I survived the "new OB" appt. I survived a new nurse that doesn't know me. I survived the how many live births and how many pregnancies question. I survived (and even smiled) being handed the bag (full of hospital registration info and samples), even though it stays untouched and out of site.
I did see the doctor, but didn't get scanned. His scans are less accurate for early, and the ultrasound tech wasn't in that day. We made an appt for Monday (5w5d) for my first and for the following Tues (6w6d) to look for a heartbeat.
I got my first progesterone draw, and it went great. The lab I always used no longer mails to PPVI, so I wasn't sure what to do. PPVI actually mentioned to me who they receive blood from in the area, which was very helpful. The lab told me they do it all the time, and seemed competent. I guess the test will be if it gets there! I am curious to see if there was healing in that area.
HCG shots are going well. Dh is giving them in my thigh without too much trouble. HCG insurance is another story. Kubats got a request for precert so I paid out of pocket this month ($250-by far the cheapest!). Then I called my insurance. Usually if you go to their mail order pharmacy, they have the ability to access your medical benefits (not just pharmacy). Often medical will cover injectible specialty meds when pharmacy denies them. I found out after lots of calls that medical actually denied it as well. The pharmacy they wanted me to go to for coverage (if there had been any), was Freedom Fertility Pharmacy. So then it gets confusing stating it isn't for fertility, I don't have any fertility benefits, etc. Can you believe their cost is over $900 for a month? Yikes! So the plan now is to request Dr. Hilger's office to submit a letter of medical necessity. They told me they were willing to do anything as they see me being on this long term. I did, however, see something online about HCG during pregnancy being harmful, so while I trust Dr. H, I did ask them in an email to help me understand the risk.
That is it for now. The boys are doing a decent job distracting me, and I suppose it's time to get the Christmas tree down. :) Illness kept us from doing anything after Christmas officially ended. And I have a few fun things planned to look forward to. Dh and I are going on a movie date tonight (american sniper) and I have been arranging a few girl's nights. If you don't mind, I would appreciate continued prayers as this is the period (20-24 dpo) that levels really dropped and signified an issue for us. If you want, you can join me in my novena to St. Gerard. And please include some friends in your prayers. One woman just had her fourth baby, a boy after three girls. However, her husband has colon cancer and a big surgery coming up. Another friend is still mourning the loss of her baby at 37 weeks. I have several friends discerning or at some point in the adoption journey, and you may have heard of this blogger, http://luckyassunshine.blogspot.com/, who experienced a terrible late loss just recently.
I am on the journey we are all called to-to accept God's will and perfect love. Whether I am white knuckling it with my eyes shut tight or standing up with my arms outstretched enjoying the ride, I try always to let God be the driver and not bail out the side when there are bumps (like IF!). On good days, I trust He won't run me into a tree. :)
Showing posts with label insurance. Show all posts
Showing posts with label insurance. Show all posts
4.23.2014
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!
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!
3.20.2014
Insurance and Sibling Madness
No time to update fully on the family situation, but can only say it is getting way worse. I have been disowned by my sister, she has disowned two other sisters and my mother, but I am her main victim. She is telling me its my fault if her kids are taken away, and if that is the case she will commit suicide and that too will be my fault. I, however, am in the Holy Spirit bubble, thank goodness as my blood pressure didn't even raise during that conversation, I just calmly let her vent and felt bad for her believing her crazy worldview is truth, and I haven't lost a night of sleep since. If that isn't the Holy Spirit, I don't know what is.
Moving on, I wanted to let all those that found their way here from the Dr. Toth discussion board know that all our claims were denied and so was our appeal. Today I found some potential light, however, because they are saying Jessica from the office (who provided the codes) used home health codes incorrectly. At first I thought a change of code would do nothing, as we were doubly denied for not precertifying anything (we were told not needed by husband's work). However I know from digging, it was the home health diagnosis that triggered the precertification requirement and if that is incorrect than maybe there's a chance. And I am sure all veteran readers of my blog know this, but dang those insurance companies because you sure can't get distracted for a second and not follow up, and you must ask question phrased perfectly every time. Exhausting and maddening!
Moving on, I wanted to let all those that found their way here from the Dr. Toth discussion board know that all our claims were denied and so was our appeal. Today I found some potential light, however, because they are saying Jessica from the office (who provided the codes) used home health codes incorrectly. At first I thought a change of code would do nothing, as we were doubly denied for not precertifying anything (we were told not needed by husband's work). However I know from digging, it was the home health diagnosis that triggered the precertification requirement and if that is incorrect than maybe there's a chance. And I am sure all veteran readers of my blog know this, but dang those insurance companies because you sure can't get distracted for a second and not follow up, and you must ask question phrased perfectly every time. Exhausting and maddening!
9.25.2013
Attempting to Let Him Lead
From the last post you may recall reading: "Here we are. Facing potentially $20k in surgery. We are done. Unless God swings the door wide open, we will try with what we have. Tubes blocked or unblocked, we don't know."
Things appear to have changed. While I don't know the outcome and if this path will lead to surgery Friday, I continue on the path that God has lead us by continuing to walk through the doors swinging wide open. The turn of events happened after I posted, of course. I called Dr. Toth to tell him we are canceling the selective HSG due the chance it may not be covered since it isn't within the context of a lap. Dr. Toth's response was unwavering. Do it. Do it in the context of a lap. I confirmed with him about surgery risk and how I thought it was risking infection spreading. His response. Do it. No putting it on me to decide. No ambiguity. Just do it. Couldn't be more clear.
So instead of calling to cancel, I called Dr. Hilger's nurses to ask first of all, this wasn't how it was already set up right? and also, is Dr. Hilgers willing to do this? Again, I was going off my prayer-doors open if this was the path we were meant to take. The nurse brought up two more potential barriers: 1) does Dr. Hilgers have time in his schedule and 2) does the hospital have time for Dr. Hilgers to do this in their OR?
The response was clear again. Yes, Dr. Hilgers will do this, yes he has time, yes the hospital has time. Again, Renee clarified it is likely to be covered. The only "risky" thing is really the unblocking with a catheter, if necessary. I would happily pay that $900 if the hospital bill is paid by insurance.
So we continued to move forward with one more piece unknown. Would I end up in the CD 4-8 window Dr. HIlger's prefers? It looked like it when we set this up but so far, no period. Stress is for sure the likely culprit. I may have had a double peak. Being concerned your job is at risk, a huge deadline coming up with a lot riding on it, a sister that is likely on drugs, a potential upcoming out of state surgery, and my oldest child have some major behavior struggles will do that to you. In talking with Cheryl, the surgery scheduling nurse, she made it sound like there is no way Dr. Hilgers would do it post peak, but he may be willing to do it a day or two earlier. I clarified we were asked to abstain so pregnancy isn't a concern and was told there was more to it than that. So we waited.
A few questions occurred to me that I received clarification on. First, I realized the change to a lap might mean a request for me to abstain and heal. I asked Dr. Toth if he intended for that and he assured me even post lap he wants us to try that very same cycle, unless of course I needed a tubal surgery and required healing from that. Teresa agreed that it was likely alright unless we encountered anything major. I also clarified that likely Dr. Hilgers would not be able to do a tube repair during the surgery, only run the catheter through. Most of those require the robot and that would be another surgery (one I don't imagine we would do). Dr. Toth reminded me that he absolutely believes the tubes are still blocked and doesn't want us to "waste" unprotected intercourse on not tic, so for that reason I hope the surgery will be soon. Miss the hubby. If we have to wait another month, I am not sure that is best for us. I imagine I'd let hubs make that decision if we got there. I can't think that far ahead though.
Today is Wed. Surgery would be Friday. I would leave town tomorrow morning. No period yet. So I called Mariam who is subbing for Cheryl, at her request, to let her know where I was at with things. I am on cycle day 32, but a little unclear about when my peak was. If I went by point of change, it had long past. But if I went by peak-type CM, then it was pretty recent. For these reasons I skipped my draw (after confirming I could get a green light for Clomid without it). Mariam said something I never expected to hear. Come anyway. I was hoping that came from Dr. Steve Hilgers, but it sounds like isn't there. She said the policy is not to cancel surgery, but to still have me come in for all my pre-op appts. Sounds like I am to keep moving forward to me. To be honest, if he does go through with the surgery, then two weeks of healing before ttc sounds a lot better than potentially only a week. Ouch :( That doesn't exactly sound like what God meant when he creates children out of love making.
