Insurance is Maddening plus Hormone Forecast

Just a quick update on what is going on in my world:

Within the family, my oldest sister is still following through with her decision to disown me. Easter was alright with her gone. I realize that following God's will, of course, never meant everyone would like you for doing it. I still feel I did the right thing, and that writing that letter was prompted by the Holy Spirit. Confirmation is the continued bubble of peace :)

My little sister is now 24 weeks pregnant with a little boy. He is doing well. She was worried she never felt him move, but sono shows the placenta is in the way. She had a scare on Easter re losing her mucus plug, but her cervix is tight so it should regenerate. They are keeping a close eye on her.

In other drama, as you recall, I was told by our insurance company that our claim was denied due to inconsistent codes.  The location codes of doctor office mixed with home health were especially confusing, and detrimental as home health triggered a pre cert. Of course, that triggered hope they could be redone correctly. I spent a lot of time on the phone today about this. It started with finding out that wasn't at all the reason and that they are awaiting medical records. I clarified Toth had sent them all, and they mistakingly requested them from Hilgers for the HCG request and combined them with the Toth appeal. She said no, they want everything from Hilgers now because Toth's office was flagged as infertility (due to a google search by a nurse-really?!). Okay...we can fight this. First of all, Hilgers records sure don't state IF. Secondly, Toth is a pathologist and I saw him for infection. Third, I don't have the history of X amt of cycles of unsuccessful trying. We knew about various dx and were able to have meds on board from day one so thankfully we were proactive and never got there. Additionally, Hilgers office told us BC/BS was sued and it was now policy that repeat miscarriage is NOT infertility by their definition. So...bring it. Additionally, I called Jessica from Toth's office and she was under the impression the codes were changed based on their conversation. Which wasn't the case, unfortunately, so she is correcting that paperwork so it never gets down to this. I am doing this for me, and for all woman who go down this path. I really hope this reimbursement will come through. Jessica is already excited for all the extra knowledge she gained in the coding process that she can pass along.

So...I haven't been charting. But since I am not on HCG, technically a miracle conception could lead to a miscarriage without post peak support. So for now, I am semi charting and we are avoiding when I have really obvious signs. I need to get back on HCG for many reasons, but...there are barriers. Barrier one is it is flgged for infertility and they aren't covering the $100 a month. Barrier two: my skin is THICK! You really need to go at it with major force. Problem is I have no depth perception and I am afraid to stab myself hard in the wrong spot. Done it. Bad bad bad memories. My dh has never done the stomach ones. I am thinking I should maybe try my thigh, but there is no fat there and it seems painful. How is that not in the muscle? It's a sub cutaneous shot.  So I am struggling mentally with making myself continue this med indefinitely. But I know it is selfish. Plus, I was psycho over Easter and pretty sure it was hormone related. I just felt so angry about everything. I don't remember being like that before. It prompted dh to ask this morning for a hormone forecast, lol. He wanted to know if the forecast was "get the hell out of the house." Yes, I did laugh!

So that's it for now. Dh seems not ready to talk adoption (his work sucks, he is overwhelmed by house projects, the $15k from NY is still fresh in his head, and more) so I just info gather and try to be patient. It may not happen at all, and I am really okay with that even though I do badly want it. Not sure if that makes sense? I am sure $15k back from insurance wouldn't hurt toward that cause.

I hope everyone had a wonderful Resurrection Sunday and are enjoying the Easter season. He is Risen!


stacym88 said...

Interesting note about the lawsuit against BCBS and their classification of infertility. I might have to throw that one at them next time they try not to pay for something! On a different note, I give the HCG to myself in my thigh and haven't had problems. Of course, I have a LOT more fat than you do :) You are in my prayers!

Stephanie @ Blessed to Be said...

Happy Easter! Thanks for the update!

Also, "hormone forecast" is cracking me up. One clever husband you have there. :)

E said...

We had BS the first time we went to Toth and we got some reimbursement. But nothing the second time since then we changed insurance and and have no out of network benefits. hope you get something! Or at least deduct it on your taxes.

UGH, family drama. So sorry. Glad you have peace, though.

The HcG wasn't working so well when I was using it for post peak support, since going on post peak progesterone and estrodial I feel so.much.better. And it is cheaper and easier with no injections, I was so over those. Hope you get some help soon!

Rebecca said...

Ugh - insurance companies! It is criminal the way they function :(. Praying for you and impressed with your determination!

"hormone forecast" - I'm gonna have to share that one with The Man! I do hope your able to figure out a way to regulate without the shots soon.

prayerfuljourney said...

My dh and I had our own sagas with trying to find out how much my surgeries would cost so we could prepare. We don't have a money tree in our backyard! I could not imagine having 15K hanging over my head.

Praying for you as you discern and try to figure it all out.