Loading...

In Which We Kick The Insurance Company’s Ass

I have had an emotional few days, dealing with this insurance issue. 

Thursday, I came home from work and Chris, who has been on vacation this week, told me he talked to another rep from our insurance company, Bev.  This was because after talking to Puppy Killer, he had called the HR department at his work, and she was going to look into the information he gave her. That contact should have been this Rochelle, who is his company’s contact at the insurance company.  The reason she didn’t call us herself, is because this Bev “can maybe connect with us on an emotional level because her daughter went through fertility treatments.” 

Well no offense, Bev, but I don’t give two shits about your daughter.  I could care less that you think you can “relate” to us.  You have absolutely no idea what you and your company have put us through the past few days, and shame on you for using our emotions to blackmail us into accepting the fact that your company fucked us over.  I don’t care about you, I don’t care about your personal life, I want to know how you can fix this major mistake your company made.

Well Bev told us that she’s sorry this happened, she doesn’t know why it did, she doesn’t know why claims were paid when they shouldn’t have been.  She doesn’t know why we were allowed to go to our clinic, when it wasn’t in their program’s “Center for Excellence.”  She doesn’t know, she doesn’t know, she doesn’t fucking know

She told us we don’t even have out of network benefits for this clinic.  Which was funny because we confirmed it with six reps over the past five months, because we were wary and wanted to keep confirming.  Our CLINIC THEMSELVES confirmed the benefits. IVF was confirmed to be an out of network benefit.   We received confirmation of what the insurance company will pay for each of the CPT codes.  Why, after all that, would we ever doubt those confirmations??

Oh and the best part? I got my period that day.  Happy fucking CD1 to me.

Chris then flat out asked her, “So if we continue to go to our clinic, you will stop paying?”

Bev: “Well, if it’s not a Center for Excellence….”

Chris: “Well you say we don’t have out of network benefits, right?”

Bev: “Right.”

Chris: “And you won’t pay for any other clinic except the two you say we can go to.”

Bev, gleefully: “Yes, that’s correct.”

Chris: “So then if we recieve services at our clinic, which is out of network, you won’t pay for it, is that right?”

Bev: “Well, I can’t go on record to say that…”

I can almost hear Bill Lumbergh in my head: “Yeahhh..”

 I’m telling you, I would have totally lost my shit right then and there.  I am not that kind of person.  I don’t scream at people on the phone.  But I would have screamed at her.

When he was telling me this that day, I just couldn’t even believe this was happening.  I understand, that for many, IVF is entirely out of pocket.  But what makes this so bad, is that we DO have coverage.  And we were told repeatedly that we had this coverage.  And suddenly, when we are officially starting our IVF cycle, it’s all being taken away.  And no one seems to have an answer for any of it.  And we have people like fucking Rochelle, sending her subordinate to do her dirty work and tell us, “it’s because she thinks I can relate to you guys.”  Taking away the benefit like this means that instead of us owing $4,000 when this is all said and done, it’s now going to be $14,000.  Or more.  With no guarantee this will even work.  That’s a $10,000 difference that we have two days to decide if we will pay it, and where the money will even come from.

So when he gets off the phone with Bev, after all her helpfulness douchbaginess, Chris emails the benefits woman at his work, who, no joke, is the only person who could help us, outlining everything.  Friday morning before work, he received an email back saying she will need some more information, but thanks for telling our side of the story, and that she will need to talk to the insurance company to find out their side. She thought it was possibly because we should have been grandfathered in for the IUIs only with this policy change, but that we should have been notified of that.

So I went to work, crying.  Because I knew what would end up happening.  We would shell out the $14,000 because there was no other option.  We were starting our cycle.  I just couldn’t bring myself to quit.

I came home on my break and he got a call back from the benefits person.  They told her the policy changed and we should have been notified.  They pulled the phone records.  There was no documentation of anyone ever telling us that.  Like we knew.

They are waiving the claim.  We get one fresh IVF cycle for out of network benefits.  The insurance company is making an exception only because of one person who laid the smack down.  Chris looked at me while he was on the phone with her, gave me a thumbs up sign and I did what I do best.  I promptly burst into tears.

Our coverage is back.  I can go back to focusing on the medical and emotional side of this IVF, instead of this crap with the insurance company.  I know my outlook would have been different had we not had any benefits.  But this horrible, cold attitude of these women who were the cause of all this, denying us answers, taking away something that the majority confirmed was there for us, made this a completely unnecessary source of stress for us.

The other day I had a young girl tell me, “It’s been so stressful trying to get pregnant.  My husband and I have sex almost every day, trying for a baby.”