I am a tad nervous they will cancel only after I get down there and do three pre-op appts (Creighton is first, then ultrasound, then pre op with Dr. Steve Hilgers). But then again, I am still on the path as I promised I would be as long as the doors don't swing shut. Should they swing shut tomorrow after appts, well, then that's what they do. I promised I would keep walking.
Things appear to have changed. While I don't know the outcome and if this path will lead to surgery Friday, I continue on the path that God has lead us by continuing to walk through the doors swinging wide open. The turn of events happened after I posted, of course. I called Dr. Toth to tell him we are canceling the selective HSG due the chance it may not be covered since it isn't within the context of a lap. Dr. Toth's response was unwavering. Do it. Do it in the context of a lap. I confirmed with him about surgery risk and how I thought it was risking infection spreading. His response. Do it. No putting it on me to decide. No ambiguity. Just do it. Couldn't be more clear.
So instead of calling to cancel, I called Dr. Hilger's nurses to ask first of all, this wasn't how it was already set up right? and also, is Dr. Hilgers willing to do this? Again, I was going off my prayer-doors open if this was the path we were meant to take. The nurse brought up two more potential barriers: 1) does Dr. Hilgers have time in his schedule and 2) does the hospital have time for Dr. Hilgers to do this in their OR?
The response was clear again. Yes, Dr. Hilgers will do this, yes he has time, yes the hospital has time. Again, Renee clarified it is likely to be covered. The only "risky" thing is really the unblocking with a catheter, if necessary. I would happily pay that $900 if the hospital bill is paid by insurance.
So we continued to move forward with one more piece unknown. Would I end up in the CD 4-8 window Dr. HIlger's prefers? It looked like it when we set this up but so far, no period. Stress is for sure the likely culprit. I may have had a double peak. Being concerned your job is at risk, a huge deadline coming up with a lot riding on it, a sister that is likely on drugs, a potential upcoming out of state surgery, and my oldest child have some major behavior struggles will do that to you. In talking with Cheryl, the surgery scheduling nurse, she made it sound like there is no way Dr. Hilgers would do it post peak, but he may be willing to do it a day or two earlier. I clarified we were asked to abstain so pregnancy isn't a concern and was told there was more to it than that. So we waited.
A few questions occurred to me that I received clarification on. First, I realized the change to a lap might mean a request for me to abstain and heal. I asked Dr. Toth if he intended for that and he assured me even post lap he wants us to try that very same cycle, unless of course I needed a tubal surgery and required healing from that. Teresa agreed that it was likely alright unless we encountered anything major. I also clarified that likely Dr. Hilgers would not be able to do a tube repair during the surgery, only run the catheter through. Most of those require the robot and that would be another surgery (one I don't imagine we would do). Dr. Toth reminded me that he absolutely believes the tubes are still blocked and doesn't want us to "waste" unprotected intercourse on not tic, so for that reason I hope the surgery will be soon. Miss the hubby. If we have to wait another month, I am not sure that is best for us. I imagine I'd let hubs make that decision if we got there. I can't think that far ahead though.
Today is Wed. Surgery would be Friday. I would leave town tomorrow morning. No period yet. So I called Mariam who is subbing for Cheryl, at her request, to let her know where I was at with things. I am on cycle day 32, but a little unclear about when my peak was. If I went by point of change, it had long past. But if I went by peak-type CM, then it was pretty recent. For these reasons I skipped my draw (after confirming I could get a green light for Clomid without it). Mariam said something I never expected to hear. Come anyway. I was hoping that came from Dr. Steve Hilgers, but it sounds like isn't there. She said the policy is not to cancel surgery, but to still have me come in for all my pre-op appts. Sounds like I am to keep moving forward to me. To be honest, if he does go through with the surgery, then two weeks of healing before ttc sounds a lot better than potentially only a week. Ouch :( That doesn't exactly sound like what God meant when he creates children out of love making.
I am a tad nervous they will cancel only after I get down there and do three pre-op appts (Creighton is first, then ultrasound, then pre op with Dr. Steve Hilgers). But then again, I am still on the path as I promised I would be as long as the doors don't swing shut. Should they swing shut tomorrow after appts, well, then that's what they do. I promised I would keep walking.
It reminds me of the thick fog this morning.
I may only be able to see my own feet and not the path ahead, but I do know who is holding my hand and I trust Him with everything. So here we are. And eventually the Son will come out and burn off a little of that fog, as He always does when the time is right.
Until then I will just grip a little tighter.
6.29.2012
My Time in Omaha-Peeing My Pants, Poop on the Floor and, eventually, the Results
I will try to handle this in sub topics for those of you that don't want/need every detail...
Regarding the Cost...I was happy I was sent a run down of the charges from PPVI ahead of time with my appts and initial paperwork. I do not like surprises. We knew we were fortunate to have in network coverage, so we were going regardless of cost, but I didn't think it would be quite as much as it was and so learning this allowed me to break the news to Craig before the bills started rolling in. Our coverage isn't as good as the first time I went down (I used to have 90% coverage in network after a $500 deductible with a $1500 out of pocket max-last time I had no problem meeting this, but I had the ultrasound series and the hormone series done as well). This time we have 80% coverage and a $3k out of pocket maximum. We have $1700 left in our flex account (so we can use that medical expense money pre taxed) and I thought that would close to cover it. Haha. Not exactly. The bill from Hilgers that showed my 20% said $880 if they lasered endo. But the bill from Creighton (I had to call specifically to get these numbers) were astronomical. For example, one procedure, the hysteroscopy I think, was $11k. That may not have been my portion, but you do the math. That was one thing of several. So...we skipped the details and dear Lynn cut right to the chase. I had barely touched my deductible. The $3k is on top of that. I was definitely hitting the maximum. So my question to you all is...what else should I be seeking to get done this year?! Insert husband's small heart attack. Now, fyi, Creighton gives you 10% off of what you pay within 5 day, so there you go. Where else are you gonna make 10% these days? I know our bills are nothing compared to what you out of network and out of country folks are dealing with, so I won't dwell on this. I will say that out of country, I would do it again. I would. Hands down.
On being there in general...I must say, I wasn't worried about the surgery really. That may seem weird, but I will do my best to explain to you the range of emotions I was going through. I was back. in omaha. With my children. Rewind to 6 years ago, no idea if I would have children. And now I was back. I honestly know that if we can't have more children, we have already been blessed beyond words. So I guess that took some stress and anxiety away. I also just knew this was where I needed to be and I knew how blessed I was to get to be there. We drove just three hours to get there, so I am grateful to be so close. I desperately wanted to go to the celebration they had at PPVI but couldn't. This was my time. To say my thank you's. To introduce my babies. My "reunion" started a little earlier than expected, at my pre op appt for the hospital. Of all things, Nina remembered me, knew I had longer hair, a different last name, knew my story (I had shared it with her last time), remembered that she found my murmur (I have 3!). What a joy to share what has happened since I left Omaha. Her sister who lives 2 hrs away is also now a patient of Hilgers. I have a strong hunch she didn't know about Hilgers until I told her and that is why her sister saw him, but that is just part of my vague memory and I didn't realize it until after I left so that is unconfirmed. I left flying high and kept hearing my mother in the back of my mind telling me to come down off the ceiling. I was flying high and talking fast! I wanted to kiss everyone I encountered there and the tears flowed easily as I drove from Creighton to my pre op ultrasound at Pope Paul VI. I did call my mom and TRIED to pull myself together.
The ultrasound was supposed to be with Jeanine, but it was with the new girl. Young, cute, heart in the right place, knows she has the best job ever, I loved sharing our story with her. Then on to my appt. I wasn't sure who it was with there, and then I saw Dr. H. Yes, I was a little freaked out to be in the same room with him. Seriously. I wasn't sure if my appt was with him or Dr. Kargas (sp?) but it was both. Hilgers was first and he has a doctor from Mexico shadowing him. I told him my mind would be mush with him in the room, but I swear the Holy Spirit took over and I was brave and succinct and articulate like I haven't been in the last 20 months. Thank you, Jesus. It felt so good not to be tongue tied! I laughed at the thickness of my chart and was told it was 2 of 2, haha. I was able to recap my story for him, and even though he knew it in general, it was nice for him to have a succinct summary (yes, me succinct; now you know it was the Holy Spirit!) and you could tell he was thrilled to hear it and have the other doctor hear it as well. I really enjoyed my time in the room. Of course we bonded about how the pill is the cure all for everyone I know, how ob/gyns have defined life conveniently after implantation, frustration with the HHS mandate and how people think pill=healthcare, etc, and how evil and insidious infections are. He told me that 20% of his patients are positive for infections, but 60% respond positively to antibiotics. He thinks there are simply bugs out there we don't know about yet. I mentioned my desire to have the surgically trained Napro docs distinguished in some way on the website. He has felt that way too, and expressed that before, and is working on it (but seriously how long does it take-add a star or something, lol!). He is also working on the phone ap and confessed he received a package to start it recently but had been busy. He gets a pass. The man is crazy busy. I mentioned a little frustration about people not getting the full benefit of Napro when they don't take advantage of mailing in the blood work and he completely agreed that it was a major part of what they need to do their job. Its explained in his text book and he stresses it to everyone he trains-that was new to me. I know it is expensive folks, but it is so necessary to get the full benefit of what he does. He said nice things about how he is always impressed at what a smart group of clients he has so I wanted to pass that on to all of you. When he left, I felt set with the plan we had for the next day. I got to see Dr. Karges as well and tell her my story (Dr. H asked me to). She was wonderful. She relocated her family to Omaha and worked under him a year. When she goes back she is it for Texas and they are lucky to have her. Her time is almost up so Texas, here she comes you lucky dogs!
