Insurance update.

Talked with insurance company.

Let me just say that I ~puffy heart~ this company. It's small and I have ONE contact who is the plan admin for my husband's employer. When I called, I introduced myself and she cut me off saying "I remember you Nancy! How can I help you?". Wow. She knew me by name.

She looked up my account and said it was not denied, it was simply pending for more information. Since I thought all information was already sent, she got me over to the woman on the authorization review team. She was just as nice as the first lady.

She told me the only medical records she's gone through were the ones from my OB. She said they were very thorough and saw had recorded I started with progesterone tests in Jan of 07. She then saw I had been prescribed clomid in January also, even though I didn't start that until my February cycle. What was missing was any record of an IUI, which they need completed before they would pay for IVF. We discovered she did not have any record from my current doctor, explaining I have had 3 IUIs, 1 hcg triggered monitored cycle, 3 surgeries and a butt load of appointments.

It scared me for a moment in that I thought they looked at the first IUI being 12 months prior to IVF eligibility. I asked her if the oral meds cycle I had completed over a year ago "counted", she said "yes."

The medical review lady calmed me down a lot. While I knew she couldn't give me an answer before she received the records, she did elude to the fact I'm starting my cycle in 5 days shouldn't be a problem. She said the process is already started, she's simply requested more info, and as long as she receives it soon, I shouldn't be in panic mode.

After getting off the phone with her, I called the billing girl at my RE's office. She told me that she did, in fact, send over my records, so she acted all defensive. Hey, I don't care who/what/where the records when to, I just need her to respond to the records request. I wasn't yelling at her or anything, so there was no need for her defensiveness - especially in her line of work. Billing for an RE's office must be tough. High emotions on the part of the patient probably have made her this way.

Anywho, I hope that all the records are sent over today and it's all figured out. I'll still start Lupron next Wednesday if I hadn't received all the approvals yet. I already have the meds, so no reason to not start it. Hopefully it won't be all for nothing.

insurance freak out.

RE billing office called. Insurance company denied IVF coverage due to not showing "12 months of less evasive treatments".

I'm thinking this is all due to a paperwork error, as I talked to insurance company on January 31st and made sure the first femara cycle in February 2007 counted. It did. I requested paperwork to be sent from OB's office to insurance company. Confirmed today that it was, in fact, sent out on February 1st. That was almost a full 4 weeks ago.

Insurance company is closed because they think it's perfectly okay to keep hours of 9a-430p CT. I will call first thing in the morning.

Yet, I still am freaking out. What if I have to cancel this cycle?

To wrap up ... Canadian healthcare coverage vs mine.

Okay, so what I've been reading is in Canada, IVF/IUIs are generally ~not~ covered. Drugs can be covered through workplace, but the maximum w/ most is $5,000. All testing and procedures surrounding IF is covered.

Hrm. Sounds like my regular old insurance I've had for the last 10 years. No infertility ~treatment~ coverage, but all tests and procedures to diagnose it are covered 100%. I paid nothing for all my office visits, blood work, HSGs, HSSs, diagnostic ultrasounds when related to cysts and all my surgeries. My meds were covered and I generally spent $5-10 for my clomid, femara, novarel, progesterone, estrace and whatever else I've had to take over the last 16 months.

I also have my Health Care Reimbursement Account (HCRA) through my workplace, which takes out however much I wish to contribute, pre-tax. This is ~fabulous~ by the way - if your company offers it - DO IT. For anyone who doesn't know, here's a quick US tax lesson for medical expenses.

Medical and Dental expenses are tax deductible here in the US. I recently printed out the document from the IRS and was actually quite amazed in regards to how much IS actually deductible. Let me just run through a few of the them. Abortion (can you believe it?!), Acupuncture, Addiction services like rehab, Bandages, Birth control pills, braille books and magazines, Chiropractor, Crutches, "Fertility Enhancement" (IVF, tube reversals, etc), Insurance premiums (although most people have this paid for pre-tax), Lead paint removal, Lodging (ie: if you had to stay at a hotel during your IVF week), Medications ~including~ over the counter, Psychiatric care, Psychoanalysis, Stop smoking programs, TVs if you need it for the subtitles because you are hearing impaired, Therapy, Transportation to go to and from doctor appointments (yes, in 2006, 18 cents a mile in gas was allowed), Trips to another city if the trip is used primarily for medical services, Weight loss programs and even Wigs if hair loss was from a medical condition. The list for what isn't covered is longer than the list that is covered, but really, did the IRS actually have to document "Dancing Lessons" are not included?

This is all well and good - but there IS a catch. You can deduct only the amount of your medical/dental expenses that is ~more than~ 7.5% of your adjusted gross income. Which blows. Let me give an example:

Let's say you spent $3,500 in eligible medical expenses for the year. And let's say your adjusted gross income is $40,000. Well, 7.5% of your AGI is $3,000. This would mean that only $500 of the $3,500 you spent would be eligible for you to deduct. LAME!!!