I win.

You might also like

23
Leave a Reply

avatar
23 Comment threads
0 Thread replies
0 Followers
 
Most reacted comment
Hottest comment thread
1 Comment authors
AmberJennifer JuniperEgg TimerRisaA Place to be Me Recent comment authors
  Subscribe  
newest oldest most voted
Notify of
Em
Guest

Huge sigh of relief.

I am so happy to hear this. I got super choked up picturing Chris giving you a thumb's up. Yay!!!!

Impatiently Waiting
Guest

So glad it all worked out. I hate insurance companies! I refuse to ever work for one! Yay for winning! Oh! And to the young girl who has it so stressful… STFU!

Emily
Guest

Woo Hoo!!! Thank goodness!

inconceivable12
Guest

So glad for you and Chris!

Insurance companies suck. I'm sorry that yours added so much stress for you – nobody going through infertility needs more stress on top of that! Ever. Especially not when you're gearing up for IVF.

Hope everything for the IVF keeps coming together. Will be thinking of you.

jAllen
Guest

Go Team Risa and Chris! What a shitty ordeal you went through, but so glad you persisted and prevailed and good for your insurance company for recognising their error, but correcting the situation. It goes to show for the people on the other end at your insurance, it's just processing paperwork. Even when they try to be sensitive by sending in someone 'whose daughter was infertile'. (BTW, I bet her treatment worked too)

Not Pregnant And Pissed!
Guest

I am so happy you guys prevailed! That is awesome! You are very lucky to have a husband who has the patience to deal with the insurance co. like that. I think mine would lose his shit and give up after one phone call. Good luck!

Sarah J
Guest

Oh my gosh, I'm so sorry you had to go through all that crap. But woot woot that you won the battle for this cycle and will get to go through it as you had originally planned, without the burden of extra expense and stress.

Will be wishing that this is it for you! You certainly deserve it.

belovedburnttoast
Guest

You win! That sounds so stressful, but must have been so validating when you ultimately triumphed. Wishing you good luck on a hell of a lot less stress for the rest of your cycle.

jAllen
Guest

Additionally, I love how they refered to their approved 'Centers of Excellence' a clinic with lower success rates!

Aramis
Guest

So glad this worked out. I am convinced insurance companies would screw everyone over and never pay out a cent if they didn't get sued so much. What assholes! Now, stress free for the rest of it!

Cristy
Guest

I am so unbelievable angry reading this. Does it surprise me that insurance companies pull this BS? No. But to jerk people around using someone who *thinks* they understand their situation?!?! Honestly, if I was Bev's daughter, I would be so hurt by her actions and seriously contemplate allowing her access to my children. Because she not only demeaned you, but used her daughter to do so, all for the benefit of a company. So wrong on so many levels. That said, I'm very relieved to see the news about you getting this round covered. I'm just really sorry you… Read more »

Sarah at Midwest Pillowtalk
Guest

great outcome!

Aubrey
Guest

Yayyy! I'm so glad that you guys didn't back down on all of this… It totally paid off!!

JustHeather
Guest

Woohoo! Sorry for all the heartache and tears, but glad you won in the end. Now let's get the focus on your upcoming cycle!!! Fingers crossed.

Infertile625
Guest

This is it. Too many stars have aligned for this not to be it. Oh my god. What craziness!

Stasy
Guest

YAY! I'm sorry you've been through hell and back with the insurance company, but I'm so glad it's worked out for you. Crossing everything that this is your cycle!

Shelley
Guest

Wow, what a roller coaster. Glad that you can focus on your cycle now.

Elizabeth :: Bébé Suisse
Guest

What an unbelievable saga. I'm so glad you prevailed, but so sorry you had to go through this emotional upheaval to get to that point. One more incredible unfairness on top of another.

A Place to be Me
Guest

WOOOOOOO!!! Way to go! Don't let them crush your dreams!

Risa
Guest

Yes, Cristy, you are absolutely right. It just makes me shake my head.

Egg Timer
Guest

Hurrah!! So glad you got your benefits back!!

Jennifer Juniper
Guest

Thank goodness! I'm not going to lie… when you got to the good part, I teared up. Woohoo!

Amber
Guest

I am so glad it all got worked out, but so sorry for all of the upset. I totally understand how stressful the financial side is. I have gone rounds with the financial advisor at our clinic almost every single cycle. We keep getting bills for what was supposed to already paid for. My sister kept getting bills, and was even threatened being sent to collections, even though we explained numerous times that she was the donor. If anyone should be getting the bills, it should have been me – even though it was supposed to be covered. It was… Read more »