Surgery Day...What to say? This is the time I began to think about how my dear friend stopped breathing during the meds used to calm her prior to anesthesia-this happened just one week before my surgery. That was my only nervousness and I still knew it was rare and kept it pretty much in check. I took my time to stress with everyone that I get crazy nausea with anesthesia and CANNOT take narcotics. I have learned these things the hard way given I have had 5 eye surgeries, 2 D&Cs, 2 cysts removed, and this was my fourth laporoscopy. Yeah, I guess this is what I do in my spare time! They did all the things that worked well last time PLUS a motion sickness patch behind my ear. Which was great except it did totally dry me out and I could not swallow crackers without chugging a ton of water. They put these like, support hose things on to prevent blood clots, and they also had me wipe down again with those crazy wipes. But I knew I was in good hands and they put up with me desperately wanting my kids in the room even before the IV. I just didn't want the only hr they were there to be dh chasing them in the waiting room. So they came back and all was well. Charlie didn't even notice the IV (he was on the other side), but he has seen me get plenty of blood work. (We did prep him a lot and got pearls of wisdom from him such as "mom, if they give you a shot in your belly button, run!") The kids were actually really good in the room and entertaining and distracting for sure. Then back I went. They didn't tell me they were giving me something to relax until I asked because the room was moving as I switched beds. I am glad b/c if it was what Nan had it would not have relaxed me! Before I knew it, it was over. I had zero stomach pain that day (I guess they numb it up good), but that night the shoulder pain hit hard. First right, then left, then right again. I was told to sit up 45 degrees and use ice packs and that was the only thing that helped. I never did really get too nauseated. I remember women saying they couldn't leave the hospital until they went to the bathroom. I thought that meant a bowel movement, but am glad that was not the case. I have a tiny bladder and peed almost immediately out of recovery (all that IV fluid, I am sure). But a bm, well that finally came tonight-a full 72 hrs post pre surgery enema. And if that is TMI for you, well then you probably are not in the right place :)
Surgery Results...The next day I brough the whole family in for results. Dh knew to take the boys out if I couldn't hear, but again, they were super good which is crazy. They did have each other though, usually all the entertaining they need. And cheerios. Pretty sure we left a few of those crunched everywhere we went. Anyhow...there were some unexpected results. I wish I had details of my last surgery on my blog, but I don't. I knew this time they would likely find endo, but not a ton. The soreness I experienced hadn't been back very long. They found 3 spots and lasered them. They also found a micropolyp (associated with infection and/or inflammation) and a cyst in the cervical canal (which was inflammatory in nature). He found a mini/accessory fallopian tube-crazy right? He said it is common in women with endo. They also found, in general, a lot of inflammation on the wall (they can only treat with abx b/c surgically it would cause too much scar tissue)-do you see a theme here people?! Inflammation can be from endo or infection so not a lot of answers on that one but consistency is clearly my middle name. Hoping the results of the cultures will clarify the culprit. They saw spots from previous lasering, but not a lot of scar tissue, which was good news. Now for the 2 pieces of shocking news (to me at least). First of all, my tubes were blocked. What?! Yes. I got confused on the details because it sounded contradictory, but he couldn't get the dye through at all and they were blocked, but then he did eventually with a different technique. They are open now, yet he couldn't get the wire through? This sounds like Alive in Hope, so if T or anyone has clarification on this, I would appreciate it. But I am sure it is either infection or endo related because that is the theme in my life. And secondly, I have an abnormality that is assosciated with 2nd trimester miscarriages. Its a large septum. I suck at anatomy so he drew a triangle pointed down and then another triangle inside it attached at the top (flat edge). He said the space it is taking up can affect the baby as it tries to grow. It is associated with miscarriages around 16, 18, or 20 weeks. Ladies, can I just tell you how important it is to have a lap-I learned so much! They are not just for folks that suspect endo. I think they are a good idea for anyone with infertility, they are meant to be exploratory in nature and IF is as good a reason as any to have one done IMO. I know it is surgery, and no one wants unnecessary surgery, but exploring is necessary when questions are unanswered. He said that any ob/gyn that worked with me would need to do frequent ultrasounds and keep an eye on my cervix around that point. I think the treatment is a stitch (cerclage-anyone here need one of these?). I have comfort knowing that for whatever reason, it wasn't an issue with my 2 kiddos here (and the miscarriages I had were earlier, with TEBB cycles and good prog so we are still confident they were due to infection) and therefore there is less chance it will be in the future. I seriously can't imagine a 2nd trimester miscarriage. Someone would have to commit me.
On the logistics of being there with children...let's see, one room, 2 adults, 2 young children. Hmm. I don't know how you cosleepers do it, maybe it is because you start them out doing this early, but I don't know if even that would have helped. My kids have never really been a good match to sleep with us. Charlie will literally say, you can go back to your room now (we do some snuggling with him in his bed, but just for a minute). lol. And he is a talker. So anyway, we had Charlie in one bed, dh and I in another and AJ in the pack and play. Since the world series was going on there, and then after that the Olympic swim team trials, there was NO ROOM AT THE INN! Eventually we got a hotel (two, dh had the pleasure of changing hotels with both boys while I was in surgery b/c our hotel didn't have a 3rd night) but our hotel had none of the amenities that would have made it go smoother. Like location. Or a microwave. Or a fridge. Or a hot breakfast. Heck, continental would have been nice. Nada. So I packed. And packed. And packed. I organized. I printed off directions from every which way and researched kid friendly things to do. I packed swimsuits and bouncy balls and a entire thing of toys (heck, they play well with them on their own at home, why not at a hotel?) Let's just say if we could have kept the luggage rack wheely cart thing (why yes, that is the technical name for that), we would have. That was prime entertainment. And the telephone, unplugged. AJ enjoyed spilling powdered coffee creamer on the hotel carpet and then spent the next 24 hrs there sneaking licks of it. Ewwww! Rock star immune system-check. And flushing the toilet was big fun for him, as was unwinding toilet paper. He could open the doors there thanks to the long doorknobs. The schedule went out the window and the naps were all off. Charlie alternated between fake snoring and every possible attempt to engage us in conversation. AJ slept fabulously in pack in play in the pitch black bathroom (we had a handicapped room for the first hotel) when we finally got to town and to bed after a late dinner that next night (my appts ran long with all that talking), but that presented a bit of a problem. Let's just say I wet my pants one night and dh peed in a cup. No lie. Okay, now realize that I needed do an enema pre surgery. What did that look like? Wheeling AJ out of the bathroom asleep. Administering it laying down on the bathroom floor-both 'approved" positions were laying down-on towels of course. Using the bathroom. Showering. Wiping myself down with those nasty antibacterial wipes. Go to get dh to do my back and he is sound asleep. Because what else is there to do in a dark quiet hotel room with all the lights off at 10pm. Something about laying on that floor made me all too aware of how much I probably needed those nasty wipes, but I didn't like how dirty I felt having to use them. Dirty times 100 even post shower. The next hotel we had didn't give us a handicapped room so that was probably the worst sleep ever for me and kids (post surgery), but we all managed and there was plenty to laugh about. (I go to pick dh and kids up after pre op appts and receive this text-"C just pooped on the floor." Um, evidently potty trained for a year doesn't mean we don't regress at a totally foreign place (referred to repeatedly as the Cozy Cone by my Cars loving child, his only previous hotel/motel experience). Shockingly, the kids were not crabby at all despite the crazy schedule. Example-they woke an hour earlier (at 6am), never took a nap in the new hotel, and went to bed about 2 hrs later than normal. We really squeezed in the activities too (arrived Monday pm, Tues 9am-1pm zoo, Tues afternoon all my appts while they napped, Wed one of those bouncy inflatable places before my surgery which was scheduled for noon (yes, I starved. It didn't start until 1:45pm actually!), and we even hit the children's museum after my post op (there were lots of benches and I let dh do the running and lifting). We headed home after that since dh wasn't able to get Friday off (today. My mom came and stayed with me). They were clearly happy to be back in their own beds because C took a 3 hr nap, ate dinner, and went back to bed; AJ had to be woke at 8pm for dinner and was easily put back to bed. All in all, it was a pretty great trip, and like I said, plenty to laugh about when you throw the kids into the mix.
