Thursday, 16 May 2013

Don't Rock the Boat...

I developed pneumonia during my third year at University. I missed classes for an entire week, but kept up with my assignments while I was recovering. When I handed in a paper, the professor informed me that he was "very disappointed with my absence" and he was questioning "my commitment to my studies" I tried to explain that I had been diagnosed with pneumonia, but he cut me off "Do you know how many sick days I've taken in 35 years?" he asked. "Zero!" he answered his own question and made a zero with his hand just to emphasize his point.  I turned away and went to my next class, but I couldn't concentrate. I walked out of my international relations class, leaving my books on my desk and returned to confront the professor. I pointed out that this was the first time I had been sick. (I was the nerdy child who won the Perfect Attendance Award -three consecutive years) I was doing my best to keep up with my studies while I recovered, and I really objected to the way my commitment had been challenged by him. To my surprise, he apologised.  He admited that he felt badly about the way he spoke to me and was proud that I came back to confront him. It would be one of the most important lessons I learned at University: knowing when you admit that you're wrong, and knowing when to stand up for yourself.

I thought back to this event after reading Lentil's post describing how her RE berated her after a recent IUI procedure. It's much harder to stand up for yourself in this context. She commented, "For some reason, I desperately want this particular human being to like me. I think it's because I am relying on her for something so huge." There is such a precarious relationship between you and RE as well as their office staff. As it feels like they have the life of your potential baby in their hands, it's only natural to want to appease them. At the least, it is desirable to have a collaborative and cohesive relationship with everyone on your team. No one wants to rock the boat and or make any waves...

Update on our billing/insurance issues: When we were proceeding with our hysteroscopy we weren't sure what the total cost would be or how much would be covered by my insurance. My insurance covers 50% of infertility treatments, but we weren't sure if this would only apply to my RE's surgeon fee or to the entire hospital operating room charge. Additionally, they used the code of  'uterine anomaly' rather than an infertility diagnosis, so we weren't sure if the 50% rule would apply. A month after the procedure, we received an explanation of benefits informing us that the $17,000 in charges from the hospital were "in review". As with all correspondence from my insurance company, they always include the statement, "authorisation of services does not guarantee payment." Every time we opened the postbox, we were fearful of receiving a bill for the entire amount. I started entertaining the worst case scenario; where would be be if the savings we had earmarked for IVF were eaten up by the hysteroscopy? "Don't worry, we'll figure something out." Husband tried to stay calm and reassure me, but I know he was thinking, 'yeah, we're fucked...'

I was inspecting my account from the insurance's secure website on a weekly basis and the status finally changed from "pending" to "processed". I called to speak with an agent, who informed me that a check had been issued. He couldn't tell me the amount, so there was some relief that they were at least paying some of the bill. We were still on edge until the explanation of benefits arrived and indicated that all charged were paid in full. Despite seeing the words "Patient Co-insurance $0, Patient Co-pay $0" we still won't feel assured until a few months go by without a bill from XYZ hospital.

After learning from the billing coordinator at my RE's that I wouldn't be able to proceed with any further treatment until they received payment from my insurance company, I decided to do some investigation on my own. I worked in accounts receivable for a medical office and I know how these bastards at insurance companies operate; they'll apply any and every trick in the book to hold off paying as long as possible. Their electronic submission system is rigged so that the slightest hiccup in the transmission will erase data. Their fax machine is permanently engaged; and if you're sending paper claims via snail mail, you'll note their mailing address is in the Bermuda Triangle. I'm convinced sometimes they'll just sit on charges just to see if busy clinics will try to pursue. I'm not sure which tactic was used in my case, but sure enough a phone call to an insurance representative confirmed that none of the charges from my RE's office were ever received.

When Husband paid our portion for our last IUI, he shared this information with the billing person. "Oh, she called?" the woman asked, as Husband detected a slight attitude from her tone. I gave her back the printout of my outstanding charges (which she printed for me on paper that still has small holes on the sides) where I had highlighted which one needed to be re-submitted and I had listed the address. "No, I don't need this. I know the address." she replied in pissy manner. Husband and I looked at each other and had a conversation without speaking any words
"Is it me, or is she acting like a [bad vagina word]"
"Seriously! You're doing her job"
Husband and I just turned to her and smiled sweetly. We both know better than to risk getting on her bad side.

