Boston IVF visit

[judecorp]

Yesterday I learned some very important things.

1. I learned that the doctor is pretty optimistic that he can figure something out to get me pregnant, one way or another, and that he's a pretty supportive guy who was very normalizing and nice and good to Jen and all of that. In fact, the whole office was very good to Jen, which was nice.

2. That insurance won't cover a cent of any sort of treatment I might want, because I don't have a male partner and therefore cannot say that we have been "trying" for one year. Because of this, the insurance company assumes that the ENTIRE FIRST YEAR of treatment is the "trying" and will start paying after 12 months of attempts. And according to my PCP's office, at-home inseminations don't count.

I'll give this a moment to settle in.

Nevermind that I have a diagnosis of a fertility-related condition, nevermind that I have been trying medication treatment for such things for a year, nevermind that I .pay. for my insurance and therefore deserve to actually get my claims paid. Just, "no." And, of course, they told me none of this on the telephone when I called customer service the other week to inquire about my fertility benefits. I found out quite suddenly in the midst of conversation with the doctor who assumed I knew all of this and surrepitiously shattered my dream of actually being able to do this.

One cycle of IUI (intrauterine insemination) costs $400, plus the cost of sperm. (One thing we DID learn is how long and difficult the process of known-donor sperm is when you go through a clinic as opposed to at-home.) One cycle of IUI plus the monitoring (blood work and ultrasound to try to confirm ovulation) that is recommended for me because I don't ovulate is $925.

Now we have this terrible dilemma. Do we chew through a huge chunk of our savings to try to get me pregnant (which might or might not work) for x number of months until we're a) broke or b) ready to just cry? Do we say, "eff it" and decide to try to get Jen inseminated, since she doesn't have apparent fertility problems and is probably more likely to conceive - if we have to pay, we might as well have better chances? Do we just bag the whole thing and save money for adoption? Do we try a couple of months of the cheapest option and see what happens?

I am just so broken about the whole thing. I was just so blindsided. I went into the visit nerrvous that I would hear how difficult it would be for me to do this and how stressful it would be. Instead we found out that insurance doesn't like to cover two chicks making a baby (because straight couples can just SAY they're trying, they don't need to show any 'proof').

I'm going to try to call my insurance on Monday and tell them I was previously married to a man and was unable to conceive... but I doubt that will go anywhere. And it sucks that I am even considering delving into my personal, private life to try to get fair coverage.

All I want is one tiny shred of good news. That's all. I feel like my life is just one long series of shitty events.

Comments

[thatpatti.livejournal.com]

wow, that's shitty. i mean, i don't get how at-home insemination is any different than sex with a male partner. in fact, you actually sort of *do* have a male partner if you're putting his sperm inside you a coupla times a month.

so , i know this would be lying and all, but could you just go to the doctor a year from now and tell him you've found a willing partner (you can tell him it was scott - ha!) and you've been having sex for a year with no success?

god, it just sucks that you'd have to LIE to get treated like you SHOULD.

i'm so sorry.

[thatpatti.livejournal.com]

awwww - so i told scott what i said, and he laughed. but then he got serious and said, "that's fine. seriously, i don't care." which i thought was so cute and sweet.

and he even pointed out that it would prove beyond a doubt that the problem was with you since he has already-proven "super sperm". :)

[thatpatti.livejournal.com]

another thought: have you ever done any cycle charting? you do ovulate a couple of times a year, right? buy "taking charge of your fertility" and start charting your cycle, then try at-home when you find that you *do* ovulate. then you won't be wasting money on infertile cycles.

but maybe you've thought of this already. just an idea.

crap. i need to get back to cleaning!

[judecorp.livejournal.com]

I've done some charting (not seriously) throughout the last year since I started taking the meds and I've never come up with any indication of ovulation. I get crazy up-down-up-down type temps or else they just don't change. Ever. And I don't usually get any kinds of signs - cervical mucus is unreliable and doesn't seem to change consistency.

Occasionally I will get some signs of an impending period (sore boobs, acne) but even that is not all the times. Sometimes I will just wake up and be like, "Oh wow, my period." Heck, I've been known to randomly bleed for one day!

Before I started taking the Metformin at all, I didn't have ANY cycles. Before the meds, I hadn't had a spontaneous period (without drugs) since June 2002 - the day I moved into that apartment on Buttles, it came totally randomly! And after that, I had one cycle between then and early 2005, and it was because I took Provera.

