Who is Brenda? Brenda is the manager for my company's account at Cigna, our insurance carrier, and she and I are going to get to the bottom of why my infertility coverage is so fucked up.
The whole thing started bad last year when I was first looking into it. When I called to ask about coverage for specific procedures, the clever operator forwarded me a benefits letter that they had sent to a colleague that indicated that retrieval, transfer and other testing were not covered. Which was surprising because the policy stated that I had $30K of infertility coverage. So why the discrepancy? Apparently the colleague who wanted to get pregnant was a gay man interested in using a surrogate. And while personally I think his course of action should have been covered, too, it shouldn't have taken me 30 minutes on the phone to explain why my situation was a tiny bit different.
So I have $30K of coverage, and since we've done 2 IVF and 1 FET with a preferred provider, we've had mercifully little out of pocket so far, but figured our luck, and coverage, was likely running out.
And so here's where the fun begins. When I asked for the balance in April, I was told I had used $28K. And so I asked for an itemized listing of all of the charges that added up to $28K. That took a week. And then it only added up to $25K, and some of the items on there were clearly not IF related (my annual mammogram? my annual physical? my dermatologist to check on a mole?).
The front line rep (Sandy, the very same one who sent me the incorrect memo 12 months ago) basically said that there was nothing that she could do, but that the system couldn't be wrong because, well, it was "the System" and the codes that it pulled were only IF. When I explained to her that there were clearly some issues with what she sent me, she blamed the physicians for coding it incorrectly.
So then I started talking to her boss, Brenda. And Brenda has been awesome, and basically agrees with me that unless they can itemize the charge, it should not count against my maximum, and she has been unbelievably helpful in pulling off charges that are clearly not IF related, and has allowed me to get new bills for things that appear to have been given the wrong diagnosis code.
But there are some charges, such as all of the blood tests I just took on clotting and the full karyotype that is still at the lab, that I was told by both my RE's office and a cigna rep -- I read the rep every single code -- would not count against the max. These tests actually are IF-related, but I might not have done all of them if I knew they would burn through my increasingly scarce resources. So I'm going to the mat with Brenda on these charges, which are about $1K total. And right now, it looks like I am winning.
It's a fuckload of hassle for only a few thousand dollars, but there is principle involved (I can't imagine how many other women have gotten screwed out of some of their benefit) and it is actually enough to cover this FET and perhaps some monitoring next time, so I guess it's worth it.
But I hate having to lay all of these charge out there and talk about it with Brenda. Because even though she is really nice, and very helpful to my cause of getting the numbers right, she is probably thinking "this woman is a crazy person. she's 40 and trying to get pregnant and yet is arguing with me over pennies -- how pathetic." And so that bugs me. I don't want to be judged, or pitied, or to even have my situation known, and yet I need to go through every line item of this pathetic story with her to get to a point where I think it is fair. Yet none of this is fair. I shouldn't have to do this, or know Brenda, or have my medical history laid out for all to see. It's profoundly unfair, and I am getting to the point where I really resent everyone who isn't or hasn't gone through this. I even resent the women who got pregnant on their first IVF, and then seem to have forgotten all about the infertility that led up to it. I'm just bitter and resentful and angry. But I'm not giving up on my search for justice with Brenda. Because someone, somewhere owes me something and there's only so much getting screwed over that I am willing to take.
You are not pathetic! You are a strong, responsible woman in a vulnerable situation and you should be very proud of yourself!
ReplyDeleteYou rock!
You really do rock. When it comes to anything to do with insurance coverage, I feel like crying. I mean, we don't have any coverage so it doesn't come up that often, but I find the whole system so overwhelming that I can't stand up for myself one bit. It may help that I have a husband in the business, so he gets to step in and make sure we don't spend money on prescriptions we can get covered, whatever. Anyway, I can see how exposing yourself in this way would really wear you down. I"m really glad Brenda is fixing things, and if she's judging you it's only because she doesn't understand. Maybe you can pretend to yourself that she too has been through IVF, but isn't allowed to say anything personal. So secretly she's really sympathetic!
ReplyDeleteI like to think that when I get pregnant after my first IVF (HA HA HA!) I'll be an advocate for IF. But I'm not now, so why would I change? I certainly really respect people like you who are willing to go through some humiliation to make sure insurance companies are more accurate.
Fight on!!!! You deserve this benefit. I cannot beleive a mole check went towards your IF benefits really??!!! Keep going, even if it is just to make a point to yourself and Brenda.
ReplyDeleteI'm glad you're advocating for yourself and, hopefully, getting some more $$ to go toward treatment. I've never had infertility coverage per se (no IUIs or IVFs) but my current insurance company has been great about covering all diagnostic tests/procedures, and my copay for drugs is quite reasonable. I have a few things that I probably could have questioned, but I figured I'd rather not rock the boat, as I'm already getting more than I thought when I started...
ReplyDeletei always feel better when i have an insurance person on the other end of the line and i'm giving them a piece of my mind. i *have to* take all this aggression on SOMEONE, so it might as well be the insurance person or the billing dept of various dr's offices. esp the latter, as they've f'd up one thing too many for me.