Back home and feeling alright...So that's it. It was plenty of news, as you can imagine, and I am ready for life to be dull again. I am fine with all the diagnoses. As usual, I feel better to know what I am dealing with and attack it head on. I wasn't expecting to get the green light to ttc again so soon, but here it is. Not this cycle (I am on CD 6) BUT NEXT. Again, I just feel like we are plugging our nose and jumping. If we stand around analyzing this too much, we may just stay on the ledge and what fun is that? So here we go again. Stay tuned...But first things first, does anyone know how soon I am allowed to be intimate? The pelvic rest box was checked but it said f/u with doc or X weeks and that number was blank. Obviously my f/u was the next day, I didn't think to ask Dr. H about it, figured it would be in my discharge instructions. Just curious.
Some bad news from friends...Completely changing topics, today has been a funk due to some really bad news I received from 2 dear friends. First of all, my friend Nan underwent her double masectomy last Wed. We are grateful that her scare with anesthesia turned out alright and was reversed quickly, but SCARY! But now, as of today, those lymph nodes they expected to be okay ARE NOT. It has spread. She will be doing radiation. Of which her mom died of (not from cancer, she was cancer free, but the radiation had done bad dammage to her lungs). We are devastated by this news. We were flying so high, the chemo had shrunk that tumor so that it wasn't even recognizable. Back to reality. Nan has cancer and she is still in the fight of her life. Prayers needed. And my dear friend Laura, who only has one brother in his thirties whom she is very close to, lives in town, has three YOUNG kids (oldest is eight)...has mesothelioma. They have no idea how he got this rare cancer from asbestos, which makes it all the more scary (who else was around it? Laura? the parents?). They gave him a month or two (actually his family-he and his wife didn't want to know). They flew him to Boston to the people who specialize in this. He was on the list for surgery. They just did some serious bloodwork and testing and determined he is no longer a candidate. That was the news this Wed, the day of my surgery. He is still in Boston, half the family there, half at home in my state. Then the email today came that he will be in heaven soon and his dad and three kids are desperately trying to make it to Boston to say goodbye. My.heart.is.breaking for this family and their very young children. Please take some time out of your day to pray for them and the soul of Sam.
Regarding the Cost...I was happy I was sent a run down of the charges from PPVI ahead of time with my appts and initial paperwork. I do not like surprises. We knew we were fortunate to have in network coverage, so we were going regardless of cost, but I didn't think it would be quite as much as it was and so learning this allowed me to break the news to Craig before the bills started rolling in. Our coverage isn't as good as the first time I went down (I used to have 90% coverage in network after a $500 deductible with a $1500 out of pocket max-last time I had no problem meeting this, but I had the ultrasound series and the hormone series done as well). This time we have 80% coverage and a $3k out of pocket maximum. We have $1700 left in our flex account (so we can use that medical expense money pre taxed) and I thought that would close to cover it. Haha. Not exactly. The bill from Hilgers that showed my 20% said $880 if they lasered endo. But the bill from Creighton (I had to call specifically to get these numbers) were astronomical. For example, one procedure, the hysteroscopy I think, was $11k. That may not have been my portion, but you do the math. That was one thing of several. So...we skipped the details and dear Lynn cut right to the chase. I had barely touched my deductible. The $3k is on top of that. I was definitely hitting the maximum. So my question to you all is...what else should I be seeking to get done this year?! Insert husband's small heart attack. Now, fyi, Creighton gives you 10% off of what you pay within 5 day, so there you go. Where else are you gonna make 10% these days? I know our bills are nothing compared to what you out of network and out of country folks are dealing with, so I won't dwell on this. I will say that out of country, I would do it again. I would. Hands down.
On being there in general...I must say, I wasn't worried about the surgery really. That may seem weird, but I will do my best to explain to you the range of emotions I was going through. I was back. in omaha. With my children. Rewind to 6 years ago, no idea if I would have children. And now I was back. I honestly know that if we can't have more children, we have already been blessed beyond words. So I guess that took some stress and anxiety away. I also just knew this was where I needed to be and I knew how blessed I was to get to be there. We drove just three hours to get there, so I am grateful to be so close. I desperately wanted to go to the celebration they had at PPVI but couldn't. This was my time. To say my thank you's. To introduce my babies. My "reunion" started a little earlier than expected, at my pre op appt for the hospital. Of all things, Nina remembered me, knew I had longer hair, a different last name, knew my story (I had shared it with her last time), remembered that she found my murmur (I have 3!). What a joy to share what has happened since I left Omaha. Her sister who lives 2 hrs away is also now a patient of Hilgers. I have a strong hunch she didn't know about Hilgers until I told her and that is why her sister saw him, but that is just part of my vague memory and I didn't realize it until after I left so that is unconfirmed. I left flying high and kept hearing my mother in the back of my mind telling me to come down off the ceiling. I was flying high and talking fast! I wanted to kiss everyone I encountered there and the tears flowed easily as I drove from Creighton to my pre op ultrasound at Pope Paul VI. I did call my mom and TRIED to pull myself together.
The ultrasound was supposed to be with Jeanine, but it was with the new girl. Young, cute, heart in the right place, knows she has the best job ever, I loved sharing our story with her. Then on to my appt. I wasn't sure who it was with there, and then I saw Dr. H. Yes, I was a little freaked out to be in the same room with him. Seriously. I wasn't sure if my appt was with him or Dr. Kargas (sp?) but it was both. Hilgers was first and he has a doctor from Mexico shadowing him. I told him my mind would be mush with him in the room, but I swear the Holy Spirit took over and I was brave and succinct and articulate like I haven't been in the last 20 months. Thank you, Jesus. It felt so good not to be tongue tied! I laughed at the thickness of my chart and was told it was 2 of 2, haha. I was able to recap my story for him, and even though he knew it in general, it was nice for him to have a succinct summary (yes, me succinct; now you know it was the Holy Spirit!) and you could tell he was thrilled to hear it and have the other doctor hear it as well. I really enjoyed my time in the room. Of course we bonded about how the pill is the cure all for everyone I know, how ob/gyns have defined life conveniently after implantation, frustration with the HHS mandate and how people think pill=healthcare, etc, and how evil and insidious infections are. He told me that 20% of his patients are positive for infections, but 60% respond positively to antibiotics. He thinks there are simply bugs out there we don't know about yet. I mentioned my desire to have the surgically trained Napro docs distinguished in some way on the website. He has felt that way too, and expressed that before, and is working on it (but seriously how long does it take-add a star or something, lol!). He is also working on the phone ap and confessed he received a package to start it recently but had been busy. He gets a pass. The man is crazy busy. I mentioned a little frustration about people not getting the full benefit of Napro when they don't take advantage of mailing in the blood work and he completely agreed that it was a major part of what they need to do their job. Its explained in his text book and he stresses it to everyone he trains-that was new to me. I know it is expensive folks, but it is so necessary to get the full benefit of what he does. He said nice things about how he is always impressed at what a smart group of clients he has so I wanted to pass that on to all of you. When he left, I felt set with the plan we had for the next day. I got to see Dr. Karges as well and tell her my story (Dr. H asked me to). She was wonderful. She relocated her family to Omaha and worked under him a year. When she goes back she is it for Texas and they are lucky to have her. Her time is almost up so Texas, here she comes you lucky dogs!