As I drove back to my office, I could appreciate some of her resentment: no one likes to be called out for failing to complete a task. Yet, did she seriously not expect that I would look into this? After being told that my fertility treatments would be placed on hold, I was supposed to just continue to wait? For how long? The account was 90 days past due and she hadn't bothered to chase up.

After encountering so many delays, I've started to view infertility as a chess match -you always want to think two or three moves ahead. Okay, I don't really play chess, but sometimes when I have writer's block, I'll play Tetris for a few minutes, which also requires forward thinking. If it could be logistically possible, I was reconsidering our decision to skip an IUI in May, as we looked to June and saw that Husband would be away for a few days during the trigger and IUI week. That seemed to be a bigger gamble. I also recounted memories of our difficulties with timed intercourse, and began to realise that we could conceivably (pun intended) miss two months in a row.

Even if this current IUI cycle doesn't work, I feel we will still have reason to feel encouraged and I want to continue the momentum from this last cycle, which numbers-wise represented our best chance to date. Truth be told, I was tempted to ask if they were sure that it definitely was Husband's sperm after I heard what the count was. Other parameters were similar and I think the MA mentioned that we were the only IUI on schedule that morning. We're not sure what he was doing three months ago, but I hope it had lasting effects. If we can keep these numbers up, I believe it could be merely a matter of time, and I want to try to do as many IUI cycles before our tentative plans for IVF in October.

Although, if we were able to navigate around the Memorial Day holiday in terms of my monitoring, we would need to be excused from the 'no treatment while you're carrying a balance' policy. I think it's only fair since technically my insurance can't pay for services when they have no claims on file. If she insists on sticking to the rules, we can offer to clear the unpaid charges and receive a credit when the insurance payment comes through. I just really don't want to have to negotiate with this woman. I don't intend to ever use it, but I feel the ultimate threat I carry in my back pocket is to bring up that I am in a position where I refer patients to their office. The ultimate question -is it worth it to rock the boat over one IUI cycle when we don't know how long we're going to be dealing with this person in our life and may be dealing with greater sums? Oh, there is such an added bonus if this IUI cycle works!


  1. Definitely a rock and a hard place. My general approach is to be politely annoying. Annoying by calling every 2 days (or web chatting with the insurance company) to request constant status updates. Maybe you can ask your RE if you can get a waver on that policy. It seems like a very reasonable professional courtesy to extend...because even if you clear out the balance this time...there could very well be a next time (hopefully IUI works and it won't be an issue!)

  2. I love that line--"I've started to view infertility as a chess match -you always want to think two or three moves ahead" I don't think that way due to delays, but rather in a "what can go wrong next" way. But I'm always three moves ahead!

  3. "Politely annoying" is the way to go! They can never accuse you of being a bitch, but they'll be so sick of hearing from you they'll do whatever they can to get you off their back. As hard as it is, you should stay on her good side until you don't need her anymore. Then give her a FIRM piece of your mind and a bad review to her supervisor. Karma, bitches.

  4. My anxiety increased just reading your post! Shouldn't an IF clinic know that stress isn't good for women trying to conceive?? It is so funny how these clinics have all these protocols, but no sense of urgency to back it up.

  5. It's amazing what you can find out when you stay on top of these things. I kept track of the charges from my IVF in October, because I was trying to see how much my insurance company actually paid for the cycle (they cover 100% up to my lifetime max) and I discovered that I was charged twice for the biopsy for the PGD. The billing person gave me the run-around, made me call my insurance, and was very unhelpful when the insurance rep (who was surprisingly awesome) and I called back to find out what we needed to do to reverse the charges, which would eventually increase the amount I had left for the lifetime maximum.

    It seemed like a moot point when I proceeded to get pregnant, but when I miscarried, I was very happy to have that $2000 back in my balance.

  6. Oh that woman is definitely a bad word! I don't know why it's so difficult for some people to do their jobs. Anyway, I hope it's all gotten worked out and you e been able to move forward!