And this is why HCRAs are so awesome. I save 15% right off the top from federal taxes and 5% from state on ALL my HCRA dollars. And if I worked it right, hopefully it will be all my eligible medical expenses for the year, no more, no less (HCRA is a "use it or lose it, so it's scary when you start putting in big bucks). I think I put in $4,000 this year, which is an immediate $800 saved. Beats losing that first 7.5% from your AGI. Although if I miscalculate and spend WAY more, I'm screwed.

Though this was about Canadian coverage vs my coverage. Seems that when I kept getting told how much better it was to have Canadian coverage, there didn't end up being any difference at all!

When did I become "that woman"?

I've mentioned my upcoming IVF plans a few times recently. Here, in private conversations and on some private and public message boards. And I talk about how it's so strange that I'm ~here~ and already in the pre-authorization process. Like it's NO BIG DEAL to have IVF coverage.

Do you know that I've been insanely jealous of women with coverage for years? Even when IVF wasn't in part of my plan? Although I must admit that I would have probably gone for IVF earlier in ttc #1 and now for #3 if I had coverage - so I've always been a little miffed that IVF wasn't an option for me because I just couldn't see spending $12,500 out of pocket.

But seriously - whenever I saw anyone mention their IVF coverage casually, I got a little pissed off. I wanted each and every women WITH coverage to add onto each and every WORD about their IVF coverage with the caveat - "and I count my blessing everyday for this coverage because I know I am one of the few with coverage".

It's like I wanted covered people to bow down and feel humbled for the coverage they have. I ~know~ this is unfair though and it's why I never verbalized it to anyone. I would never ever of scoffed at anyone for not saying how they were lucky, although I know I quite frequently would have to add in "you sure are lucky" to any of my comments to these people.

And here I am. With coverage. Talking about it. Without the caveats. Just talking about it like it's normal. Good lord, I suck big monkey assholes. I do. And I'm sorry. I've become her. THAT girl with coverage. Who isn't visibly counting her lucky stars (but believe me, they are being counted more than you could imagine).

Quick question. Is IVF covered for Candians? I know general health care is covered, but what about IVF? Can any Canadian just get IVF for free? Meds too?

Along these same lines about the ~need~ I've felt for women to humble themselves for their good fortune, hHave I mentioned how I've recently become free from the non-humbling actions of fertiles? For so long, it's bothered me that girls who got pregnant easy and had no views into the IF world weren't falling all over themselves with the knowledge they dodged a bullet. I've always known they wouldn't be able to understand how IF feels, but I always thought they should not only know, but they should SHOW they understand just how lucky they were to conceive easily.

I finally came to an understanding how I can't hold this against them when they really have no idea "it" even existed. It was pompous of me to think my feelings and journey should be sought out and understood and coddled when they wouldn't even know to begin to look for it. Although, once I explain it to them, I think my journey should be respected. For example, after I explain 35 months of my life has been spent TTC, they shouldn't respond with "Sucks to be you! Only took 3 months for me to get 3 kids!".

Yes, I have talked about this before because now I remember my example. It's like someone who loses their ability to walk. This person may be quite pissed off that everyone takes walking for granted. But for most, walking IS something we take for granted because we have had no opportunity to think otherwise. However, if we become aquainted with the issue, suddenly walking is something that is hugely on our minds and never again will we take it for granted.

And that is how I have to think about fertiles. Until they have a reason, I can't expect them to know.

Why am I explaining all of this when I'm just trying to explain that I understand just how lucky I am right now? Who am I equating myself with? The person who just innocently doesn't know about something? The person who is annoyed that someone else isn't humbled? Or am I the person who has been explained the situation, yet I say something really lame back?

I think I am trying to say that I feel like I may look like that last person, but I swear, I'm not. I know just where I am right now and I understand the gravity of it. It's not something I'm taking for granted. And I should be careful not to make it sound like I am.

My RE is on TOP of things (financially)

I saw him yesterday. I sat and talked to the finance guy before I left, telling him I will no longer be paying out of pocket for all things infertile (no, no, it's not all rainbows and sunshine). He said he'd bill for IUI and I'll have to pay up to $300 for what insurance doesn't pay for (and as I mentioned, I have a $250 deductible, so hoping the "up to" only means another $50 on top of that). I also mentioned I wanted to get pre-authed for IVF. I don't know if there is an official pre-authorization for it, but I know there are rules (12 months of infertility using other less expensive methods, letter of credible coverage from old insurance, etc) and I want them to all be in a row for if/when IVF is necessary. (good lord. IVF. Queue "I never thought it would be me" flashbacks).

My god, I ramble.

Anywho, I saw him YESTERDAY and I already got in the mail today a "just to confirm we will bill insurance for IUI and you'll have to pay up to $300. And I've talked to finance-girl-x and she will start the pre-authorization for IVF".

Day-um. He must have run back to his office to write the letter to get it in yesterday's mail. Maybe the poor guy's bored. Shouldn't be with the lines of people in and out of that waiting room.

Oh - and tell me. Is EVERYONE employed by your RE pregnant too? It's really annoying to find at least one VERY pregnant person waddling working there. Maybe they hire pregnant girls on purpose - kind of as positive reinforcement of their all powerful treatments. But it doesn't do much for me except piss me off. And I REALLY have to bite my tongue from asking "do you get an employee discount?"