Surgery Day...What to say? This is the time I began to think about how my dear friend stopped breathing during the meds used to calm her prior to anesthesia-this happened just one week before my surgery. That was my only nervousness and I still knew it was rare and kept it pretty much in check. I took my time to stress with everyone that I get crazy nausea with anesthesia and CANNOT take narcotics. I have learned these things the hard way given I have had 5 eye surgeries, 2 D&Cs, 2 cysts removed, and this was my fourth laporoscopy. Yeah, I guess this is what I do in my spare time! They did all the things that worked well last time PLUS a motion sickness patch behind my ear. Which was great except it did totally dry me out and I could not swallow crackers without chugging a ton of water. They put these like, support hose things on to prevent blood clots, and they also had me wipe down again with those crazy wipes. But I knew I was in good hands and they put up with me desperately wanting my kids in the room even before the IV. I just didn't want the only hr they were there to be dh chasing them in the waiting room. So they came back and all was well. Charlie didn't even notice the IV (he was on the other side), but he has seen me get plenty of blood work. (We did prep him a lot and got pearls of wisdom from him such as "mom, if they give you a shot in your belly button, run!") The kids were actually really good in the room and entertaining and distracting for sure. Then back I went. They didn't tell me they were giving me something to relax until I asked because the room was moving as I switched beds. I am glad b/c if it was what Nan had it would not have relaxed me! Before I knew it, it was over. I had zero stomach pain that day (I guess they numb it up good), but that night the shoulder pain hit hard. First right, then left, then right again. I was told to sit up 45 degrees and use ice packs and that was the only thing that helped. I never did really get too nauseated. I remember women saying they couldn't leave the hospital until they went to the bathroom. I thought that meant a bowel movement, but am glad that was not the case. I have a tiny bladder and peed almost immediately out of recovery (all that IV fluid, I am sure). But a bm, well that finally came tonight-a full 72 hrs post pre surgery enema. And if that is TMI for you, well then you probably are not in the right place :)
Surgery Results...The next day I brough the whole family in for results. Dh knew to take the boys out if I couldn't hear, but again, they were super good which is crazy. They did have each other though, usually all the entertaining they need. And cheerios. Pretty sure we left a few of those crunched everywhere we went. Anyhow...there were some unexpected results. I wish I had details of my last surgery on my blog, but I don't. I knew this time they would likely find endo, but not a ton. The soreness I experienced hadn't been back very long. They found 3 spots and lasered them. They also found a micropolyp (associated with infection and/or inflammation) and a cyst in the cervical canal (which was inflammatory in nature). He found a mini/accessory fallopian tube-crazy right? He said it is common in women with endo. They also found, in general, a lot of inflammation on the wall (they can only treat with abx b/c surgically it would cause too much scar tissue)-do you see a theme here people?! Inflammation can be from endo or infection so not a lot of answers on that one but consistency is clearly my middle name. Hoping the results of the cultures will clarify the culprit. They saw spots from previous lasering, but not a lot of scar tissue, which was good news. Now for the 2 pieces of shocking news (to me at least). First of all, my tubes were blocked. What?! Yes. I got confused on the details because it sounded contradictory, but he couldn't get the dye through at all and they were blocked, but then he did eventually with a different technique. They are open now, yet he couldn't get the wire through? This sounds like Alive in Hope, so if T or anyone has clarification on this, I would appreciate it. But I am sure it is either infection or endo related because that is the theme in my life. And secondly, I have an abnormality that is assosciated with 2nd trimester miscarriages. Its a large septum. I suck at anatomy so he drew a triangle pointed down and then another triangle inside it attached at the top (flat edge). He said the space it is taking up can affect the baby as it tries to grow. It is associated with miscarriages around 16, 18, or 20 weeks. Ladies, can I just tell you how important it is to have a lap-I learned so much! They are not just for folks that suspect endo. I think they are a good idea for anyone with infertility, they are meant to be exploratory in nature and IF is as good a reason as any to have one done IMO. I know it is surgery, and no one wants unnecessary surgery, but exploring is necessary when questions are unanswered. He said that any ob/gyn that worked with me would need to do frequent ultrasounds and keep an eye on my cervix around that point. I think the treatment is a stitch (cerclage-anyone here need one of these?). I have comfort knowing that for whatever reason, it wasn't an issue with my 2 kiddos here (and the miscarriages I had were earlier, with TEBB cycles and good prog so we are still confident they were due to infection) and therefore there is less chance it will be in the future. I seriously can't imagine a 2nd trimester miscarriage. Someone would have to commit me.
On the logistics of being there with children...let's see, one room, 2 adults, 2 young children. Hmm. I don't know how you cosleepers do it, maybe it is because you start them out doing this early, but I don't know if even that would have helped. My kids have never really been a good match to sleep with us. Charlie will literally say, you can go back to your room now (we do some snuggling with him in his bed, but just for a minute). lol. And he is a talker. So anyway, we had Charlie in one bed, dh and I in another and AJ in the pack and play. Since the world series was going on there, and then after that the Olympic swim team trials, there was NO ROOM AT THE INN! Eventually we got a hotel (two, dh had the pleasure of changing hotels with both boys while I was in surgery b/c our hotel didn't have a 3rd night) but our hotel had none of the amenities that would have made it go smoother. Like location. Or a microwave. Or a fridge. Or a hot breakfast. Heck, continental would have been nice. Nada. So I packed. And packed. And packed. I organized. I printed off directions from every which way and researched kid friendly things to do. I packed swimsuits and bouncy balls and a entire thing of toys (heck, they play well with them on their own at home, why not at a hotel?) Let's just say if we could have kept the luggage rack wheely cart thing (why yes, that is the technical name for that), we would have. That was prime entertainment. And the telephone, unplugged. AJ enjoyed spilling powdered coffee creamer on the hotel carpet and then spent the next 24 hrs there sneaking licks of it. Ewwww! Rock star immune system-check. And flushing the toilet was big fun for him, as was unwinding toilet paper. He could open the doors there thanks to the long doorknobs. The schedule went out the window and the naps were all off. Charlie alternated between fake snoring and every possible attempt to engage us in conversation. AJ slept fabulously in pack in play in the pitch black bathroom (we had a handicapped room for the first hotel) when we finally got to town and to bed after a late dinner that next night (my appts ran long with all that talking), but that presented a bit of a problem. Let's just say I wet my pants one night and dh peed in a cup. No lie. Okay, now realize that I needed do an enema pre surgery. What did that look like? Wheeling AJ out of the bathroom asleep. Administering it laying down on the bathroom floor-both 'approved" positions were laying down-on towels of course. Using the bathroom. Showering. Wiping myself down with those nasty antibacterial wipes. Go to get dh to do my back and he is sound asleep. Because what else is there to do in a dark quiet hotel room with all the lights off at 10pm. Something about laying on that floor made me all too aware of how much I probably needed those nasty wipes, but I didn't like how dirty I felt having to use them. Dirty times 100 even post shower. The next hotel we had didn't give us a handicapped room so that was probably the worst sleep ever for me and kids (post surgery), but we all managed and there was plenty to laugh about. (I go to pick dh and kids up after pre op appts and receive this text-"C just pooped on the floor." Um, evidently potty trained for a year doesn't mean we don't regress at a totally foreign place (referred to repeatedly as the Cozy Cone by my Cars loving child, his only previous hotel/motel experience). Shockingly, the kids were not crabby at all despite the crazy schedule. Example-they woke an hour earlier (at 6am), never took a nap in the new hotel, and went to bed about 2 hrs later than normal. We really squeezed in the activities too (arrived Monday pm, Tues 9am-1pm zoo, Tues afternoon all my appts while they napped, Wed one of those bouncy inflatable places before my surgery which was scheduled for noon (yes, I starved. It didn't start until 1:45pm actually!), and we even hit the children's museum after my post op (there were lots of benches and I let dh do the running and lifting). We headed home after that since dh wasn't able to get Friday off (today. My mom came and stayed with me). They were clearly happy to be back in their own beds because C took a 3 hr nap, ate dinner, and went back to bed; AJ had to be woke at 8pm for dinner and was easily put back to bed. All in all, it was a pretty great trip, and like I said, plenty to laugh about when you throw the kids into the mix.
Back home and feeling alright...So that's it. It was plenty of news, as you can imagine, and I am ready for life to be dull again. I am fine with all the diagnoses. As usual, I feel better to know what I am dealing with and attack it head on. I wasn't expecting to get the green light to ttc again so soon, but here it is. Not this cycle (I am on CD 6) BUT NEXT. Again, I just feel like we are plugging our nose and jumping. If we stand around analyzing this too much, we may just stay on the ledge and what fun is that? So here we go again. Stay tuned...But first things first, does anyone know how soon I am allowed to be intimate? The pelvic rest box was checked but it said f/u with doc or X weeks and that number was blank. Obviously my f/u was the next day, I didn't think to ask Dr. H about it, figured it would be in my discharge instructions. Just curious.
