming to cover half, and all over a certain amount, only to not contract for it to begin with sounds like it borders on fraud.

 

A few things September 16, 2008

Filed under: Frustrations,Medical appointments and stuff — Aria @ 4:58 pm

Baby Momma. Who the hell at whatever studio thought infertility issues was a good topic for comedy? At the store I keep going by the kiosk for DVD rentals and it has a poster, “Would you put your eggs…in this basket?” In my opinion, this is on par with making a comedy out of a family dealing with one of its members having cancer. It’s not funny and there are no good times that come as a result of it.

The people who will understand what goes on with infertility and in vitro and donors are people who are going through it, those least likely to laugh. And if someone won’t understand, why see it? Why see it anyway? It’s belittling to those suffering through this. All, one of my thoughts was someone as rich as it looks like the main person was could afford the best surrogate, and someone who wasn’t was going to do a damned careful job finding the best one because that might be the only shot, no taking chances. Instead a drugged-out (or so she looks) woman was chosen. And then lulz are supposed to ensue. I can laugh at a lot of things (e.g. Timmy on South Park, who is really precious, and religious jokes, etc.), but not something that is the direct cause of suffering of so many. Let’s all laugh at cancer, or those people losing homes in Texas! Right? NO.

Okay, now I feel like I’m going to cry.

~~~~~~~~~~~~~~~~~~~~~~~~

Tomorrow we have our first appointment with a new doctor. I am nervous and excited and scared and hopeful and extremely thankful that it’s only $5 more than a regular co-pay. We are so fortunate with the coverage we have.

Now something I keep thinking about. When an embryo transfer is done, does the doctor have you lay still for a few days? I know this may be an irrational thought, but if you stand up soon afterward, can it basically fall out? I will lay there and not move for nine months if I have to.

 

Starting again September 3, 2008

Filed under: Financials for IVF,Medical appointments and stuff — Aria @ 7:13 pm

Okay, so we found out the benefits Cody was going to be able to get through work kick ass and would take the cost of IVF from $12,000 to $6k. Then that plan was no longer available, so cue panic attack. Then cue disbelief when finding out that there is a plan that has a $1,500 out-of-pocket with anything over that that is an eligible expense being covered 100%, and IVF is covered! So from $12,000 to $1,500. However, the place we originally started with isn’t covered by the EPO we now have, so have to start over. Well, records and such can transfer, but a new doc.

I’m really appreciative right now that Cody took the initiative today and got the appointment set up, so we go in on the 17th at 1pm. We get to start all over, sort of. Records will transfer.

Even though we have this appointment, I feel rather ejected, like it’s just going to take forever and never happen in the end. I’m begging for encouragement right now when I should feel some encouragement.