What I'm thinking I /might/ do is take the increased Metformin that he gave me and see if my cycles regulate somehow, and do more consistent charting even if they don't. And then maybe take Clomid to encourage ovulation and try to predict it with an at-home fertility monitor (even though I know Clomid effs with the results from that) and then do a couple of insemination tries (without all of the monitoring) and see if anything happens.

But I'm /really/ scared that will just break my heart.

[jadefu.livejournal.com]

Or....
You can start calling the state reps who supported gay marriage and tell them what is happening, because you're being discriminated against by your insurance company. This was probably one of the issues they didn't know/think to address.

[oxlahun.livejournal.com]

... and the state Attorney General's office, and the state Insurance Commissioner's office, and depending on what kind of response you get, the press.

Remember, AG Reilly's running for Governor; he won't shy away from beating up an insurance company to get some votes. :)

Making babies is your right as a citizen of the Commonwealth. If they provide coverage for anyone, they have to provide it to you, too.

[judecorp.livejournal.com]

I will look into that.

I wonder, though, if it CAN be considered actual discrimination, because the insurance company can say that they require ALL people to try for 12 months... and it's only by our choice that we haven't been able to do it.

(Although not accepting home insems is kind of assy.)

[amyura.livejournal.com]

I'm so sorry. Insurance companies suck and are the last true bastion of evil on the planet.

[judecorp.livejournal.com]

So true. So true.

[indigodove.livejournal.com]

*hug*

I don't have to say it, but that was completely awful. I wish we could help.

[judecorp.livejournal.com]

You already help by being my friend.

[buddhafly4224.livejournal.com]

in all seriousness, have you ever thought of adoption?

sorry everything's so difficult.

[judecorp.livejournal.com]

We definitely DO want to adopt and/or be foster parents. (We really want to be foster parents and if we end up adopting that way, so be it... otherwise, just be foster parents.)

We're going to go through that whole foster parent process once we have our own home. Our landlords were pretty straightforward that they'd rather not have kids in the house.

[scirocco.livejournal.com]

I am Teh Confused. I thought Kieron was the one who was going to be made to carry the spawn of the two of you?

[judecorp.livejournal.com]

She wants to have a child, yes, but right now she is working through some health issues and trying to get some things under control (blood pressure meds, etc.) So at one point we decided to have me give it a go since it seemed like it would all be covered by insurance and blah blah blah.

And then somewhere along the line of all of that discussion, I started kind of getting my hopes up about it. Which I guess was mistake number one.

So who knows? It could end up that we decide just to have Jen give it a go in a while after all of the health stuff is under control. We'll see. We were just kind of hoping to get going sooner rather than later, and aside from the fertility thing, I'm in pretty decent health.

[thespian.livejournal.com]

I'd suggest contacting the Center for Reproductive Rights (http://www.crlp.org/), and finding out if this is actually legal; there are hooks to the story, as you tell it, that hinge on by the book interpretation, which have been overturned in Massachusetts in the past.

Contact your employer, who has been nothing but understanding of your situation, and make sure they're aware of the discrimination caused by your insurance company (copy the company). I bring this up because, while they don't care about you at all (they get their money anyways), the loss of an entire employer's contract *will* speak to them. Especially if, in Massachusetts, being discriminatory on the basis of sexual preference will cost them *all* government bids. It's cheaper to provide a few gay couples with repro services than to lose their inroads to government money.

[thespian.livejournal.com]

from steve, who used to be the person who sat there at the insurance company saying no (I gave no identifying info):

[17:00] wayward va: hmmm. would her current GYN or primary care doctor be referring her out to the doctor providing treatment?
[17:01] wayward va: what I'm thinking is that at some point her insurance company is going to say no to a doctor; either for referral to a specialist, or for approval of a treatment plan, or for payment of a claim.............
[17:03] wayward va: once the insurance company says no, then she gets out of the standard procedure box and into the appeals process. then she and her doctors can submit the documentation that "yes, she really does have fertility problems and needs this treatment. the standard process should be skipped because we already know she has a problem."

[judecorp.livejournal.com]

Well, the part that doesn't fit your comment is that I don't work for the state... I work for a lowly little non-profit that does work that is overseen by the Dept. of Public Health. If I worked for DPH, maybe that would have more clout. As it is, we're just the bastard stepkids of DPH. They come and audit us... that's about it. And we kiss their butts. :)

My little agency is part of a larger social service agency that is nowhere near as cool and progressive as my little subset... mostly because we're the coolest people ever!

