Wednesday, May 20, 2009

Okay insurance company, I'll play your twisted game...

Thanks for all the suggestions and sympathy following my previous post about insurance woes. Here's the deal. Yes, we did have to change insurance companies when we moved. Health insurance is regulated by each state and many insurance companies are regional (even the "big names" -- they have local subcontractors). So by necessity DH's employer offers different insurance providers based on your location. Thus the plan we have now is very similar, but not identical, to our old one. Coincidentally, this weekend is DH's annual benefits enrollment, so we'll be renewing our plan (or picking a new one). I am almost positive that there is nothing offered with better IF coverage than we have now, but obviously we'll look into it. And I'll be doing happy dances all over this blog if the news is good. But don't count on it.

What really steams my vegetables is that the insurance company will pay for medication and lab work if you then go home and make a baby in your own bedroom. (Or wherever you choose to do the deed, I don't judge. Good for you for keeping it exciting.) But if instead I want to PAY FOR MY OWN IUI, they snap their wallet closed and shake their fat finger at me scoldingly. I mean, it's absolutely none of their business how I get myself knocked up after they give me the drugs. Next they'll be saying they want to watch, just to make sure there are no basters involved. Sickos.

I was feeling resigned to continue waiting... waiting... waiting... until something hit me while I was supervising Bean in the bathtub tonight. It was his plastic fishy ball, he loves to throw that darn thing. Then I had a thought. Would it be that bad to try Clomid again? I swore up and down I would not get near the stuff this time around. Two main reasons.

1. It didn't work for me. Eight times.

2. It turns me into a raving lunatic Queen Bitch.

But if what I really want/need isn't covered, and my ovulation is a mess these days, is there a reason NOT to try it again? Okay, sure, there is #2 above. During those five days of pills, I morphed into the meanest person I have ever met in my entire life. But to be fair, I haven't met all that many mean people. Seen them in television interviews from prison perhaps, but not actually met them.

The other good thing about Clomid is that I can (probably) get a prescription from my OB/GYN, so I don't have to go through an inconvenient and possibly expensive consultation with the new RE's office. I am due for my annual exam anyway.... (hmmmm....)

Now if I do decide to gulp down the evil drug, which I'm guessing would be more of an emotional boost than any real physical help at this point, there is still the issue of BFing to contend with. The only side effect that some women report is a reduced milk supply, which on the other hand many also report not experiencing. Although there isn't a definitive answer, most sources say that there is no reason to believe Clomid would harm the baby, but (of course) talk to your doctor first. Because hopefully your doc has more scientific and proven knowledge on the subject than you do, just reading random articles you find online. But probably not.

In a Hail Mary, I am also going to call the insurance company again tomorrow (when they are open... how DARE they go home to their families when I need ANSWERS NOW!) and see if they will cover Follistim without IUI. I would be surprised, because in three years of hanging around the IF crowd I have never heard of anyone using Follistim and NOT doing an IUI or IVF. But the insurance company is clearly illogical anyway, so who knows. "Gather your own information," my Dad likes to say. Right on, Dad.

So what do you think? Is taking Clomid now worth the risk of 1) my husband divorcing me, 2) my son growing girlie parts from the drug getting into my breastmilk, and 3) suffering more emotional pain from the rollercoaster of IF treatment that likely won't even work?

Or should I *gasp* be patient a while longer, save some dough in order to do the treatment that worked the first time, and allow the kiddo to wean first? (I'm almost pissed that you even suggested it.)


  1. Don't do letrozole. Way fewer side effects. My friend (who may have the same OB/GYN as you since that is where I got the recommendation from) is currently on letrozole prescribed by that doc.

    That aside, patience is a virtue indeed.

  2. Oh and if one of your alternatives health plan wise is Group Health...don't do it! I can guarantee their IF coverage is zero.