Some bad news from friends...Completely changing topics, today has been a funk due to some really bad news I received from 2 dear friends. First of all, my friend Nan underwent her double masectomy last Wed. We are grateful that her scare with anesthesia turned out alright and was reversed quickly, but SCARY! But now, as of today, those lymph nodes they expected to be okay ARE NOT. It has spread. She will be doing radiation. Of which her mom died of (not from cancer, she was cancer free, but the radiation had done bad dammage to her lungs). We are devastated by this news. We were flying so high, the chemo had shrunk that tumor so that it wasn't even recognizable. Back to reality. Nan has cancer and she is still in the fight of her life. Prayers needed. And my dear friend Laura, who only has one brother in his thirties whom she is very close to, lives in town, has three YOUNG kids (oldest is eight)...has mesothelioma. They have no idea how he got this rare cancer from asbestos, which makes it all the more scary (who else was around it? Laura? the parents?). They gave him a month or two (actually his family-he and his wife didn't want to know). They flew him to Boston to the people who specialize in this. He was on the list for surgery. They just did some serious bloodwork and testing and determined he is no longer a candidate. That was the news this Wed, the day of my surgery. He is still in Boston, half the family there, half at home in my state. Then the email today came that he will be in heaven soon and his dad and three kids are desperately trying to make it to Boston to say goodbye. My.heart.is.breaking for this family and their very young children. Please take some time out of your day to pray for them and the soul of Sam.
2.07.2011
More Insurance Insanity
Because if we can't laugh about it we will cry, right? I feel like I am on another planet talking to insurance.
Mine currently is Ci.gna. Here is how a conversation over the weekend went. I get a call. Hi, this is Cigna and we are calling to let you know about a wellness benefit you qualify for. Great. What? Its for patients with chronic lower back pain. That's nice but, um, I don't have lower back pain. Oh. Did you recently receive physical therapy? Learily (because I don't know if this is some trap by the evil organization), I reluctantly reply that I did receive PT, while I was pregnant. There is no chronic issue. Okay, they accept this but then here is the kicker, please stay on hold while I transfer you to unenroll from our wellness program. Excuse me? The one I never enrolled in? And now I have to wait? Yes, evidently there is no way around it. Had I been any busier I would have hung up. I mean really, what are they gonna do? Keep me enrolled in a free benefit? Good grief! But I hold. Like a good girl. Until they come back and say due to high call volume they can't unenroll me at this time and can I call back? Are.you.serious? I was sure to point out the insanity in all of this and that the high call volume was due to others being mistakingly enrolled, lest it escaped her.
Fast forward to today. When I get a call from my delivering hospital to see if I am going to pay the bill for Anthony's delivery. I say, no, not yet because I was billed $1600 and it is clear that insurance hasn't processed it. She looks into it and tells me insurance denied it because I haven't called to notifiy them I don't have a second insurance. Seriously? I have to call to tell them I don't have a second insurance? There isn't a secondary on anyone else in the family. Can't we just take the giant leap and make an assumption on this one? Seriously. Then the gal proceeds to tell me they always do this or something else, like say they weren't added in time or anything they can as a stall tactic to pay. We have to pay immediately of course, but evidently those rules don't apply to them. Its like a separate reality when it comes to insurance.
Update-I just called Cign.a to let them know we don't have a secondary but...their systems are down and I was told I would need to call back another time.
Mine currently is Ci.gna. Here is how a conversation over the weekend went. I get a call. Hi, this is Cigna and we are calling to let you know about a wellness benefit you qualify for. Great. What? Its for patients with chronic lower back pain. That's nice but, um, I don't have lower back pain. Oh. Did you recently receive physical therapy? Learily (because I don't know if this is some trap by the evil organization), I reluctantly reply that I did receive PT, while I was pregnant. There is no chronic issue. Okay, they accept this but then here is the kicker, please stay on hold while I transfer you to unenroll from our wellness program. Excuse me? The one I never enrolled in? And now I have to wait? Yes, evidently there is no way around it. Had I been any busier I would have hung up. I mean really, what are they gonna do? Keep me enrolled in a free benefit? Good grief! But I hold. Like a good girl. Until they come back and say due to high call volume they can't unenroll me at this time and can I call back? Are.you.serious? I was sure to point out the insanity in all of this and that the high call volume was due to others being mistakingly enrolled, lest it escaped her.
Fast forward to today. When I get a call from my delivering hospital to see if I am going to pay the bill for Anthony's delivery. I say, no, not yet because I was billed $1600 and it is clear that insurance hasn't processed it. She looks into it and tells me insurance denied it because I haven't called to notifiy them I don't have a second insurance. Seriously? I have to call to tell them I don't have a second insurance? There isn't a secondary on anyone else in the family. Can't we just take the giant leap and make an assumption on this one? Seriously. Then the gal proceeds to tell me they always do this or something else, like say they weren't added in time or anything they can as a stall tactic to pay. We have to pay immediately of course, but evidently those rules don't apply to them. Its like a separate reality when it comes to insurance.
Update-I just called Cign.a to let them know we don't have a secondary but...their systems are down and I was told I would need to call back another time.
5.26.2010
Blog giveaway, Vegas, Charlie, yeast and more drama at Cig.na
First of all, let me say that Sew was the only entry in my blog giveaway, so progesterone in oil to you asap my friend!
I called Ci.gna again yesterday because they can’t seem to repeat the correct things about my order two times in a row resulting in a different error every time they mail me meds or needles. That is five times now. Geez. One of these days maybe…one can hope. Weight gain and eating has slowed down to half of what it was before or more, probably because I am on half the progesterone and out of the first trimester. I got a progesterone draw today so hoping I can remain on this dose, but armed with my super strength progesterone in case I go back up to four shots a week (then it will only be two like now-yeah!) Also, dh and I just finished our ten days of orals that we go on every 8 weeks of the pregnancy per Dr. Toth. I am amazed at how well the Syn.tol is working at keeping any yeast at bay-for the “small” price of $70 for 180 pills-yikes!
On to fun topics, Dh and I had a little getaway last week to Vegas. It is funny, I would NEVER choose Vegas given the option, but I always have a good time. Dh had to go there for work and so I tagged along. We had an amazing hotel, oh my gosh (Ar.ia in the new City Cen.ter-paid for by his work)! A remote control worked the tv, lighting, do not disturb sign, curtains…it was crazy. I enjoyed days by the pool while dh was at his conference during the day for two days plus we had the whole day the day we got in to bum around. Dh did want to play some blackjack, and so we were able to find a few good alternatives to dark and smoky casinos. We especially enjoyed Harrah’s outside where the dj was good and we could sing along and enjoy the 75 degree weather (at night). Perfect. And we saw “O” which is absolutely incredible. It is the Cirque d’ Solei water show and it featured 9 former Olympians (divers, synchronized swimmers, and gymnasts). It was right up my alley (I don’t get into the other shows as much) and dh enjoyed it as well. And there was plenty of good food to be had the whole trip-I have a weak spot for Smit.h and Wolens.ky’s and envy those of you that live in Chicago. We don’t have one here, not that I could afford it more often! I wish I had pictures other than the hotel (the remote control is on the left side table), lol, but I didn’t take my camera around much and I have none of dh and I :(
It was also nice that Charlie did so well with my in laws, that went a long way toward us relaxing; they kept him on schedule and he slept great, which is probably why they were amazed at such a good boy he was. Sleep is imperative for that! They live 3 hrs away and I could tell they had a whole new bond when we got back so that was great too. Dh and I needed some time for just us. It was only the 2nd time we have ever left him for more than a date night. The first was only about 30 hrs (a quick getaway to a nearby bed and breakfast).
Speaking of Charlie, I know I rarely talk about him here, but that guys just melts my heart daily. He language is growing, but it is still the things he says wrong that I love so much, like “wiwi” for kiwi now and “wawa” for water. He gives tight hugs and pats our backs and comes up for random leg hugs or arm pats before running off to play with his trucks. His summer sitter is a friend of mine (speech path with the summer off-I have the best sitters!) and she has a 2 ½ year old daughter. She led him all over the house yesterday by the hand and it was cracking me up seeing him be her willing follower. I need to post a video or two of that man in action. He does keep me humble though! The other day we hit the library for the first time by our house and he saw a huge stuffed dog. He ran over, mounted it, and started “vigorously” riding it screaming “go horsie go” and other things I couldn’t make out. Let’s just say we had all eyes on us! He is definitely full of personality.:) Here is a pic of another friends' daughter and him cheesing it up!
