Monday, March 23, 2009

The Insurance Company Giveth, the Insurance Company Taketh Away

As you know, being in ART-limbo has been driving me steadily insane. Last week, J and I decided to buy a little piece of sanity—we are going start paying out-of-pocket for at least some of the drugs that might (emphasis *might*) kick-start J’s sperm production. We figure that even if insurance eventually denies us coverage, we would probably pay for a couple of months of treatment, just to see if it was going to do any good. So we decided to pay for a few weeks while we waited to hear back on our most recent appeal.

Last Wednesday I faxed in J’s prescriptions to Schraft’s (the cheapest specialty pharmacy out there), along with a note saying that he would call to work out ordering and delivery. The next morning, I got a call from Schraft’s with a question for the doctor (they assumed that I was the nurse). Once I gave them the doctor information, I also gave them J’s information—phone numbers, e-mail, date of birth, etc. When she asked about insurance I told her not to worry about it. “We’re in a protracted battle with the insurance company right now, so we don’t have any coverage,” I explained. She suggested that I give her the information anyway, just so his files would be complete.

That night, J picked me up at the train station with “good news.” His prescriptions were covered! “Not possible,” I said. Our most recent appeal—the previous one having been rejected by the asshole HMO because we had the wrong pre-auth number on it—was only a day old.

“That’s what I told them,” he said, “but they told me it had gone through and I owed a $50 copay.”

“So you filled the whole thing? All three months?” I asked, incredulous.

“Yup.” He grinned. “They actually called back to tell me it was going to be a $50 copay per month. I was like, ‘okay!’”

“I don’t believe it,” I said, “They’re gonna call back and say it was a mistake. Tonight.”

“Probably,” he agreed.

We went into the house and I went back into the bedroom to change my clothes. The phone rang. Our caller ID—which we’ve never been able to take off of “audio”—announced “Call from . . . Schrafts.” We looked at each other. “Well, it was a nice 15 minutes,” I offered.

From what J was saying on the phone, it was obvious what was happening. “Not covered? . . . We’ve reached our ‘cap’? . . . What exactly does that mean?” After a minute, he pulled out his credit card and ordered a three-week supply. We both knew that there was no “cap” to our coverage; we just weren’t covered. But whatever.

And in a normal world, that would be that. But this was no normal world. Because 15 minutes later the phone rang again. “Call from . . . Schrafts,” announced our caller ID in its creepy computer monotone.

“What the fuck?” I muttered, handing the phone off to him.

A minute later, he was off the phone again, total confusion on his face. “That was the pharmacist. She was calling to tell me that the person who called earlier was wrong and we haven’t exceeded our cap.”

“So we’re covered?”

“That’s what they say.”

“And you filled the entire thing?”


We waited all evening for the call that never came. The next day the drugs were delivered to our RE. Today J picked them up.

I don’t think Schraft’s come after us for this when our HMO realizes its mistake, can they? We were totally up front with them about this.

Score one for the little guy. (Not that J’s little, or anything.)

Thursday, March 19, 2009

The Deer Ate My Crocus!

Not a metaphor. Last night, as I pulled into my driveway, I was struck by my favorite sight of the spring: the berm in front of my house covered with giant crocus (crocuses? croci?). Mostly purple and white, with a smattering of yellow, the bold colors—surrounded by the brilliant green of new growth on top of the dark mulch I laid last fall—seemed to glow in the gold, early-evening sunlight (god, I love daylight savings time).

This morning, the purple and white and yellow were gone, vanished. Standing on my porch, I thought the blooms had just closed up for the night, but it seemed too drastic a change from the evening before. When I got closer the truth became clear—some son-of-a-bitch, rat-bastard, greedy-ass deer ate my flowers! My first flowers of spring! The flowers that made me so happy last night are gone.

Again, not a metaphor. No greedy monster came in the night and ate my chances at being a mom. And it could be worse. A few years ago the deer came by and ate every bud off of my prize daylilies—on the same berm—killing my chances of getting any blooms that entire late summer and fall. The crocus would have been fading out in a couple of weeks anyway.

But it doesn’t have to be a metaphor to piss me off. It’s been a long, dark, cold, hard, painful winter for me. The coming of spring has been keeping me sane the past few weeks. And for me, spring is all about the bulbs blooming. Now the berm isn’t going to really be pretty until May (my giant daffodils have always been a disappointment), when my tulips bloom (provided, of course, that the deer don’t get to them). And yes, I will be spraying tonight. Fucking deer. They even nibbled on my new daylily foliage just breaking through. Must have been a tough winter for them, too, but I refuse to feel sorry for them.

Oh, oh, of course it’s a metaphor! (You had to know I’d get there eventually.) Because what I was really looking forward to this spring, what I’ve been waiting for since last August, was finally moving on with IVF, and getting an answer once and for all about whether I am going to bear a child. And that hope has been snatched away, pushed back into later in the year, as we battle the insurance company for coverage for super-expensive hormone treatment for J.

Or maybe it isn’t a metaphor, but just a piling on of disappointment and delay. At the end of last year, whenever I looked forward toward March, there were two bright spots on the horizon: finishing my chiropractic treatment in time for spring gardening, and starting IVF again. By the end of January, I knew that the chiropractic treatment was going to take much longer (and that any gardening would have to take place in the heat, humidity, and mosquito-terror of summer in the swamp), but I still thought we would soon be starting IVF. When we saw the doc in mid-February and learned that J’s sperm count had dropped to zero, and that it would be months before we even knew whether we could use his sperm, the only thing I had left to look forward to was my spring flowers. And now they, too, have been gobbled up.

Fucking deer. Assholes.