Venty McVenterson

Fair warning: this is long, venty, and full of insurance talk, ie boring and whiny.

I took today off to give the shot, hang out at home (read: do homework that ended up taking all day) and basically chill out before tomorrow's IUI. Well, since yesterday, work is trying like mad to make me lose my chit.

Remember that whole situation about the insurance telling us we had used almost all of our benefit when in actuality, the only amount that had been applied to the benefit was $250 for our first IUI? I have to admit, I kept my cool AMAZINGLY about that situation. It's nagged a bit at me, but I just ignored it and moved on. What's done is done, and I can't go back and change us canceling the cycle.

Fast-forward to last week. It's open enrollment time, and I know there are two plans that actually cover multiple IVF cycles; all of the other options just give the $5,000 calendar limit. (I am thankful to even have the $5k limit, but obviously I am more grateful to switch to whatever insurance will cover multiple IVF rounds, IF we need them. It's crap that I have to make this decision with technically two cycles still left. We could get screwed and end up with an HMO for no reason, though I guess "no reason" it's really a fair estimate if we're talking pregnancy. But really, do I need more silver lining talk? I think not.)

Anyway, I went to the benefits fair. When I entered, I started speaking to a lovely woman who was I told about our situation and that I needed EXACT coverage information moving forward. She was very apologetic, confessed that her SIL had done IVF, and she understood how problematic the previous situation was and recognized that we needed more definitive information moving forward. None of the insurance people at the fair could give me info (surprise, surprise), so this lovely gal said she would look into details and contact me this week. She also mentioned that because of us canceling the cycle and knowing that there wasn't enough time in the year to start a new cycle with the money we actually did have, she would see what could be done about maybe extending my coverage for next year. She brought this up all on her own, and I was impressed. There were also some mumblings about her knowing about the situation b/c there were some apparent problems with the benefits person I spoke with at my company, and she sits next to said benefits person, so she knew what I had originally been told.

She did contact me, but when she did, it was all vague information. The current carrier informed her that only "procedures" count toward the calendar max. Any ideas what "procedures" might mean in an IVF treatment?! Bloodwork and ultrasounds are not procedures, I do know that from the previous cycle. Retrieval? Anesthesia for retrieval? (That's not technically a procedure...) Transfer? Fertilization? No clue. I emailed back with detailed questions, and the previously lovely gal told me my questions are too detailed so I should contact the carrier directly (um, tried that before, spoke to 4 people, and all I got was a needlessly canceled cycle). She also added this juicy little tidbit:

I would say that most people that I have talked to have hit limits but still have
elected to continue with procedures because typically people do hit the
limit.

This was in direct response to a part of my email where I VERY POLITELY (b/c remember, I have yet to lose my chit on this) said I would be happy to provide any additional information needed regarding this situation and also to speak to anyone higher up, as part of the problem was that my employer's benefit staff does not seem to understand the offered benefits or the treatments. Thus, when the insurance company defers to the benefits office to interpret what they really mean to cover, it's a giant cluster that leads to canceled IVF cycles.

So, to recap, she went from being overly apologetic and extending sympathy to telling me that "most people" just continue on with treatment when they are faced with thousands of dollars in bills for a CHANCE to get pregnant. We're now going to discuss our choices? Um, who the eff are you, benefits girl? We decided to hold off because we'd rather have the money in the bank in case we need it if/when next year's insurance benefits run out, not to mention that I am moving to an HMO with no out of network benefits that will make my therapist become an out of pocket cost. Also, we have a medication LIFETIME limit of $15,000, which will not last if we make it to IVF #3. And my prescription coverage is the same no matter what health insurance carrier I choose, so in the event I stay with my current employer longterm (as is the plan) and we ever need to go through IF treatment again, we're likely to run out of pharmaceutical coverage.

So, benefits girl, would you like to talk again about how what "most people" do? It's funny to me that she knows what most people do, yet when I ask her questions about whether or not the insurance company's definition of ovulation induction means injections alone or includes injections and Clomid, she can't answer and has to refer me to the insurance carrier. And believe me, the insurance carrier doesn't know either. They don't even know that they don't manage my pharmaceuticals.

Can you see how this is a giant cluster?

Oh, and she also told me she can't guarantee a response by Friday, when open enrollment ends. Oh, helpful. How the eff am I supposed to make a decision by Friday if you can't guarantee answers to my questions?! Ahhhhhhhhhhhhhhhhhhhhhhhh.

So, with her lovely little comment, last night, I blew my chit. I've sent an email to the Assistant Vice President of Benefits explaining the situation and telling her that I need to speak with her directly to navigate the benefits as well as discuss benefit girl's comment and the previous handling of our situation. I am the queen of a strongly worded email, and I have to say, I was even courteous and calm in my email to the benefit queen. Benefit queen gets ONE chance. If I get a chitty comment, it's on. Her office needs to step up and do their job; it's their JOB to understand the health insurance benefits! They don't even handle retirement, human resource issues, etc b/c those are separate offices! Hello!

I really don't want to deal with this, but I've let too many things slide with work right now. I had questions about my time off for procedures b/c someone wanted me to take them as vacation rather than sick. I work at a very well-respected medical center, and I'm tired of being on the receiving end of people not understanding infertility treatments to the point that it has now affected me. It's a MEDICAL CENTER. These are MEDICAL TREATMENTS. Why are we so confused people?!

It's on. This girl's comment about what I should have done is my point of no return. Because really, I'd love to have a conversation with someone about things I should and shouldn't have done regarding my vag, my empty womb, and our financial situation.

Asshole.

And with that inordinately long post, I'm letting it go. I will deal with it again when I get the email and set up the talk, and I will deal with making a selection for health care.

The End.