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More cruddy news... what's next?

post #1 of 15
Thread Starter 
The business manager from my RE's office just called me here at work. My insurance company won't pay for me to have the laparoscopy done, because they don't cover fertility treatments. When I had talked to the nurse last week she said she could submit the code for painful periods, etc instead of infertility. Well, the business manager said that wouldn't work b/c my ins co would request my records for such a large claim and would see that the original reason I went to my RE was for fertility consultation.

BUT....

She said my RE offerred to do the surgery at the wonderful reduced rate of $1500!! (Payable up front, of course, and not including what the hospital would actually charge me.)

I have been trying *sooooo* hard to keep my chin up, to not get discouraged, to not believe that some greater power is telling me to not have children... I just don't get it! This is an obstacle that I simply cannot overcome. I don't even know what to do now. I don't think that woman realizes that she just ripped the rug out from under me. I have no hope left. I don't believe I'll ever be a mother. Sorry to unload all this, but I needed to get it out somewhere.

Kelly
post #2 of 15
Oh, Kelly! Sweetie, I am so so sorry.

I really don't know what to say. I can't imagine how you are feeling right now. Please be gentle with yourself and know that you are in my thoughts and prayers.

Kelly
post #3 of 15
So sorry, Kelly. I'd still speak with the doc if I were you. There still might be something he can do (if he really wants to). I would also tell him how that lady made you feel! That is so out of line!
Or just go see a different doc, and not mention any infertility problems, and see about getting that lap anyway! Really, you need to know regardless, especially if the RE suspects endo! (((BIG HUGS))) If you want, I can give you loads of links about endo and lap surgery, etc. Just let me know.
post #4 of 15
{{{{{{Kelly}}}}}
Oh honey. I am so sorry to hear that. Insurance companies suck don't they? That is the big reason I haven't gone in to get a fertility work up. Cause I need a referral and not all of it is covered and if there is a problem - the diagnosis is mostly covered and yet the treatment is not....stupid system. Talk to the doc and see. Good luck!!! I am pulling for you.

post #5 of 15
Maybe the doctor could talk to the insurance company and explain the reasons why he wants to do the surgery aren't fertility related. That the original reason you went to see him or her was fertility related but that the surgery is for medical issues not fertility.
Good Luck!
post #6 of 15
Kelly, I'm so sorry...that is really awful. I can only imagine what you are going through, and I am having empathy pains. I don't have any practical advice for you, but there are a few old sayings that come to mind: When God closes a door, he always opens a window. This too shall pass. and Miracles happen when you least expect them. I hope that a miracle will happen for you and you are in my baby prayers.
Brandi
post #7 of 15
I'm so sorry for you. What horrible news. Insurance companies can really make life miserable. I hope you get better news soon.
post #8 of 15
Have you looked into any alternative therapies? Chiropractic and acupuncture have helped many women who have given up because of fertility problems. They are alot less expensive, less risky.

If you have, and have not had the results you would like. I would try a different Dr. to dx it differently. Then they can do the procedure. Insurance SUCKS! I am so sorry you have to go through all this.
post #9 of 15
I have a friend with a similar problem, and her RE referred her to another non-RE doctor to do the surgery for non-fertility reasons, so that it would be covered. Apparently it worked, because she's having surgery this month.
post #10 of 15

Kelly, I wanted to just say how sorry I am. I know that this has been such a long a painful road for you. Sometimes it really does seem like things can't get any worse.
All I can offer is love and support and to remind you how many friends you have here.
I too hope that God opens a big wide perfect window for you.

Sarah
post #11 of 15
Agree with everyone...don't give up and go to another doctor, it is really unprofessional for the doctor's manager to call you with the price tag for treatment. I would go to another doctor IMMEDIATELY!!!! At the very least the MD should have had you back in to talk about the cost himself

good luck
post #12 of 15
Kelly,

Do you have ANY reason to suspect you have endo? Lap surgery is the ONLY way to diagnosis endo and the doctor should be able to justify the surgery based on concerns of endo. (if you have any).

I am so sorry that the roadblocks just keep coming.

Hang in there and PUSH for the surgery!

kathy
post #13 of 15
{{{{ Kelly }}}}}

What a bummer!!! I hate to have this happen to you.

I have known quite some people who did have their insurance change their minds after they called/wrote letters/etc to explain why this procedure was needed and why it should be covered.

So if there is any way that you can make a good case for this being something not infertility related, but for painful periods or whatever, I would start kicking towards the insurance and see whether you can make something happen.

{{{ HUGS }}}

Karen
post #14 of 15
Thread Starter 
Thanks, everyone, for your concerns and well wishes. Also, thanks for the good ideas! I have been kicking around ways to "beat the system". Going to another Dr is one good idea, especially since I *do* have painful periods (endo?!). I have also considered changing insurance companies to one that does cover infertility treatment, although that would be much more expensive for me on a monthly basis. I don't think contacting this particular ins co would help, as I have had huge battles with them before over totally legitimate claims for back problems that I have. They simply don't want to cover anything at all. I have also gotten back in touch with my local DFCS office for the possibility of pursuing foster care again (as I have done in the past), with the potential for adoption, but I'm not sure that I'm at that point yet.

I, too, thought it in poor taste that the business manager gave me this bad news and just left me hanging. When I told her what the nurse and I had discussed (re: my painful periods as a diagnosis), this woman spoke to me as though I was asking her to commit fraud, which really upset me. And then when I told her I would have to cancel my surgery date, she just said, 'okay, I'll tell the nurse'. That was it. Not the most sympathetic person. In fact, discussing this here is making me want to write a letter to the Dr about my experience.

Anyway, I sure do appreciate all of your advice. I will take it to heart. All of my friends tell me I'm "mommy" material - say I'm more comfortable around their children than they are. I need to have patience and faith that I was not given mommy qualities for them to be wasted by me not being able to have children.

I probably won't be around here as much as I have been before, but I sure wish you all the best of luck in your quest for children of your own. I'll keep you all posted with any big news on my end.

Kelly
post #15 of 15
I'm rooting for you too, Kelly. How awful to have to deal with insurance companies regarding your health care. I live in Canada so that is a foreign concept to me.

Best wishes and I should be back on the Baby train in a month or so after tests, etc.

Love Anne!
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