Silver linings.

My apologies in advance – this isn’t my best or most descriptive writing, but things are now transpiring so fast and furiously that I am just trying to get as much of the detail transcribed as possible before I forget.

So the last few weeks have been rough. Work has been stressful, we have gotten bad news after bad news about how much this IVF treatment is going to cost, and my wife and I have just felt like a grey cloud has always been lingering close by (which is kind of partially true since we’ve also had a lot of rain).

Earlier this week, I had a conversation with the manager of the IVF Finance team for our fertility clinic (I don’t know if that’s her exact title, but you can gather what her role is…) and she seemed kind of argumentative, and my wife and I were speculating that perhaps she wasn’t the biggest fan of same-sex couples. Nothing she said or did was blatantly homophobic – it was just a feeling we got. So, we went into yesterday’s meeting with the doctor (and subsequent meeting with her)…guns blazing, if you will.

Before we get to her: the appointment with the doctor was…interesting. He provided us the results of my wife’s bloodwork and internal ultrasound, and dropped a slight bomb on us (I say “slight” as we’re still doing research on exactly what this means for us). He advised that she has polycystic ovaries (we had previously known that she had benign cysts, but the term “PCOS” never came up before). He explained that she showed approximately 50 egg follicles and an AMH level of 10.9. He further explained that I was showing approximately 18 follicles – which he said is a very healthy number – and that although my AMH test was not yet finished, that there should be no problem with my ability to produce eggs should I need to now, or in a few years.

He said the fact that she has polycystic ovaries means that she is at an increased risk of “overcooking them” (his words). He said she’ll have to be monitored more closely once she starts the medication that will help her to get the eggs ready to be harvested, as she could be overstimulated if not. He said that he is not concerned, and simply wants to keep a closer eye on her.

On my side, everything looks good. The only major concern that we have is the fact that my work travel schedule is expected to continue into the near future, and when I am away (which is expected to be 4 days at a time going forward), I won’t have a way to manage the injectable medications (which – he confirmed – will be going into my rear). He said that he could put me on an injectable for 7 weeks, and then switch me over to a vaginal form of the medication at that point, but that there is no way of getting around the injectables for the first 7 weeks. As it stands right now, I’ll be traveling once more the second to last week of July, and then twice in August (evenly spaced out). After August, I’m hoping it drops down to a monthly or EOM cadence. My wife said she could take off of work for a week and come with me for one trip, but coming every other week would be really challenging – even with the flexible job she has. I would consider telling my boss, but my company went through a huge change this year and I just started working with her back in February. I work at a satellite office we have (a 2 hour direct flight from our headquarters) but there has been a lot of pressure over the last few years to transition my role from that office to our corporate headquarters, and so far I have successfully evaded it (although the question was raised again about 2 months ago). I am fearful that if I explain that I am trying to get pregnant, that they will start to look for someone who is willing to do my job in the state where they want the position to be located. I was hoping that by this point in the year, things at work would be more settled, but every day seems to bring new big challenges and “what-if’s”.

So, aside from the injection dilemma (which I would love thoughts on if anyone has any!!) and the PCOS diagnosis (which – again – we are still unsure is truly an “issue” or not), the meeting with the doctor went pretty well. He recommended we move forward with a consult meeting with one of the nurses at the practice who would help us identify the best day to start, and would help us get our medication ordered so we can begin to figure out if any of it is covered. That meeting is scheduled for Wednesday of next week, so in the very near future we should know a lot more about how things are going to proceed as well as the timeline.

After we wrapped up with the doctor, we sat down to a meeting with the woman in charge of finance. She works out of an office that’s about an hour from us, and told us when I spoke with her earlier in the week that she’d be making a trip to “our” office to go over everything. Before she came in, I could hear her talking to another couple (husband and wife, from what I gathered) and her told of voice seemed pushy and cold. My heart started racing and my hands started shaking. I was ready to argue.

On Thursday night, I  sat down and mapped out all of our questions in a word document (which I subsequently printed). On it, I made a table with two columns: one for the regular IVF multiple cycle package that they offer, and one for the co-IVF “package”. I mapped out the costs, services mentioned in each, and made separate boxes for the differences: both cost and service. At the end, it came down to an approximate $8000 difference once you factored in that added value (an additional frozen cycle transfer, cryopreservation of embryos, and anesthesia primarily) of the multiple cycle package that they offer to women who are using their own eggs/bodies.