  3. Gah! Insurance games just really annoy me. My insurance used to be similar, except that they covered IUIs, but buy the same drugs for IVF and nope, not covered. Like you, I don't understand the reasoning. Good luck with figuring everything out. It may even be worth doing that appointment with an RE, since I imagine they're used to working with all the different crazy insurance set ups and they may have good advice on how to go forward.

  4. Um, maybe I'm missing something, but have you talked to your RE's office about just not filing a claim for the IUI? Have insurance cover all the drugs and labwork, then don't file anything after that. From the insurance perspective, you MUST have gone home and done things au naturel, because they never see another claim. Then you pay for the IUI out of pocket. Surely the RE's office has dealt with screwy insurance before. Heck, the way IF treatment works, they don't necessarily know what they want to do next until they see how you respond anyway! When they're prescribing the drugs, they don't know for sure that you'll ultimately have an IUI.

    Good luck!

  5. Nicky - That does make perfect sense. However, my insurance company is on to the game... and they require the NOTES from every visit in order to reimburse. So in that consultation when we make the plan, if the insurance company sees the plan is for IUI, they will NOT cover ANYTHING from that point forward. So the RE's office would have to submit only partial notes or something else sneaky to get around that... and I would be very surprised if they would commit blantant insurance fraud for us. :/ Curses on the insurance company for being so smart!

  6. Gack! I don't know. Good questions and I have no good answers to them.

  7. Hmm could you maybe do what I may do and try one time on your own with the insurance covering and then have your dr order double. The insurance doesn't know how much you need to make a baby.

    Also you never know it won't hurt to try clomid. I hope you find better insurance.

  8. Your questions are too difficult to give a difinitive answer to, so perhaps an action plan would be of use. I would say, don't make any decisions yet. First, go to your annual appointment and discuss your options with your new doctors. Perhaps they will have new drugs, methods or suggestions that will be suitable for you. Then, definitely go to the open season insurance fair this week to discuss other programs, but be careful not to focus too much on infertility issues. You don't want to give them any excuse not to put you on their plan (I saw this suggestion online). I wouldn't go on Clomid right away due to your previous experience. You don't want to challenge your marriage and tolerance of your toddler too soon! Clear your head, design a plan of attack, enjoy Bean and breastfeeding, and use the basic LH Strips by Clear Blue Easy in the meantime. Three things to always remember: 1) You can carry a baby to full term, 2) You are able to get pregnant on your own - even if a chemical pregnancy, you did conceive (and that is telling!), 3) You are young and fit! Your body has to recover from breastfeeding a lot as well. Sometimes your body just isn't ready for another pregnancy due to breastfeeding, but often when you stop, you are extra fertile. You may not see it right now, but God does have a plan for you in all this!!! Have HOPE an answer will come to you!!!

  9. I have no particular thoughts or advice - just thought I'd say "Go you for coming up with some proactive alternatives/steps!"

  10. Aw, what's a little insurance fraud among friends?

  11. This just stinks!!!! I was thinking along the same sides as Nicky. I suppose you could have a 'front' RE office doing a timed BD cycle and a 'covert' RE office as doing the IUI? BTW...that is the stupidest thing I have ever heard.

    I'll give you my advice for trying to go the 'cheap route' after primary IF with my son...I feel like I wasted 6 months doing Femara/Metformin/trigger with my reg OBgyn. I would resist the urge to jump right to clomid...enjoy that nursing time while you can and start saving for the real deal.

    That's just my .02 cents worth. Though in this economy, I could maybe call it a dollar.

  12. I am a RN who works with insurance companies and this is such baloney for you to go through all these hoops!
    Thanks for stopping by my blog and your comment, I appreciate it.
    Great picture in your header, such a cutie pie!!

  13. Arggh! I hear you on all this insurance crap. Ours isn't supposed to pay for any treatments, but since I go to a nurse who doesn't work for an RE, she somehow codes it so we pay less than we should. I've been terrified to talk to the insurance company at all, lest they get their antennae up on what we're doing.


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