Bionic Mamas

you're not losing a vagina, you're gaining a son

Interim Items

12 Comments

Gosh, internets, thank you for all the love and enthusiasm. Warms the cockles, I tell you what.

I keep thinking I’ll pull together the mental wherewithal to organize a proper post, but I’ve been spending all my wherewithal talking to insurance companies and billing offices. Herewith, the Insurance Items:

Background Item: Since the Bean was born, I have been on Sugar’s health insurance (Aetna, lifetime health cover loading), first because I wasn’t working and then because I wasn’t working in the right place to have my own. However, that insurance doesn’t have the kind of gold-plated fertility coverage I require, so this spring I accepted two night classes with a wretched commute in order to return to my old insurance (Empire Plan) long enough for an FET or two. This coverage ends in late August, at which point I will be back on Sugar’s plan.

Item: I screwed my courage but good and called the office of the nice OB — you know, the one who said four hours of pushing didn’t mean I wasn’t trying and used the word “horrified” more than once as I quivered on her exam table, trying to explain why coming in for a Pap smear had me so anxious. I like her a good deal and trust her about as much as I’m currently able to trust any member of her profession (midwives included, I’m afraid), and even so, I was quite dizzy with nerves as I waited on hold. (This bodes well for the coming months, eh?) I finally made it out of the holding tank and then through the nine million questions necessary to schedule early pregnancy appointments (knock wood, practice belief, knock wood), at which I point I casually mentioned that my insurance had changed since my last visit.

Guess who doesn’t take my current insurance, only six or so plans with remarkably similar names?

Cue panic attack.

After a lot of phone calls and mental math, I decided that the cost of seeing the good practice for a couple of out-of-network visits before returning to their accepted Aetna plan (three, I’m guessing) is lower than the cost of patching my mental health back together if I have to find a new practice, even just for a couple of months. I have a few hundred dollars of deductible to cover, after which my insurance will pay 80% of “reasonable and customary” charges; someone from billing is supposed to call me back this week, but she sounded like she thought they would likely work with me to charge amounts my insurance finds acceptable. This will still end up costing us quite a bit more than seeing someone in network, but therapy ain’t free, either. Especially at a time when I can’t avail myself of the kind sold in fifths of a gallon.

And anyway, that deductible has nearly take care of itself already, because…

Item: I am suddenly outside the bounds of my coverage at the Baby Factory, despite not being released as a patient yet.

My insurance considers the Baby Factory in-network for fertility care only, not for pregnancy care. This seems like no big deal, since the Baby Factory doesn’t do OB, but it did cause me some stress three years ago, when I started bleeding after they had released me but before I’d found an OB. At that point, Empire Plan considered a heartbeat on ultrasound as the boundary between fertility and obstetrics; I had a first beta, a second one week later, saw a heartbeat two weeks after that, and was sent on my way. It all seemed perfectly reasonable. We know too well that a positive first beta does not mean a Real Live Baby, but the rate of miscarriage drops significantly after a heartbeat.

Imagine my surprise, then, when having been relieved of yet another vial of blood this Sunday, I was handed a bill for the second beta (and progesterone and estradiol just for fun, I guess), to the tune of $300 and change. We can send it out to a lab your insurance pays for, said the lady in billing, but you won’t get results quickly. My cheapness fought my anxiety; cheapness is strong, but anxiety has throwing stars. So even though I had a sinking suspicion I wasn’t pregnant anymore, I decided to bet on good fortune and pay the bill, hoping that money would count against the deductible I’d spend at the OB’s anyway, assuming I got there.

So far, so good. Which brings us to…

Item: Ultrasound.

My father’s family has been going to this particular place on the shore of Lake Superior for a bit more than hundred years; there’s a gathering of cousins there planned for the end of June. We go there rarely, and I so want the Bean to see it. It is so beautiful, I won’t even pretend to do it justice in a rushed blog post except to say that it is what I picture when I think about heaven. And I’m not really a cold weather girl. It is also quite remote. The only telephone is several miles from where the cabins are; the nearest hospital certainly over an hour. It is sublime, but it would be a hell of a place to have an ectopic rupture.

I asked Dr. BF back in March what he thought of our going the on the heels of a May cycle. As long as your betas are unambiguous, he said. If they look potentially ectopic, I might have to tell you to stay home. Fair enough, I agreed. Just because this place is like heaven doesn’t mean I want to die there.

All this time, I’ve been refusing to quite believe that this trip will happen as planned, but the plan is to leave on Friday. (We are going to a wedding in DC, then to Sugar’s parents’ in lower Michigan, then to the UP, then home (Sugar) and Arkansas (the Bean and me, to see my mother). It’s quite the odyssey, even by our standards.) So after the first beta, I called Dr. BF to remind him of our deal, and that this means we will not be in town for their preferred viability ultrasound at something like 10 days past the second beta.

“You’re leaving Friday? Just come in Thursday morning for a scan. We won’t be able to see much, but as long as we can see something in your uterus, you can go.”