When Ms. Pushy entered the room, I pulled it together and smiled pleasantly and thanked her for taking the time to meet with us. If this meeting gets hostile, I reasoned to myself, it won’t be on my accord. My wife is the stoic type and she’ll interject as necessary, but she knows that I am very direct, relatively articulate, and thorough with all of my facts – so in situations like this she usually lets me loose to do my thing, and backs me up when she needs to.

So we commenced the meeting discussing the “pre authorization request” that she told us our insurance company requires prior to treatment. I explained that we were told by several representatives of the insurance company that there is no required pre-authorization, and she told us that they ALWAYS require it for our particular insurance company or they won’t get paid. I asked her if that was a routine procedure, why we would have gotten back paperwork after our first visit that said, “No prior authorization required for IVF or IUI” (word-for-word). I slid the paper across the table, and she looked up, narrowed her eyes, and spit out, “well we’ll just call that a mistake.” She handed me the “sheet” that needs to be filled out, and after taking a look at it, I realized that it isn’t a prior authorization, rather, it is form that we have to sign acknowledging that we meet the criteria under the mandate for an egg retrieval (which we are happy to sign as we do believe we meet the criteria of not being able to get one another pregnant). I told her that I thought our confusion was around the name of the form, as I was told that no prior authorization was required and that this technically wasn’t a prior authorization, so I thought we were all on the same page, and at that point, she started to smile (just a little!) and we seemed to turn a corner. I then explained to her that – in the event that the insurance still doesn’t pay the claim (which it very well may not) – that we wanted to discuss the self-pay options and the huge discrepancy in cost/service between the multiple cycle package for a woman carrying her own embryo, and the co-IVF package. I tried explaining my calculations and she told me “I lost her” at which point I showed her the table I typed out the night before, and highlighted the overall differences in the packages and she said, “you know, this is all really new for us. We’ve had co-IVF couples before but this isn’t something we are completely used to. I actually helped create the co-IVF package, you know.” I explained that I understood that, and certainly didn’t expect to pay the SAME as someone who was carrying their own embryos (due to the additional paperwork and monitoring) but that I also couldn’t justify an $8000 difference. She took another look at everything and said, “Listen: I can do a multiple cycle package for you.” (at this point, my jaw was beginning to look like the grand canyon and I just about had to pick it up off of the floor).

She said that it would cost more for the synchronization of our cycles since we are a couple, but that she’d honor a package. In fact, she said they have higher packages with money back guarantees if any of this goes wrong and offered to get us prices on those as well!!

Even though the conversation was headed in a more pleasant direction at that point, I was still ready to defend us. When she said that, I didn’t know what to say. I was still waiting for her to take it back. When she looked down at the papers again, I looked at my wife and snuck her the biggest smile I think I may ever had. The price dropped down to only $500 more than than the package that a heterosexual couple would utilize.

Lesson learned, here: ADVOCATE, ADVOCATE, ADVOCATE!!!! I don’t think I would have gotten the same answer if I hadn’t made that comparison table and mapped out everything piece-by-piece, so do your homework. It’s worth it.

So at this point, we are going to meet with the nurse and determine our schedule, see if the medications get covered, and then pursue coverage of the egg retrieval with the ins. co. If that goes well, we’ll continue to try to get everything covered (even though we were told it would not be) and if it gets pushed back, we now have a much more reasonable amount to fund out of pocket, which we don’t think will completely drive us into bankruptcy.

By the end of the conversation, all three of us were smiling. My wife said afterward, that she sensed that our prior assumptions about the finance lady were correct, but that during that meeting – either my attention to detail or passion for our cause won her over. I don’t know – maybe she’s been having a bad week, and the fact that our case was more complicated made it worse – either way, I don’t feel that sense of bad energy when I think about the practice and I am getting excited to take the next steps forward in this journey.

Fingers crossed, prayers, positive wishes (whatever you have!!!) that the good news continues and that the insurance company pays for the two visits I had this week, and the medication we order next week (I would ask for the same for my work situation, but don’t want to be too greedy :))

Hoping everyone else had some good news this week, too. If not, you have my thoughts/prayers/crossed fingers and positive wishes.

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