Butt Naked Bad News

Feb. 19:  We woke up bright and early and arrived at Reproductive Associates of Delaware (RAD) at around 7:45 for my blood work and ultrasound.  During the weekdays, I’ve been going by myself, but Bri decided to join me on my weekend appointments.   A few other men were there, but I think they were just drivers as I didn’t see them go into any of the exam rooms.  I asked Bri to join me in the exam room because I think the ultrasound and how they count and measure everything is kind of cool.  And I wanted him to see everything.  I’m so glad he was there with me.

I had my blood work first and then sat in the waiting room – FOREVER!  Most mornings, I’m in and out with everything in 20 minutes or so.  But on Saturday, we were there for about 2 hours from start to finish.   As we were waiting in the exam room, I was totally surprised when the door opened and in walked a man I had never met before.  I was expecting the nurse practitioner or P.A.  The gentleman introduced himself as Dr. Feinberg and from their website, I knew that he was one of the founding doctors of the practice.  I found it delightful and unusual that the head doc was working the weekend just to do the ultrasounds.  He was happy with my progress, but then he just blurted out that he had bad news for us.  It was kind of weird how he delivered the news because I was still without clothes from the waist down sitting on the exam bed and I felt a lil exposed.  Anyway, he told me us that insurance had denied coverage for all costs associated with IVF.  What?  Perhaps we’re naive, but we would have never expected that outcome.  Well, the tears came immediately.  Thankfully, Dr. Feinberg seemed just as annoyed and upset as we were.  I asked what we should do.  He recommended that we make some noise, go to the press and if need be get a lawyer.  Wow, that serious?  In as polite a way as possible, he did also remind us that we would have to reconcile all costs for their services.  Of course.  I get it and understand that its only fair.

So, I quickly dressed and we went out to meet with the IVF coordinator, Amy.  She is super sweet and expressed her concern and disgust with Blue Cross Blue Shield (BCBS).  She told us it was the medical director, Paul Kaplan, who denied our coverage.  BCBS has requirements before they’ll authorize coverage (although partial) for IVF.  First patients are required to try to naturally get pregnant for one year without any method of birth control.  If that doesn’t work, then patients try insemination and if that fails, only then will they cover IVF.  I guess they just don’t get that I can’t follow that path while starting my cancer treatments, the same treatments that are the whole reason why we’re doing IVF in the first place – to preserve my fertility.  UGH.  In the nicest way possible, Amy described the financial obligations that we will face and have to commit to.  It’s not cheap, but after going through this whole process, I totally understand how everything adds up to such a great amount.  It is truly high tech baby making happening here.  Similar to buying car insurance or a phone plan, Amy continued to describe the packages they offer and what’s included.  Given the unfortunate nature of our circumstances, their office agreed to throw in my embryo transfer into the basic IVF package.  This is normally an “add-on” and can run a couple of thousand dollars, so Bri and I were really grateful.    Amy also explained that we can submit an appeal to BCBS as one last attempt to fight for coverage.  Their office will write a letter to provide the medical backing and then it is up to us to write a compelling argument.  Once I get all of our paperwork, I might also ask my oncologist to also write a letter describing my treatment plan and the risks involved.

So, although this totally sucks, I am so happy to be going through this process with the staff and doctors at RAD.  Usually they require financial commitments from their patients prior to the start of IVF.  However, given my situation, they just jumped right in and got started so I could move on to chemo.  They just figured that insurance would work out.  And now that it’s not working out they are being so flexible and understanding with us.  Egg retrieval is literally days away and they understand that most people just don’t have that kind of money sitting around, so they are willing to work with us and still move forward with getting my lil eggs out.  Thank god.  So, I’m still stressing about starting chemo and having to battle with this appeal, but at least there are some friendly people out there rooting for us!

One thing I mentioned in previous messages was our intention to also explore adoption as a way to start a family earlier.  We had scheduled an appointment in Baltimore with Catholic Charities for mid-March.  Well, we’ve decided to cancel the appointment given the emotional and financial stress of our current situation.  In a few months, we will reassess the everything and see if we can meet with Catholic Charities again.  I’m sad, but remaining hopeful that somewhere along the line we’ll catch a break.  And I’m going to take Dr. Feinberg’s recommendation and make a lot of noise!

After coming home completely frustrated and crying my eyes out yesterday, I was going to write this post as a petition for readers to send hate mail to Paul Kaplan.  Well, after going to church this morning I’ve had a change of heart.  I still don’t like him and his decision, but I don’t hate him.

Feb. 20:  Back to RAD.  Dr. Feinberg once again told us that things look good, but I’m not quite ready.  The ultrasound measures the follicles and I should be at about 20mm and as of today, I’m only at 18mm.  He mentioned that Wednesday may be retrieval day, but I would need to come back Monday.  I’ll keep everyone posted.

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7 Responses to Butt Naked Bad News

  1. Courtney says:

    i am glad that i read this post this morning and not before I went to bed last night. i really think you have a good case to not be denied. In a way, it’s that guy’s job to decline such expensive procedures that don’t follow protocol, but that doesn’t mean that you shouldn’t have another go (or two) at it. Some people just don’t have it in them to fight for the coverage and the companies know that. I’m going to think about this for a few days, but if it goes to getting press, your story is certainly a VERY compelling one.

  2. Courtney says:

    and another thought… all those projects you did for your most recent degree might have been good preparation for making and presenting your appeal/argument. 🙂

  3. Aunt Patti says:

    Having worked in insurance for a lot of years, I think Courtney may be totally correct! It is one of the reasons my issue came up with my job–I was feeling very torn between wanting to do a good job for the company and the need to do what was ethically right, and somehow there was a huge gap between the two in a lot of areas. Start letter writing, phone calls, and make as much noise as you have the energy to make–the worst thing an insurance company can have it negative publicity about the denial of reasonable coverages! If you need anything, please let me know! You have the love and support of a lot of people who will jump right in to help however they can!
    Don’t be afraid or hesitant to ask! Big hugs to both of you!

    • Alexis says:

      Thanks! Not ready to make a big stink & contact the media like the doc suggested, but we’re really motivated to write a compelling argument for our appeal. Looks like we have some homework to do 🙂

  4. amyreinink says:

    This makes me absolutely ill. You know who to call if you need help fighting this one to the end … but I really think that somewhere along the line, there’s going to be a human being who hears the situation and realizes that denying you coverage would be CRAZY. Stay strong, sistah!

  5. Pingback: Signed, Sealed, and Delivered | Brave & Bubbly

  6. Pingback: Great News! | Brave & Bubbly

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