The first problem with this plan is the “Thursday” part. Thursday is Dr. Paternalistic’s shift. I do not want to get bad news from his mouth. I’m not even sure he’s capable of giving me good news without being an ass. But all my scheming about whether I could convince a babysitter to wait in a playground with the Bean (and our luggage?) so that I could go on Friday instead, on our way to the train (pause to appreciate the crazy scheme), was displaced on Sunday by fretting over the cost of the ultrasound without insurance. (Both, of course, a form of distraction from the more obvious anxieties attending such a scan.)

Happily, many phone calls later, it transpires that the prices of everything except the progesterone test are within the bounds of “reasonable and customary.” I confess shock that the blood tests are, frankly, and suspect this has less to do with chemistry than lab monopolies, but whatever, not my (immediate, individual) problem.

Item: The plan. Scan Thursday, very early so that Sugar can come before work. Probably too early to see a heartbeat, so we’ll try not to think about that part. I will see if I can sweet talk a nurse into jiggering the schedule so that we get the fellow I like instead of Dr. Paternalistic. If not, I guess I’ll live. On the other hand, this might be my last chance to kick him from the stirrups….

Item: this post is absurdly long. Sorry.

Item: I think that today I entered the part of pregnancy when I can’t have coffee anymore without feeling really sick. This lasted for the duration last time, and boy, is caffeine a more important part of my life with an early-rising toddler than it was pre-Bean.

Item: This morning also marked the first convincing nausea of this process (doxycycline excepted). Not so bad, as these things go, but still not my favorite.

Item: I’m not sure if this quite rises to the level of a craving yet, but holy Moses, is beef all I want to eat in the whole world. I could have wept for joy at the sight of hamburgers grilling at Sunday’s pool party.

Item: this post is absurdly unstructured. Sorry.

Item: I will leave you with some Bean cultural anthropology, inspired by his asking after the whereabouts of our local ice cream truck at six or seven on Saturday morning:

ME: Many people do not consider ice cream a breakfast food.

BEAN (thoughtful, serious): Maybe some do.

(And then, in the spirit of self-fulfilling prophecy, he fell backwards off a picnic bench while we were out to brunch with a friend, smacked his head on the concrete patio, acquiring in the process a magnificent goose egg and a free gelato from a sympathetic waiter. How is it so many people survive being toddlers?)

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12 thoughts on “Interim Items

  1. Item: The American health/insurance system makes me want to weep and then make out with tongues with the NHS.

    Item: Will be thinking of you on Thursday.

    Item: Poor Bean. I am beginning to thing several hearty bangs on the noggin are MANDATORY by age four, for natural brain development. I don’t know any child at all who hasn’t had them. (In my case, a friend of the family picked me up, dangled me upside down holding onto my hips, and wouldn’t you know, toddler hips being the shape they are, promptly dropped me onto a stone pavement. I was under three years old, and yet I actually remember the incident. With mucho wailing, and no ice-cream, dammit).

  2. Now, this is my kind of post.

    I, too, wonder about early am ice cream. A smoothie is legit, but not ice cream? Huh.

  3. I often weep for joy at the sight of beef, too! x

  4. WordPress keeps eating all my wonderful witty comments (they exist, I swear).

    Yoghurt is a breakfast food, and if you freeze it then it’s pretty much ice cream. Breakfast ice cream!!

    Also – the US healthcare system makes me want to cry.

    And never apologize for long posts – I like them! In fact I often want to apologize for the brevity of mine. When they exist at all that is.

  5. That thing about airlines being run like healthcare makes me laugh and then cry my eyes out every time I read it. What the what, insurance companies??? Dear socialism, please come visit some more, thank you.

    As far as I know it has to do not with how reasonable OR customary something is, but with how well that insurance company has negotiated rates with that particular provider and/or lab. I could tell you a long story of getting screwed by ‘reasonable and customary’ but instead I will just hope you work it all out.

    WHAT NO COFFEE AIEEEEEEEEEEE.

    • After much holding and transferring, it seems that in addition to the negotiated rate with a given provider, there is a general rate (which varies by zip code) they use to decide what to pay 80% of when dealing with an out of network provider. Or words to that effect.

      For example, the Baby Factory charges $230 for a transvaginal ultrasound. Current insurance has negotiated a rate of $161, so that’s what they pay for the ones I am covered for. However, for pregnancy care, when they are out of network, the insurance company’s customary and reasonable amount is $550 (of which they pay 80% after the deductible, or at least would if the Baby Factory charged that much).

      Meanwhile, life without coffee but with a toddler and insomnia is going ABOUT AS WELL AS YOU’D THINK.

  6. This post was great! Aside from the tricky details of insurance, that is. Of all insurance plans everywhere, I’ve never seen much rhyme or reason in coverage. Take Sea’s for instance, which covers orthodics but not podiatry. Or mine, which didn’t cover any fertility treatments/procedures, but did cover Femara because my four day dose could theoretically have been treating cancer. Regardless, I agree that there is a price worth paying for mental health. And that price includes both good healthcare and the occassional breakfast ice cream.

  7. I am impressed with your persistence in getting all of the insurance info. I hatehatehate that kind of insurance math! Especially when half of the numbers have to be replaces with variables because it’s so hard to get anyone one to tell you what certain things will cost ahead of time.
    Hoping that everything went well today and that Dr. Obnoxious behaved himself and that you guys have a fabulous trip.

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