I have emerged victorious

About a month ago our HR department held its benefits open season presentation and informed us that we were switching health insurance carriers from Oxford to Cigna. Aside from the tremendous pain in the ass of switching doctors, learning a new computer system, etc., we were told that our coverage was essentially the same so there was nothing much to worry about.

But since this isn't my first rodeo, I figured I would call up our "benefits services" company and ask about our infertility coverage. Turns out that our benefits services people didn't even understand that we currently had $10K of advanced infertility coverage (IVF and IUI) in addition to full coverage for all ultrasounds, drugs, etc. And what they told me about our new coverage? That we had none. Well, that's not entirely true. They told me that our new coverage "met the state mandate" in NY (coverage of testing and treatment of medical causes of infertility. So if I had a blocked tube, and needed that sorted out, all covered. If I had crappy eggs and wanted to do IUI with injectables, no dice.

Clearly, that was not "equivalent coverage" so I marched myself into our Chief Admin Officer's office and began the first of a series of very awkward conversations about infertility benefits and coverage levels. Now, let's put aside for a second how imprudent it is to discuss one's potential future desires to be pregnant and out on maternity leave. The uncomfortable conversations where I had to explain to him that artificial insemination and ivf were different things (and what each were) were just really so awkward as to be comical.

Long story short, after 3 weeks of working directly with our new insurance company (because despite my infertility treatment tutorial, the CAO deferred sorting this out to me, leading me to wonder whether I could get part of his large salary), we now have even better benefits.

Our new coverage covers everything. The only limits are:

- if you (female) are over 45, you don't qualify for ivf

- you have to be able to document that you have been trying to get pregnant for 2 years (under 35) and 1 year (over 35)

- 4 complete lifetime retrievals are covered. No limit on the transfers.

- All drugs are covered

So we are good to go. As are all of the other people in my office. No one else knows that I did this, and there is no one that I really think needs telling, but I am happy I could ensure that others have this same coverage.

Pat Pat (that's me, patting myself on the back).

My new friend Brenda

Brenda has become my new bff.

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.