Thursday, February 7, 2008

You don't really mean last, do you?

I have to preface this entry by saying that I know I am lucky to even have insurance that covers IVF.  However, I also have to say that I'm no luckier than most Massachusetts residents.  That being said, I hate my new insurance company.  I had to switch in January because the town for which I worked decided to go to a single carrier and it wasn't mine.  My previous insurer had easily authorized 3 IVF cycles.  They have rules, but they bend them to individual circumstances.  They are a nonprofit and are very humane in their treatment of members.

My new insurer sent me a letter yesterday that they will cover IVF#4 for me, but they made it clear that they are making a one-time exemption because I'm a new member.  I don't meet their criteria at all because I've had two canceled IVF cycles due to poor response.  They're basically giving me a pity cycle.  If I get canceled again, they will cut me off.   There will be no more IVFs paid for by them.   Which means there will be no more IVFs because DH and I have decided that we will spend the money on adoption rather than IVF.  

I was due to start lupron on Monday, but after getting the letter from my insurer last night I had a major meltdown.  I had talked about this being my last cycle before moving to adoption, but I had always had in the back of my mind that I could always do a fifth IVF cycle if I wanted to.  I even knew the RE with whom I would work. Why didn't I just plan to do #4 with her? Because she's in major teaching hospital with a kind of rude and disorganized support staff that's really inconvenient for me to get to.  I figured I could deal with all of that if it's my last shot at IVF.  Well now it looks like it's my last shot at IVF. 

So no big deal go ahead and do IVF#4 with your last shot RE, you say.  I thought that too and put my current cycle on hold until I can figure this out.  It turns out that just because I was approved to do a cycle with one clinic, that authorization doesn't carry over to a new clinic.  The new clinic has to start the process over AND (this is why I hate my insurer) there is no guarantee that they will authorize me to cycle with the new clinic.  Same medical review board, same patient, different decision.  Apparently their decision is dependent on what information they received from the clinic and the medical review board will not even take into account that they themselves just authorized me to cycle.  The prior authorization will just be wiped out.  Gone.  So if I go with my last shot RE, I may not even get to do IVF#4 at all.

I asked if I could find out what information my current RE sent in and was told that only the review board has that information.  I asked if I could contact the review board and was told they don't deal with members.  I asked if the member service rep. with whom I was speaking could get that information for me.  She said no.  

So now I need to decide if I'm going to take a chance with the last shot RE or if my current RE is going to need to be my last shot RE.  Either way I'm not taking lupron on Monday because I need time.  I felt hugely relieved when I made the decision to push my cycle back.  Which leads me to whole new set of questions.  Does this relief mean that I don't really want to do the cycle at all and am ready to move on to adoption?

2 comments:

Barb said...

The usual questions and tribulations. I'm sorry. :(

Freyja said...

Wow now THAT is a loaded question. I sure don't know but I hope you figure it out! (((HUGS)))