Wednesday, February 4, 2009

Say it with me: "I hate insusance companies!"

**UPDATE** It looks like we may be in for the long haul!
-The PPO will not pay for the TREATMENTS but will pay for diagnosis and everything in between.
-The HMO will pay for the treatments IF my company has bought this "rider" about IVF (we are doubting this, seriously!) AND we have to be pre-approved before the diagnosis' are paid for. So, by going to the Dr today, we may have shot ourselves in the foot. We were not pre-approved...so this appt wont be paid for ($500) and they may say that we already started the process and not "pre-approve" anything after this.

So, which do we go with? We are thinking that we may stay with the PPO until July (when enrollment opens again) and have the visits, sonos, and such paid for. Then maybe change to the HMO? We dont know! I am for SURE trying to find things to do a give-away and raise $$. I also learned how to make bows and want to sell them. So, I will be pushing our "chip-in" more often now! We need all the help and prayers that we can get. Prayers being most important!!

About the appt...apparently, my Dr T, who I loved so much, only sent about half of my records. There were no surgery reports, no sono pics (there should be a MILLION), a LOT of history was missing, and only 1 of Ben's 7 analysis' was there. So, there was not much that could be done. He did an exam and a sono. He said that there are some abnormalities in my uterus and he will have to study them more. That makes me mad at Dr. T, too, because he kept telling me that I have a "perfect" uterus and just gets all happy about what a good job he did reconstructing it after my myo. in 2007. If there were these problems, why would he not tell us and why would he let us spend about $2500 on trying to get pregnant? I'm ticked! And annoyed! And frustrated! And cant stop crying to talk about it...and that makes me madder (thats a word to me!), cause I HATE crying!!!
So, now we wait until the beginning of my next cycle and do some bloodwork, another sono with fluid injected (yippee!), and a test for Ben. At least the ball is rolling.

What a difference a day makes. Two days ago I was on cloud 9 because everything seemed perfect. I KNOW that God has a plan, but right now I dont like it!
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Original post:
So, when I took the job I have now, I was only part time. However, the job became full time in Jan and I received benefits. I had been looking at the benefit packages and found that one company would cover IVF and we became excited and put trying to get pregnant on hold until Jan to get to go to the Dr.

My consult with Dr. Putman was set for today at 11:15 (he was in surgery, so I will be going back at 1:30). My enrollment period for insurance is up at mid-night tonight. Yesterday I get a call from the Drs office saying that the office visit would be the co-pay, but that none of the procedures (IUI, IVF) would be covered. I was confused and hung up. I called her back later and said that the booklet states that they SHOULD be covered. She calls the insurance place again and calls me back to say that they are still saying it's not covered. So, I am upset by this time. Ben calls the insurance co and finds out that the booklet that we have is NOT for Texas and that IVF is not covered in TX.

We dont have an HR dept at work, it's all done by a 3rd party Internet thing. So, I get on the phone with them and ask if they know of any of my options for health care that will cover IVF (there are a TON to choose from...and my open enrollment ends the next day 2/4, so we need to make changes QUICK). She tells me that no place will cover that.

So, I call Ben back upset again, and tell him this. But, he had found one that was an HMO instead of PPO and had a "rider" for Texas that stated that it would be covered if certain criteria were met. I call the HR co back and ask another lady. This lady is rude and says that she has been working there for a long time and KNOWS that nothing will cover it. So I said "Then can you explain why this says "**** gold TEXAS HMO?" She talks to a supervisor and comes back and without admitting that she was wrong...admits that I MAY be right if in fact it does say "Texas."

I am so stressed and such a mess at this point! I have had the door to my office closed and have been crying by myself. This is around 3:30 and I have a client coming in at 5. So, I go into Natalyia's office where she and Heather are and cry to them. (I hate to cry, but I was so frustrated!) Heather calls my 5:00 appt and says that I went home sick and I talk a while longer and then do go home. Well, really I went to Leah's and loved on her babies and let Leah feed me and keep my mind off of everything!

For now, we are fixing to head back to the Dr, will pay a co-pay on one insurance, ask a LOT of questions about the HMO and prob. change over to THAT insurance before midnight tonight. We thank GOD that we found this out yesterday and that my appt just HAPPENED to be the same day that enrollment ended! But, we are praying SO hard right now not to get our hearts broken again! Please pray with us and for us!

If we cant get IVF paid for by insurance, there is no way we can do it...except to try to raise a lot of $$.

I am LITERALLY about to be late for the Dr if I dont leave now...so, pray for us...

God is able to do IMMEASURABLY MORE than we ask or imagine...
K

2 comments:

Anonymous said...

Oh girl, I can relate to being so stressed at work that you cry. I just don't have a door to close to hide from everyone, so I am sitting here in my cubical crying my eyes out. I had 3/4 of a box of tissues here on my desk when the cry started a little while ago. I polished off that box and have started on a new one...lol

Molly

The Moore Family said...

I just read your updates. I am so sorry and know you feel discouraged...beyond discouraged. Hang in there and keep me posted. I am praying for you and so sad this can't be easier for someone who wants a baby so badly! When IT happens...and IT will...I will be celebrating with you!

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