Night off

[judecorp]

Normally I would be heading to babysitting right now but they called and asked to switch to tomorrow for the week and I said okay. I thought about just saying no and not babysitting until next Monday, but hey, we really end up using that $60 that I bring back every week. It usually ends up being our weekend spending money so we don't use our real money. We should probably just save it, but that's something else entirely.

Jen is at work tonight so I have a night all to my little lonesome, where I will eat macaroni and cheese out of a box (but I will cook it first) and maybe watch a movie or something. And do some crap around the house. And just be lazy. Tomorrow, if Jen's not working late, she can have the house to herself and do... whatever it is she does when I'm not around. (I envision time on the couch watching sci-fi.)

~//~

I called the insurance company today to talk about their crappy policy. While the person I spoke with was incredibly sympathetic, it pretty much looks like a no-go. She suggested that I talk to the doctor's office and get them to fill out the approval paperwork anyway, and let it get rejected so I can appeal. And maybe I can get the doctor's office to write about how I used to be married to a guy. Who knows? But basically we pored through all of the policies again and there are specific sentences that talk about how they won't provide for benefits if the woman "has not had access to sperm" for the last year. And I also learned that I wouldn't need a year of failed IUIs for them to start paying, but at least 12 failed IUI cycles, which is even longer. Ugh. They just suck a whole lot.

She tried to be as encouraging as possible, but it's kind of all there in black and white. It all depends how much the doctor wants to go out on a limb and whether they would even consider some sex I had in the mid-90s. Otherwise we're looking at spending something like $10-$15K before the insurance /that I pay for/ will even start. I guess, if we DO decide to go for it, we would have to, like, hope it didn't take that long!

Maybe I can just get a big fat prescription for clomid and go around having anonymous sex with strange Bostonian men every month. HA!

Comments

[haloumi.livejournal.com]

"Has not had access to sperm"

What crap. You, potentially, have had access to as much sperm as you want. What a devious way to say "Is not sleeping in a bed with a man AS GOD INTENDED!"

How do they prove that a heterosexual couple has been trying? Stick a camera on the end of the penis and look for it go light/dark/light/dark at least 12 times a year? Or is their word good enough because they're heterosexual? Yes, there is a possibility that a heterosexual couple has been trying, and hasn't succeeded, but their sexual orientation and adjacency in bed does not guarantee that they have been trying. Any attempt to capture this in pure, logical language would quickly reveal it to be the crock that is.

You've paid for your medical insurance - you have a right to the benefits.

[siercia]

If it weren't for your infertility issues, would you just be doing at home insemination?

I ask because I do know enough women who have had good success with taking Clomid and not needing very much further intervention that I wonder if it might be worth trying that route, at least for a few months? (Obviously, I don't know if that would be covered or how much it would cost, etc, but if it's less, would it be worth it?

[judecorp.livejournal.com]

Yes, if not for the fertility crap we would have been doing inseminations at home. And in a perfect world, I still want to do this, provided we a) find someone local who wants to help us out, or b) find someplace to store a whole bunch of frozen sperm!

It would definitely cost less, because we'd only have to pay for supplies. And if upping the medication I'm taking now helps (or if I can get a doctor - my PCP or the endo - to just prescribe the clomid with no other services), I definitely want to consider it.

The only thing that holds me back is that home inseminations don't count toward "trying" in terms of the insurance since technically they require 12 cycles of IUIs. So it's so mixed. Do we start right away with the IUIs so that we get to the insurance stuff sooner?

I'm also wondering if we DO go the IUI route, should we also try home inseminations to give us a better chance? So many questions.

My friend has a local friend that she thinks would want to do all of this stuff... but since we don't know him (or anything about him), that makes me so nervous!

Keep your fingers crossed that I come up with a better solution or something!

[judecorp.livejournal.com]

I agree. I'm so peeved about the "medical policy." It just seems so ridiculous, I just want to go scream at the people who make the policies. Grrrrr.

As far as I know, hets don't need any proof that they were trying... just a doctor saying that they have been. Grr.

[eeka13.livejournal.com]

Dude, are you on the insurance policy from our agency? If so, I'd recommend bringing it to the attention of some higher-ups that the policy only covers insemination for people in straight relationships. The agency does get to choose what we do and don't have included in our policy. If the issue is that the insurer doesn't offer it at all, then the agency could switch insurers; I know that at least once they switched insurers because of employees complaining that something wasn't covered. Worth a try. I can suggest who to talk to if you want.

[siercia]

If it were me, I'd likely try at least a few rounds of at home, just to see, if nothing else, so I wasn't plagued forever with what-ifs and second guessing.

