The “Joys” of Insurance…

For the record, I’ve never had a problem with military insurance–even when seeing doctors that are civilians.  The money is taken out of my account automatically every month, I get a referral from my PCP when I need to see a specialist for the first time, and usually can schedule an appointment within a week–two, at the most.  The appointment itself may not be in that time frame, but at least I can get on the schedule.  In the last 10 years of living with Lupus I’ve seen an assortment of cardiologists, gastroenterologists, nephrologists, neurologists, ophthalmologists, and rheumatologists (still with me?).  There have also been appointments with reproductive endocrinologists, but those were surrogacy-related, not for Lupus. 😉 I’ve been poked, prodded, and punctured to be diagnosed and treated, and have honestly lost count of the number of appointments I’ve had with the various specialists and the techs.

My point is this: in dealing with all those specialists and that insurance, never once did they put me through the kind of stress I’m dealing with now.  Seriously, my hair is falling out more than usual, my sleep schedule is jacked, and my appetite is off–all due to the CF this other insurance company has created with my surrogate (for those who don’t know, in this case CF is an abbreviation for Charlie-Fox, or ClusterF*ck).  While most anyone would be stressed, the fact that I have Lupus makes the effects worse, and potentially damaging to my health.

Before I really get going, I have to say that the agency and the coordinator have been awesome through this mess.  They’re the ones that have been dealing with this insurance company (heretofore referred to as Evil HMO) and the OB’s office the whole time.  The phone calls, faxes, and all the other crap have been handled by them, trying to get Evil HMO to do what they’re supposed to–and for that, I’m truly thankful.  I can’t imagine how much more of a wreck I’d be if I were the one trying to get this stuff pushed through, because I have no experience trying to make things work with any insurance company, much less Evil HMO.  As far as I’m concerned, the agency has definitely earned its fee and more.

The agency is the one who writes the check to Evil HMO, and does so for 6 months coverage at a time. The policy was purchased early this year, after our GS’s screening but before contracts.  Apparently some moron with Evil HMO’s billing entered the wrong amount of payment on the account.  It wasn’t like the idiot transposed a pair of numbers, either, which I could totally understand.  No, it (I won’t dignify this individual with a gender pronoun) entered the perfect number of $800 for no obvious reason, instead of the $1958.61 (or something like that) we paid by check to cover 6 months.  Apparently when that amount ran out, Evil HMO cancelled the insurance for non-payment–even though they had cashed the check for more than twice that amount.

The whole issue didn’t come to light until the agency and the coordinator started trying 3-4 weeks ago to schedule an OB appointment for our GS.  The agency coordinator (AC) proved to Evil HMO that the check had been cashed, so they were expected to reinstate the insurance and provide services. Evil HMO claimed to have refunded the money (it didn’t show up until late last week), and demanded another check which AC overnighted to them.  But even after the check was delivered, the billing idiots still hadn’t posted it by the next week, so the OB’s office wouldn’t allow us to be put on the schedule.  After a ton of phone calls with all kinds of people, it was agreed last week that we were allowed to schedule, as long as AC promised that the first appointment would be paid for in cash if the insurance hadn’t been straightened out by then, and that Evil HMO would reimburse us when it was fixed.

Then came the kicker–the OB’s office didn’t have any new patient appointments available until August 1st.  That would put our GS at 19w4d, and the last time she had seen a doctor would have been the RE at our ultrasound 9 weeks earlier.  If she were pregnant with a singleton, I still would have been nervous and trying to find a way to get her in earlier. But with twins? UNACCEPTABLE.  AC agreed with me, and managed to get Evil HMO to admit that maybe another OB’s office might have an appointment in 3 weeks, but a lot more conversations would have to take place before an appointment could be made.

At this point, figuring that wouldn’t go anywhere fast, I changed tactics.  I’d heard about NT scans (though I had forgotten what it was called at the time), and knew that they were generally done between 11w0d and 13w6d. It seems that they’re pretty common with surrogacy, although I know of women who had them even though they were pregnant “naturally” and weren’t of advanced maternal age.  Even though we used PGD, there’s still the possibility that something went undetected–and if there is an issue, I’d rather know about it sooner rather than later.  So I asked AC about the scan usually done around now, and if we could get our GS in for one.  She felt it was worth requesting, and pointed out that if it got approved, the GS would have to be seen this week, as she’ll be 14w0d on Sunday.  And by getting a scan, she’d probably need a follow up appointment after that, which would be sooner than the appointment we might get in 3 weeks.

Amazingly enough Evil HMO agreed–maybe because they were sick of hearing from us.  Yesterday we got approval, and were allowed to schedule the scan for today.  So I hopped on a plane to San Diego last night, and will drive up to the scan today.  I’m missing spending our 8th anniversary with my husband, but we agreed that it was more important for me to attend the appointment.  We’ll just celebrate this weekend. 🙂

The tl;dr version:  As the Marine Corps teaches everyone who makes it through boot camp, Persistence beats Resistance.  And if one is pursuing surrogacy (either as an Intended Parent or Surrogate), persistence is mandatory.

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  1. Thanks for visiting my blog! Welcome (belatedly) to the blogosphere and congratulations on the twins! Good job getting the HMO in gear, that is ridiculous.

    • Thanks, Io 🙂

      Love the title of your blog…and may we both have our hands full with babies this time next year!

  1. First Trimester Screening, Part I… « This Butterfly's Dream

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