HOLY FUCK!!!!!

Today is my “desk day” where I sit down to go through all my paperwork and make all the phonecalls I need to make. One of the things I needed to do is call our insurance to get details on what is covered and what isn’t, as well as figure out who exactly needs to send in the paperwork for the pre-authorization, and when, since our appointment is coming up very shortly. So I’m pulling out all my paperwork to refresh my memory and prepare myself for this call, jotting down questions, etc. I pull out the insurance member guidebook. We had gotten a new one last week but I had filed it away and not paid much attention. This is the first time I flipped open to the Infertility Services page and really read it.

OUR INSURANCE NOW COVERS IVF!!! To say my jaw dropped open is an understatement. I am in shock. It only covers 2 cycles of IVF, GIFT or ZIFT, with a maximum of 2 embryos transferred each cycle, and there is some other restrictions on it that I can’t seem to make sense of right now, but holy fuck.

(The “other restrictions” I can’t seem to make sense of, it says this: ” These cycles are not covered when the Member has not been able to conceive or produce conception or sustain a successful pregnancy through the less expensive and medically viable treatments covered by this Plan.” Somehow I think that’s a big typo. Because otherwise that is just stupid – if you could get pregnant with a lesser method you wouldn’t have to do IVF, DUH.)

Is this life’s way of making up for the medical problems we just found out about with the dog? This timing is just… eerie.

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I just got off the phone with the insurance provider’s CSR. I must say, she was very helpful and very nice. Wow, what a shocker. She did point out that Den is covered by the federal government so they don’t have to follow state mandates, which I already knew. She said only IUI is covered and I read to her what the new book said. She was surprized and went to check it out herself, came back and confirmed that it was correct. She said, “Wow, that’s excellent!” LOL! She said they get calls from federal employees now and again, in regards to infertility coverage. I’m sure most of them are not very happy to hear the feds don’t cover the same as the rest of MA.

So in any case, she confirmed with me that I do not need a referral for an RE visit. I was a little bit confused, because I got the package of information from the RE’s office earlier this week and it has a letter in it about different types of insurance and that people with HMOs need to bring a referral from their PCP. Apparently we have a special kind of HMO, it’s an HMO Open Access, which means you don’t need any referrals for specialisits, as long as the specialists are within the insurance network (which the RE is).

She also said that we do need pre-authorization, but it’s something that the doctor will fax in once we decide what we’re doing. So I guess nothing is needed for the initial consultation, just when we decide we’re going to do x drugs or do IUI or whatever, then he needs to fax it in to get authorization from the insurance company. I’m sure the RE is well accustomed to dealing with insurance at every bend. They have a financial officer who is there to help with insurance issues as well.

So when I got the package I filled out the questionaire all about me and my cycles and our family histories, etc etc. Den was grumpy when I asked him what his weight was, lol. They say to hand-carry any pertinent medical records to the visit. I don’t know if my bloodtests are important, but I suppose I’ll get them just in case (they were not the day-3 bloods or anything else, they were checking immunities and thyorid function). I already have a copy of Den’s SA, yay me for being on top of things. (The first thing I said to Den that day was, “When he calls you, get him to fax it to me!!”)

Balls are in motion. Let’s just hope they don’t flatten us.