I'd never heard of the Center for Reproductive Rights but I'm going to totally look into it. Thanks for the link!

[kat-chan.livejournal.com]

Since everyone else already covered the legalistic "I am not a lawyer" mumbo-jumbo advice I would have given, I'll just rant instead.

It's so completely unfair that we live in a society where it's acceptable to say that, because there is a penis in the house, that a couple has been trying to have a baby, whether proof exists or not. That standard, the "one year of trying" is inherently unfair to homosexual couples. And what do they do if a single mother pushing fourty decides she want to go AI so that she can spawn without having to find a man to spawn with? Where is the equality before the law for people who don't want to do the "find a man, mate, have lots of babies" dance? It's even worse that they wouldn't accept that you may have been attempting with the sperm of a male friend from outside of the couple (though one from Boston, ideally). It's so heterocentric, and monogamy-centric, that it really is unfair.

[judecorp.livejournal.com]

Yeah, that's the part that burns me... the part that some straight married couple can be all, "Yeah, we've been trying," and that's the end of it... where I would have to show an entire year of forking out money at some sort of AI clinic. And so would a single mom, and that just sucks. It sends out that ridiculous message that society only supports kids born to one male-one female married families. And frankly, I disagree... because I think having kids is a right and not something for a privileged subset.

I'm REALLY going to go to battle with the insurance company about my ex-husband. There WAS a penis in the house, dang it! And he would swear to it, I know he would.

[etherial.livejournal.com]

If at some point you want to talk objectively about your biology, give me a buzz.

[judecorp.livejournal.com]

How do you mean?

And how would I give you a buzz? IM? Phone? E-mail? I'd need info! :)

Can I tell the insurance company that you and I have been doing it? ;)

[wendywoowho.livejournal.com]

Oh, HONEY! I'm so sorry. This is SHITTY! SHITTY, I tell you!

*hugs*

What can we do to help?

[judecorp.livejournal.com]

You should tell Nick to get some of his new "friends" to give the insurance people a deal they can't refuse. :)

[rachelmichellek.livejournal.com]

I thought you were looking into adoption before, why did you decide against that route? If you aare itnerested in a waiting child it's usually low-cost or free.

[judecorp.livejournal.com]

We haven't decided against it. We still want to go the foster-to-adopt route and it's still all part of the plan. Just like having at least one biological child has always been part of the plan.

We're planning to do the whole foster parent process as soon as we move into our own place.

[mayna.livejournal.com]

Bleh. my insurance also wouldn't pay for my home birth even though it's A LOT LESS EXPENSIVE than a hospital birth!!!

[judecorp.livejournal.com]

Can I ask how much it cost to do your home birth?

And I don't even want any non-covered services. I want the stuff I'm entitled to based on my insurance plan!

[estrange.livejournal.com]

if it makes you feel any better most insurance companies don't cover infertility at all. My husband's work covers the first $3000 which isn't much but it does help. Of course you have to meet a $1000 deductible first, which I have never met and then then pay 70 percent up to $3000 - so basically they are no help to me whatsoever.

I'll give you the same advice someone else gave me recently...
Anyway I know it's expensive & I know it sucks but you need to look at the big picture here - it's for a baby and you can't put a price tag on that. If this is your chance to get pregnant and have a baby, then do it. I really think you want to be pregnant - I just get that feeling - and I definitely think you should do it & not Jen unless she really wants it. It seems like you want to be pregnant more than here so do it.

[judecorp.livejournal.com]

I know that most people's insurance doesn't cover fertility services at all - heck, only 13 states require insurance companies to OFFER coverage, and even fewer require companies to provide coverage. I'm fortunate enough to live in a state that requires carriers to pay for fertility services - it's the law. So that's why it's so infuriating... not because so many other people have to pay around the country, because people /shouldn't/ have to pay here. :(

And if it makes you feel any better, your deductible is less than one month's rent here. ;) So we REALLY could use the help paying for services!!

And it's true - you can't put a price on a baby... and if we decide to shell it out, it will all be worth it for the experience. But it's still really unfair that the policy is so discriminatory - and I'm totally bummed out about that.

(And yes, I think I would like the experience of pregnancy more than she would.)