September 14, 2009

I've been labeled

I would say that I have led a pretty charmed life. Sure, I’ve had some ups and downs, but for the most part I would say that my life has been great. I definitely work hard for my successes, but I also feel very fortunate to have had so many things work out just right for me.

Except getting pregnant.

This has been the most difficult thing I’ve ever had to deal with. For a girl who got straight-A’s, was accepted to her first choice college and sorority, who got teaching jobs at the schools that were the best to teach at, who got the first assistant principal job she ever applied for…for that girl, dealing with infertility is sucking the positive spirit and hopefulness and life right out of me. I don’t want to sound ungrateful for all that I do have in life, but right now all I want more than anything is to have a baby (which I know so many of you out there can relate to). And my body is not cooperating. The hardest thing may be that there is nothing I can do to make it happen. I just have to keep waiting and trusting in my doctors.

Today I met with the RE for the first time. Mr. CB and I both liked the doctor and were happy she outlined a plan for us. The bad news came when she did the internal ultrasound to check my follicles and uterine lining. I’m on my second medicated cycle (100 mg of clomid) and Dr. M said my follicles should be measuring 18-20. My puny little follies were only 12-13. Another blow…my uterine lining is really thin, which doesn’t make for a great environment for eggs to implant. My next step is an HSG, which sounds like a lovely little test (dye inserted via catheter into your uterus to make sure the tubes are not blocked). That test has to be done at the beginning of your cycle, so now I have to wait for this one to end before I can even schedule the HSG. It should probably be sometime at the beginning of October.

Dr. M thinks clomid isn’t the right choice for me because a side effect is that it can thin the uterine lining, which isn’t good for someone who already has a thin lining. She mentioned using letrozole instead, which is a newer medicine that works like clomid. Unfortunately for me, she wants to wait to give me any prescription until after the HSG, so I won’t even be able to take it in my next cycle. So that means MORE WAITING.

To top it all off, when I called my insurance company a couple of weeks ago about coverage for seeing the RE, the rep mistakenly told me that it would be a specialist co-pay of $40. Of course that was wrong, and now I have found out that anything that is coded as infertility is only covered at 50%. So my $40 appointment today turned into $210. And the HSG will be $360 out of pocket. I also found out that my lifetime maximum for infertility treatments is $5000. SERIOUSLY???? In just two months of tests and doctor visits to monitor the medication I will have already used 1/3 of my lifetime benefits. What will happen if I need more months, or an IUI? IVF is already out the window unless we can come up with the cash to pay out of pocket. And what about kid number 2???

I know I’m getting ahead of myself and I just need to slow down or I will drive myself crazy. But now that the label is there – INFERTILITY – all of a sudden my glass has become half-empty.


Dandelion Bud said...

talk to the doctor's staff about recoding the visit and resubmitting. I've had to do this endlessly with all of my appointments, but it's worth a little bit of aggravation to have to pay less OOP.

Chef Bud said...

I called yesterday and asked them to do that. They said no, if I am in to talk to the doctor about infertility than that is what they code it as =(

Dandelion Bud said...

Then you need a new doctor. You don't have a diagnosis of infertility until you have a test that comes back abnormal.

If the doctors office won't work with you to make this process easier, then they are not the kind of office that you need to be dealing with.

I went through 2 doctors before I found one that understood that the process was painful enough without dealing with the insurance end also.

Find a new doctor that understands. Meanwhile... Call the office back. Speak with the office manager. Argue. Tell them they can't use a diagnosis code of infertility unless you've been through testing. Tell them you want the visit coded as a regular consultation or with a specific diagnosis (such as thin lining) and if they want to get paid, they'll work with you.

If you don't stand up for yourself, no one else will. Don't take no for an answer.

Flora Bud said...

That is so true what Dandelion Bud is saying... These doctors office are trying to cash in. Im glad that you liked the doctor which is a great thing, but you have to fight. They did not diagnose you with infertility so they can not bill you for that.

I hope everything comes out fine with the HSG test and that its only your lining that is preventing you from getting pregnant and you can start taking letrozole.

Pls keep us updated!


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