In which we kick the insurance company’s ass

I’ve had an emotional few days dealing with this insurance issue.

Thursday, I came home from work and Chris, who has been on vacation this week, told me he talked to another rep from our insurance company, Bev.  This was because after talking to Puppy Killer, he had called the HR department at his work, and she was going to look into the information he gave her. That contact should have been Rochelle, who is his company’s contact at the insurance company.  The reason she didn’t call us herself, is because this Bev “can maybe connect with us on an emotional level because her daughter went through fertility treatments.”

Well no offense, Bev, but I don’t give two shits about your daughter.  I could care less that you think you can “relate” to us.  You have absolutely no idea what you and your company have put us through the past few days, and shame on you for using our emotions to blackmail us into accepting the fact that your company fucked us over.  I don’t care about you, I don’t care about your personal life, I want to know how you can fix this major mistake your company made.

Well Bev told us that she’s sorry this happened, she doesn’t know why it did, she doesn’t know why claims were paid when they shouldn’t have been.  She doesn’t know why we were allowed to go to our clinic when it wasn’t in The Program’s “Center for Excellence.”  She doesn’t know, she doesn’t know, she doesn’t fucking know.

She told us we don’t even have out-of-network benefits for this clinic.  Which was funny because we confirmed it with six reps over the past five months, because we were wary and wanted to keep confirming.  Our clinic THEMSELVES confirmed the benefits. IVF was confirmed to be an out-of-network benefit. We received confirmation of what the insurance company will pay for each of the CPT codes.  Why, after all that, would we ever doubt those confirmations??

Oh and the best part? I got my period that day.  Happy fucking CD1 to me.

Chris then flat out asked her, “So if we continue to go to our clinic, you will stop paying?”

Bev: “Well, if it’s not a Center for Excellence…”

Chris: “Well you say we don’t have out of network benefits, right?”

Bev: “Right.”

Chris: “And you won’t pay for any other clinic except the two you say we can go to.”

Bev, gleefully: “Yes, that’s correct.”

Chris: “So then if we receive services at our clinic, which is out of network, you won’t pay for it, is that right?”

Bev: “Well, I can’t go on record to say that…”

I can almost hear Bill Lumbergh in my head: “Yeahhh…”

I’m telling you, I would have totally lost my shit right then and there.  I am not that kind of person.  I don’t scream at people on the phone.  But I would have screamed at her.

When he was telling me this that day, I just couldn’t even believe this was happening.  I understand, that for many, IVF is entirely out of pocket.  But what makes this so bad is that we DO have coverage. We were told repeatedly that we had this coverage.  And suddenly, when we are officially starting our IVF cycle, it’s all being taken away.  And no one seems to have an answer for any of it.  And we have people like fucking Rochelle, sending her subordinate to do her dirty work and tell us, “it’s because she thinks I can relate to you guys.”  Taking away a benefit like this means that instead of us owing $4,000 when this is all said and done, it’s now going to be $14,000.  Or more.  With no guarantee this will even work.  That’s a $10,000 difference that we have two days to decide if we will pay it, and where the money will even come from.

So when he gets off the phone with Bev, after all her helpfulness douchbaginess, Chris emails the benefits woman at his work, who, no joke, is the only person who could help us, outlining everything.  Friday morning before work, he received an email back saying she will need some more information, but thanks for telling our side of the story, and that she will need to talk to the insurance company to find out their side. She thought it was possibly because we should have been grandfathered in for the IUIs only with this policy change, but that we should have been notified of that.

So I went to work, crying.  Because I knew what would end up happening.  We would shell out the $14,000 because there was no other option.  We were starting our cycle.  I just couldn’t bring myself to quit.

I came home on my break and he got a call back from the benefits person.  They told her the policy changed and we should have been notified.  They pulled the phone records.  There was no documentation of anyone ever telling us that.  Like we knew.

They are waiving the claim.  We get one fresh IVF cycle for out-of-network benefits.  The insurance company is making an exception only because of one person who laid the smack down.  Chris looked at me while he was on the phone with her, gave me a thumbs-up sign and I did what I do best.  I promptly burst into tears.

Our coverage is back.  I can go back to focusing on the medical and emotional side of this IVF, instead of this crap with the insurance company.  I know my outlook would have been different had we not had any benefits.  But the horrible, cold attitudes of these women who were the cause of all this, denying us answers, taking away something that the majority confirmed was there for us, made this a completely unnecessary source of stress for us.

The other day I had a young girl tell me, “It’s been so stressful trying to get pregnant.  My husband and I have sex almost every day, trying for a baby.”

I win.