Oh yes, and dh left town for a day so I got my shot at the doctor's office yesterday. They just pinch the fat and shove it in. And all along, dh has been spreading the skin taught. It went in really smooth today and that may be why. Also, dh is so good about giving it slow and I can't believe how fast she gave it. But I am definitely feeling that today-thanks a lot! :( Curious as to your thoughts about skin pinching versus holding taught.
On to fun topics, Dh and I had a little getaway last week to Vegas. It is funny, I would NEVER choose Vegas given the option, but I always have a good time. Dh had to go there for work and so I tagged along. We had an amazing hotel, oh my gosh (Ar.ia in the new City Cen.ter-paid for by his work)! A remote control worked the tv, lighting, do not disturb sign, curtains…it was crazy. I enjoyed days by the pool while dh was at his conference during the day for two days plus we had the whole day the day we got in to bum around. Dh did want to play some blackjack, and so we were able to find a few good alternatives to dark and smoky casinos. We especially enjoyed Harrah’s outside where the dj was good and we could sing along and enjoy the 75 degree weather (at night). Perfect. And we saw “O” which is absolutely incredible. It is the Cirque d’ Solei water show and it featured 9 former Olympians (divers, synchronized swimmers, and gymnasts). It was right up my alley (I don’t get into the other shows as much) and dh enjoyed it as well. And there was plenty of good food to be had the whole trip-I have a weak spot for Smit.h and Wolens.ky’s and envy those of you that live in Chicago. We don’t have one here, not that I could afford it more often! I wish I had pictures other than the hotel (the remote control is on the left side table), lol, but I didn’t take my camera around much and I have none of dh and I :(
It was also nice that Charlie did so well with my in laws, that went a long way toward us relaxing; they kept him on schedule and he slept great, which is probably why they were amazed at such a good boy he was. Sleep is imperative for that! They live 3 hrs away and I could tell they had a whole new bond when we got back so that was great too. Dh and I needed some time for just us. It was only the 2nd time we have ever left him for more than a date night. The first was only about 30 hrs (a quick getaway to a nearby bed and breakfast).
Speaking of Charlie, I know I rarely talk about him here, but that guys just melts my heart daily. He language is growing, but it is still the things he says wrong that I love so much, like “wiwi” for kiwi now and “wawa” for water. He gives tight hugs and pats our backs and comes up for random leg hugs or arm pats before running off to play with his trucks. His summer sitter is a friend of mine (speech path with the summer off-I have the best sitters!) and she has a 2 ½ year old daughter. She led him all over the house yesterday by the hand and it was cracking me up seeing him be her willing follower. I need to post a video or two of that man in action. He does keep me humble though! The other day we hit the library for the first time by our house and he saw a huge stuffed dog. He ran over, mounted it, and started “vigorously” riding it screaming “go horsie go” and other things I couldn’t make out. Let’s just say we had all eyes on us! He is definitely full of personality.:) Here is a pic of another friends' daughter and him cheesing it up!
3.09.2010
Today I Hit the Motherload
It started with a phone call I received Friday night, about 7pm. It was the pharmacist from Ci.gna Teld.rug (their mail order pharmacy, which I basically have to go through to get my injectables covered-since they are covered through medical and not pharmacy benefits). The pharmacist on the phone was calling because my order from PPVI didn't make sense to him. He said they ordered needles and not syringes. He wanted to know if I needed syringes. I said yes, thanks for asking. Then I thought to mention how last time the needles were on the syringes, but they were the needles to inject. So I had to remove the needle and put a bigger one on to draw up the meds and then change it back to the smaller one to inject. He said he had thought of that and it was corrected. Then he asked about my dose and the concentration. (It would be nice to have my meds concentrated at 100mg/mL so I could take half the dose, but compounded meds aren't covered on my plan so I just stick with the 50mg/mL to save money). He said that it was ordered with refills available, but the way it was written up I was only get a one week dose (sidenote-I blame PPVI for none of this; they have always been fantastic and even have a nurse that deals only with insurance!). He said they shoot for a 90 day supply! I explained that the dose was based on a blood draw done every two weeks, but if my last pregnancy was any indication, I was on it for 36 weeks at mostly the same dose. He said given that information, that he felt it would be fine to send me out more meds. He also asked when I needed it by. He said it wasn't included and he would have to talk to the doctor to confirm what I told him, and he couldn't until Monday, and he wanted to make sure he wasn't leaving my high and dry. All I could say is "is this the same Cig.na that gave me such a hard time about the novarel?!" (seriously, they are still trying to get me to pay for the first months' supply which was filed wrong by their employees under the wrong diagnosis code; when I refilled it, they had the right code and it was covered completely!) The nice man said, "ma'am, sustaining a pregnancy is a whole different ball of wax than getting pregnant in terms of coverage." I thought "you aren't kidding!" So today, Tuesday, I receive a box with 10, yes 10, vials of progesterone and needles and alcohol pads (I love the those!) and a sharps box. Now that is service! I only wish this was the service we get prior to getting pregnant-wouldn't that make (IF) life just a little bit easier!
2.15.2010
Rough Day
Insurance companies are just evil. I got a bill for my novarel. $96. I was hot! And despite my blog venting, I really don't get hot that often. It takes a lot, but once the train gets started, it takes awhile to put on the brakes. (At least that was the analogy I used with dh this weekend. Let's say Valentine's day was NOT like in the movies at our household). I called the insurance agency and they had the gall to tell me that Dr. H submitted the dx code that was IF. I actually said BS to the lady. I am not one to get mad at messengers, but she was starting to become part of the problem. I was nice, but firm, after that and said the problem was on their end, NOT my the doctor's. After looking into again she said the 2nd refill was under a different diagnosis code and was covered. I told her it was merely a refill, nothing was actually resubmitted by the office, and she admitted it was a coding error then on their part. I wonder if they get paid to make dx code errors. Maybe that is too extreme, but I am really starting to wonder!
There is so much going on right now. I am exhausted. Charlie got the stomach bug right a few days before surgery to put in tubes. He vomited for 4 hours, every 15 minutes, and not surprisingly he is being very difficult at meals-he has been traumatized! The surgery was very minimal and he did great. But there is still night waking (we were up 3 hrs last night!) and I am confused. Has it turned behavioral? Is he reflux not controlled by medication anymore? The teeth are seeming to do a number on him too. I wish it was just one thing at a time, but no, much more complicated than that.
Dh got stomach bug next and we had to cancel our Valentine's plans (we were celebrating early-Fri). We had a nice day Saturday and took Charlie to his first basketball game at dh's alma mater. It was a good time, but Charlie was exhausted the whole time and I felt bad for him, all that stimulation and all he wanted to do was sleep. We planned it around his typical nap schedule, but he wasn't typical that day because of recouperating from the bug and surgery. (by the way, ped ENT told us it was fine to go and we used plugs to protect his hearing).
I dropped Charlie off at daycare today to work from home, only to have to pick him up a few hours later. The sitter's daughter starting throwing up. That is where we got the stomach bug in the first place, but I don't want to pass it back and forth. He spent the day crying at my feet, and just having an overall rough day. He is, at a minimum, exhausted like I am. But kids have this crazy way of not wanting to sleep when they are over tired, so he wouldn't nap until later and napped shorter. He pops up and shouts "all done" and you can't help but smile through the frustration.
Also I have MAJOR MAJOR family stuff going on right now with my sister and her kids and my parents and it is just ugly and sad. I don't have the energy to go into detail now, but it has so many twists and turns it resembles a soap opera. But it is my sister's life and even though she's nuts, it makes me sad. And especially for her children. It has also been a source of stress for dh and I lately, which just makes it worse. He sees things black and white and forgets that it is my sister and his words are hurtful, even when I agree sometimes.
On a positive note, he did say I could hire someone to clean the house once to get the germs out and get us back on track. And I got a call from my ob/gyn's office saying that my urine came back fine. So strange. They initially thought there was a UTI, but I guess when they cultured it out longer? it wasn't anything. I don't know what the deal was, but I will take it. The thought of something surviving those antibiotics...I shudder at the thought!
I hope everyone is having a better day than I am. I need my child to eat and sleep so I can too and we can return to normal!
There is so much going on right now. I am exhausted. Charlie got the stomach bug right a few days before surgery to put in tubes. He vomited for 4 hours, every 15 minutes, and not surprisingly he is being very difficult at meals-he has been traumatized! The surgery was very minimal and he did great. But there is still night waking (we were up 3 hrs last night!) and I am confused. Has it turned behavioral? Is he reflux not controlled by medication anymore? The teeth are seeming to do a number on him too. I wish it was just one thing at a time, but no, much more complicated than that.