ReplyDeletethere has to be a silver lining in all this. personally, i'm rooting for dr D to knock you up with twins. how nice would that be? a 2fer! and of course, may they be the cutest, most wellbehaved little buggers ever :o)
when's your FET? in a few weeks? i've heard of enough girls getting pregnant with their last blast as well, so *fingers crossed*.
i hope this $hitshow of a nightmare ends for you really soon :o) xxx
Wow, you're amazing! I always feel like curling up into a ball and stuffing my fingers in my ears when I have to do anything with the insurance company. I'm really glad you were able to fight them for what they OWE you - not letting them get away with stealing your coverage is AWESOME. Good for you :).
ReplyDeleteI'm so sorry you're dealing with this. I can totally sympathize. You should get every damn dollar to which you are entitled, without having to nag and cajole and plead!
ReplyDeleteMy infertility bills are supposed to be covered 100% (up to my lifetime max). But my insurance company screwed up the providers in the system, so every one is processed with a copay due from me. Every. single. bill. I have had to call about 30+ bills, wasting hours of my time. Some of the copyaments are only $2-3. But it's the principal of the thing! They keep saying they'll fix the problem, but no.
The good thing is, my IVF worked and I'm pregnant and "graduated" from the RE, so there is an end in sight to the bills. (Of course, now my RE's office billing is messed up due to all the insurance billing and rebilling.) Seriously, though - yes, it's "worth it" - but why should I have to spend HOURS of my time trying to fix someone else's screwup? Why can't people do their jobs correctly?!
Hang in there. Hope things get cleared up soon. (And you have success very soon!)
First of all, you are not pathetic by any means and no one should be judging you! You are awesome and strong and someone who deserves to be a mom!
ReplyDeleteSecond, I think all of us that experience any degree of IF go through this insurance nightmare in one form or another. Having IF coverage is a blessing and a curse, and although I'm very grateful to have some coverage, it's been a nightmare making sure that everything is correct. Those pennies add up to dollars and that is important!!
It is SO worth it. It isn't at all pinching pennies. It's standing up for yourself (and for the little gal who might not be so savvy in checking what has been counted against her benefits...a mammogram, for goodness sake!?!?). I personally think that insurance companies do this all the time. Maybe it's laziness. Maybe there's intent. Who knows? But it shouldn't happen.
ReplyDeleteI do know what you mean about having to put it all out there, and the unfairness of that. It's impossible not to feel judged. It took me a year (a whole fricking year) to iron out the insurance coverage for my second m/c because they didn't want to cover certain charges. I was also fed the "doctor filled out the wrong codes" line. The woman I dealt with, however, was an idiot. After months and months had gone by I finally asked her point-blank if she thought I should have to be dealing with it all, given all I was already dealing with. Did she care? Nope.
So, personally, I applaud the fact that you're going to the mat for this. On one hand a few thousand may seem a little thing. But I think it's actually huge.
Damn straight. I hear you. You are doing the right thing and I deeply admire the strength you have to do this. I don't have that strength. But then again, my insurance doesn't cover anything IF related so in some ways I'm spared those phone conversations. Although it doesn't spare me the same anger.
ReplyDeleteThanks for fighting "the system". I have hardly ever experienced lack of coverage, and the costs associated with IF treatments, and the unclear coverage situation scare me.
ReplyDeleteI HATE having to do this. So much so that I will literally sit and cry rather than face them. I really wish I had it in me at times to take them on. I have done it, but hate it. You are fighting a good fight and I'm glad that you are working to get the care you deserve, that you PAY for. It's just easier for them to say, um, no, rather than deal with you.
ReplyDeleteYou are lucky to have a link there and I am giving you a standing ovation here. Well done. You work for that insurance and they do owe you your contracted care.
HI Stephanie, thanks for visiting my blog. It's great to find yours, as well. A Bumpy Ride.
ReplyDeleteKeep fighting. My "Brenda's" name is "Mary Eva" and she is on speed dial. Until we discovered Mary Eva, we received conflicting answers from the consumer reps at our insurance company, wrong answers, and all sorts of crap. One hour the answer would be one thing and the next the polar opposite. In the doubly craptastic world of fertility, two things just happened: (1) the University that my husband is a professor at, under cover of darkness with no notice whatsoever, decided to cut our fertility benefits from 100% coverage subject 30K lifetime for IVF (all IVF labs, meds, etc. count), $600 life time for IUI (no meds, no labs count towards that just the actual IUI code), unlimited diagnostic testing to 75% coverage subject to 10,000 medical limit and $15,000 in meds. We live in a state which has legislatively mandated fertility coverage of 3 IVF attempts per live birth and up to $100,000 of coverage for all other fertility treatments/diagnostics BUT my husband works in a neighboring state so while just about everyone has expansive fertility coverage where we live my DH who is a tenured faculty member at a major University does has the crappy little coverage that institution offers. The change in our insurance is effective 7/1. (2) In April (on mother's day), we learned our first IVF attempt failed. We immediately set out to do a second cycle knowing at that point our insurance was going to decrease on 7/1 and go to only 75%. After stopping the pill and three days into Lupron, I developed a blood clot in my leg. My cycle was canceled and I can't cycle for at least 3 months maybe longer. My RE kicked me to the curb faster than you could say "boo" upon learning of the blood clot. Now I fear that all of the testing they are doing on clotting and the blood thinners (Lovenox) and ultrasounds of my leg and CT scans of my chest are going to be charged towards our fertility benefit even though it's not being administered for fertility purposes at all. Good thing we have Mary Eva on speed dial.
ReplyDelete