Again, if it were me, I'd worry less about starting the IUIs to get to the insurance sooner in the scenario where it's number of cycles and not time spent that matter for the insurance, since you'll end up spending about the same amount in the end. And perhaps you'll make some headway in getting it covered in the meantime, or get lucky and find that you don't need it after all.

Also, if you guys are serious about heading out to Western MA in the summer, I'd assume you'll be changing jobs and possibly insurance; you might find a different insurance company has looser regulations or is more willing to bend the rules.

Just thoughts, which I realize are easy to lob from the cheap seats of getting knocked up when you didn't mean to. =)

[stapynam.livejournal.com]

a hetero woman with pcos is not going to ovulate 12 times a year, so why make you have 12 iui's? the whole thing doesn't make sense.
it just shouldn't be this tough to have, love, and give a good home to a child.

[vorpalbla.livejournal.com]

hey won't provide for benefits if the woman "has not had access to sperm" for the last year.

You live in a major city. You have a vagina. You have PLENTY of access to sperm, pretty much any time you want it. So I don't know what they are talking about.

[hopemcg.livejournal.com]

But wouldn't trying at home (like hets do) = home inseminations? You could argue that you had access to sperm this way.

And besides, everyone has access to sperm. Sperm is everywhere. It's just that most of it you don't want anywhere near you.

[geniusorafool.livejournal.com]

So, correct me if I'm wrong, but the insurance company is saying they'd cover you if you had several hetero f*ckbuddies but won't cover you if you're in a monogamous homo relationship?

Talk about encouraging dangerous "alternative lifesyles"...ack!

[judecorp.livejournal.com]

I'm not sure what the logic is behind this, but I was told by the hot nurse at my PCP's office that the insurance companies don't consider home inseminations "trying." When it comes to approving IUIs for lez-beans, they're requirement is "at least 12 failed IUI cycles." Which is a REALLY FREAKING LONG TIME.

I don't have a ton of access to sperm. There aren't many guys at my work, and I'm ALWAYS at work! =P

[judecorp.livejournal.com]

I definitely see what you're saying, and it would be nice to try some at-home insems (which would be so much more pleasant and natural and nice) and have one be successful. That would rock!

And yes, I could do some tries at home before shelling out the $$, but we also have to consider how to maximize our chance of success. We really want to be successful ASAP... so we have to debate whether it's better to try least invasive/costly (and lowest chance of success) and possibly delay outcome or go balls to the wall and do the most intensive things we can to try to score sooner.

It's complicated.

[judecorp.livejournal.com]

From what I learned at Boston IVF from the financial person, all of the major insurance companies require that "year of trying" crap, except for Harvard Pilgrim where the wait is 6 months of trying.

So I'm not sure what work can do, really, because they all use the same definition of infertility which requires SPERMAGES.

[judecorp.livejournal.com]

I agree 100%.

[judecorp.livejournal.com]

How do you know I have a vagina? ;)

[judecorp.livejournal.com]

I don't know if they require monogamy... I mean, it's not in the policy or whatnot... the policy is that infertility is defined is "inability to conceive and maintain a pregnancy after one year of trying." Maybe they figure nonmarried folks don't try? Beats me.

The whole thing is just thoroughly not kept up with the times. Bleh.

[siercia]

Of course it's complicated. And if making this happen as soon as you can is more a goal, then just getting on with it and shelling out the cash probably makes more sense.

Stupid insurance companies.

[(Anonymous)]

I don't know, you could be like Jamie Lee Curtis.

[rizzo41.livejournal.com]

Can you like pay some dude $20 to claim he's been sticking it to you for the past year in an attempt at babymaking so that you will qualify? Surely not the most honest way to go, but they aren't exactly playing nice...

[judecorp.livejournal.com]

So many damned decisions! Argh!

[judecorp.livejournal.com]

???

[judecorp.livejournal.com]

From what I heard from the customer service person at the insurance company, the way the process goes is that the doctor's office fills out all of the authorization paperwork for fertility services and submits it to the insurance company, and at that point they decide to accept or reject the claim. So I suppose if my doctor's office wanted to write a shady note trying to advocate for me, they could do so and then see what the HMO says.

However, the HMO's policy on infertility specifically says that in order to start paying for IUIs from "people without regular access to sperm" (whom the insurance company defines as unmarried women and lesbian couples), they have to show at least 12 unsuccessful IUI cycles at their expense.

Which is totally unfair, btw.

[rizzo41.livejournal.com]

I totally agree.