Dh got stomach bug next and we had to cancel our Valentine's plans (we were celebrating early-Fri). We had a nice day Saturday and took Charlie to his first basketball game at dh's alma mater. It was a good time, but Charlie was exhausted the whole time and I felt bad for him, all that stimulation and all he wanted to do was sleep. We planned it around his typical nap schedule, but he wasn't typical that day because of recouperating from the bug and surgery. (by the way, ped ENT told us it was fine to go and we used plugs to protect his hearing).
I dropped Charlie off at daycare today to work from home, only to have to pick him up a few hours later. The sitter's daughter starting throwing up. That is where we got the stomach bug in the first place, but I don't want to pass it back and forth. He spent the day crying at my feet, and just having an overall rough day. He is, at a minimum, exhausted like I am. But kids have this crazy way of not wanting to sleep when they are over tired, so he wouldn't nap until later and napped shorter. He pops up and shouts "all done" and you can't help but smile through the frustration.
Also I have MAJOR MAJOR family stuff going on right now with my sister and her kids and my parents and it is just ugly and sad. I don't have the energy to go into detail now, but it has so many twists and turns it resembles a soap opera. But it is my sister's life and even though she's nuts, it makes me sad. And especially for her children. It has also been a source of stress for dh and I lately, which just makes it worse. He sees things black and white and forgets that it is my sister and his words are hurtful, even when I agree sometimes.
On a positive note, he did say I could hire someone to clean the house once to get the germs out and get us back on track. And I got a call from my ob/gyn's office saying that my urine came back fine. So strange. They initially thought there was a UTI, but I guess when they cultured it out longer? it wasn't anything. I don't know what the deal was, but I will take it. The thought of something surviving those antibiotics...I shudder at the thought!
I hope everyone is having a better day than I am. I need my child to eat and sleep so I can too and we can return to normal!
1.07.2010
Seriously? Seriously?!
I called today to make sure that Cigna TelDr.ug had received the script. They had, but said it would be awhile. Since I am showing peak type today, I don't necessarily have "awhile" so they were kind enough to put it on priority so it would go out today. Then I get a call back, usually it is to set up delivery. But this was to say that, fyi this isn't covered under your insurance. I told them it was covered under medical if the dx isn't infertility and it is not. It has to do with my cycle and hormones I am low on, PMS, etc. She said the dx they were given was infertility. That is absolutely BS b/c Dr. Hilgers never uses that term b/c he is smart enough to know that IF is a result (or symptom of the problem is maybe better way to describe), and not the cause. He calls everything what it is. So I just left a message for the insurance nurse again, who is fabulous. I am grateful for her to argue this on my behalf. Grrr.
1.05.2010
How Much is My Time Worth?
I think insurance companies are put here to drive us all mad. Seriously! With their double speak and other confusing language it is no wonder that we all spend hours and days of our precious time WASTED! Today I had to ask myself, how much is my time worth? I spent a good 2 hrs on the phone just today with the insurance company and mail order pharmacy (which, I realize, is really nothing as these things CAN go) and much more when you consider how long I have dealt with this particular issue.
I mentioned before that I was told hcg wasn't covered 2 year ago or so. Somehow I got the impression it was just b/c of IF, can't recall why, and so a letter was sent by Dr. Hilgers that it wasn't IF. I was told, it wasn't about it being IF, it just wasn't covered. Thankfully I had some leftover from when it was covered so I used that.
Then when I called again, last week or so, they said it wasn't covered under pharmacy, but maybe medical if it wasn't for fertility. I said it was not for fertility and so she said my doctor would have to fill out medical necessity paperwork and it would probably be covered. That would have been helpful a year ago. I guess what the women should have told me back then was that the letter merely was processed by pharmacy and should have been processed by medical.
So today I call to check on it since Dr. Hilger's office had sent in the paperwork and I need to take it in about a week. The first person I talked to said, yes it was approved and she sent me to Tel Dr.ug (their mail order pharmacy) because to get it anywhere else would be costly. Here is why. Now that it is covered under medical, Target etc are only contracted through Ci.gna pharmacy, not medical, so they would be considered out of network. It is hard to find a medical provider that will give this kind of medication as if they were a pharmacy. She suggested another option may be something like Apr.ia. (I asked for this 2nd option because sometimes Tel Dr.ug is not the cheapest option). Then they connect me with Tel Dr.ug who proceeds to tell me this medication is not covered-under pharmacy or medical. This time, armed with the right information, I tell them it has been proven medically necessary and is covered by medical since it is not related to fertility. Okay, she says, since it isn't fertility it can be covered. (Man they train them well to be so anti IF!) What if I didn't know and just said okay?! Like I basically did last time!!!! I ask how much it will be next. Full price for this Novarel (hcg) is $102.38 per vial without insurance. Of course, she had to transfer me back to Cig.na Medical to determine the coverage. I want to know because now I have been informed that Fertility Friend is $59. And I also learned that Kubats, who compounds it themselves, (mail order that Dr. Hilgers uses in Omaha) is $51! So I wanted to make sure it wasn't higher than that with insurance. At first I am told it is covered 90% and subject to my copay. But then I push more-why then was my progesterone (similar situation) while I was pregnant covered 100% with no copay or deductible? He puts me on hold again and low and behold-it will be covered 100% Yippee!
Today I asked the question, how much is my time worth? And now I know, it is worth free hcg while ttc. That's actually pretty good for once!
I hope this post will help you know the right questions to ask to get something covered that perhaps wouldn't have been covered had you not had the exact same words. Ridiculous! Please share this post with everyone you know on hcg!
P.S.This was the simplified version-there was even more confusion and transfers and I had to talk to Dr. Hilgers office twice (not their fault) and I am waiting for a 3rd call back.
I mentioned before that I was told hcg wasn't covered 2 year ago or so. Somehow I got the impression it was just b/c of IF, can't recall why, and so a letter was sent by Dr. Hilgers that it wasn't IF. I was told, it wasn't about it being IF, it just wasn't covered. Thankfully I had some leftover from when it was covered so I used that.
Then when I called again, last week or so, they said it wasn't covered under pharmacy, but maybe medical if it wasn't for fertility. I said it was not for fertility and so she said my doctor would have to fill out medical necessity paperwork and it would probably be covered. That would have been helpful a year ago. I guess what the women should have told me back then was that the letter merely was processed by pharmacy and should have been processed by medical.
So today I call to check on it since Dr. Hilger's office had sent in the paperwork and I need to take it in about a week. The first person I talked to said, yes it was approved and she sent me to Tel Dr.ug (their mail order pharmacy) because to get it anywhere else would be costly. Here is why. Now that it is covered under medical, Target etc are only contracted through Ci.gna pharmacy, not medical, so they would be considered out of network. It is hard to find a medical provider that will give this kind of medication as if they were a pharmacy. She suggested another option may be something like Apr.ia. (I asked for this 2nd option because sometimes Tel Dr.ug is not the cheapest option). Then they connect me with Tel Dr.ug who proceeds to tell me this medication is not covered-under pharmacy or medical. This time, armed with the right information, I tell them it has been proven medically necessary and is covered by medical since it is not related to fertility. Okay, she says, since it isn't fertility it can be covered. (Man they train them well to be so anti IF!) What if I didn't know and just said okay?! Like I basically did last time!!!! I ask how much it will be next. Full price for this Novarel (hcg) is $102.38 per vial without insurance. Of course, she had to transfer me back to Cig.na Medical to determine the coverage. I want to know because now I have been informed that Fertility Friend is $59. And I also learned that Kubats, who compounds it themselves, (mail order that Dr. Hilgers uses in Omaha) is $51! So I wanted to make sure it wasn't higher than that with insurance. At first I am told it is covered 90% and subject to my copay. But then I push more-why then was my progesterone (similar situation) while I was pregnant covered 100% with no copay or deductible? He puts me on hold again and low and behold-it will be covered 100% Yippee!
Today I asked the question, how much is my time worth? And now I know, it is worth free hcg while ttc. That's actually pretty good for once!
I hope this post will help you know the right questions to ask to get something covered that perhaps wouldn't have been covered had you not had the exact same words. Ridiculous! Please share this post with everyone you know on hcg!
P.S.This was the simplified version-there was even more confusion and transfers and I had to talk to Dr. Hilgers office twice (not their fault) and I am waiting for a 3rd call back.
Subscribe to:
Posts (Atom)