Sunday, February 17, 2019

Insurance

Last week I was hit with the news that we have nearly $9000 of pending claims that were denied that we may be responsible for. I didn't understand what was going on since I've been on top of the bills and there was no indication of this on any of our statements, nor was it mentioned when I called in December making sure our account was clear in prep for the next FET.

In August we did IVF 8. Prior to the cycle we got pre-authorization and got the all clear. In December, when we were getting finances ready for the next FET, we were told we had exhausted our benefits. We were expecting as much and knew we would have to pay for the FET out of pocket. I verified our account had no other outstanding balance (it did not) and I decided to make a pre-payment for our FET to get the tax credit for 2018.

Turns out that our Aug claims weren't submitted until much later than the cycle - closer to Nov/Dec. When we received the notification in Dec about our benefits being maxed out, it was actually notification of our Aug claims being denied though no such wording was used. The pre-payment for the FET was then disbursed among all the open/denied claims and the $9k is the remaining amount.

To say I was livid is an understatement. I was so, so, so upset. First, no one bothered to tell us what was going on. We would still be in the dark had I not reached out the them with a question. I got a Feb statement for $1100+ and I emailed the financial counselor, confused, since our account was clear in December. She said she'll look into it and get back to me. I followed up FIVE days later and she said she's still looking into it. Later that day I got the shocking news that not only do we definitely owe the $1100+ but there is a whopper of a bill coming up because of all the denied claims. I asked about the prepayment and she said it's gone, disbursed among the open claims. I followed up with four additional emails in quick succession asking WHAT THE HELL in various ways, pressing send before I fully formulated the thoughts to try to get her before she left for the day.

The next day I felt my heart racing. I called the doctor taking my doc's patients while she's on maternity leave. I left a message and said I don't want to over react but I also don't want to under react if this is something that needs to be checked out. Doc called me back a few min later and as we were talking I started sobbing. I said I wasn't sure if I should go to urgent care or try to get in with my PCP or what but I'd rather feel silly for coming in rather than regret ignoring something important. She offered me to come in to see her so that's what I did. My blood pressure was in the 160s, my pulse in the 90s, and I couldn't stop sobbing. The doctor was so kind and patient and understanding. Through sobs I explained about the unexpected billing issue. I also shared my incredible fear of miscarrying again, especially in a traumatic way like last year because that had also been on my mind. BP was checked again, it was lower in the 140s. Then she went to the financial office to try to get some answers. In the old clinic the doctor would never get involved in the finances. She got the financial counselor to come talk to me to try to explain what's going on, but more importantly to promise to get a supervisor involved and get back to me with answers.

Then she listened to my heart for a while and said she couldn't hear a skipped or missing or extra beat like what I was describing. She said she can order an EKG for me if that's what I wanted. Toward the end of the appointment I was feeling better and said I will skip the EKG but follow up with the pcp if I felt the need. She recommended doing things to help me relax, like massage, exercise, music, etc.

I'm normally a rational, logical person. I've had a few instances in the past where my anxiety got the better of me (basically right around my husband's varicocele surgery where I couldn't stop thinking worst case scenarios), but for the most part I feel like I have it under control. When it starts manifesting in a physical way is when I start freaking out. Having something bother me that I don't address starts compounding (in this case, fear of mc) and then when there's a trigger I wasn't expecting (in this case, the billing situation) it just blows up. It's easy for me to say that now, a few days later, because hindsight is 20/20. But at the time it felt like the sky was falling and I was drowning. I am lucky the doctor didn't dismiss me, took the time to see me, and gave me the time I needed to get through it. I am extremely grateful.

Toward evening I had mellowed out significantly and my blood pressure was back to normal and so was my pulse. The next day I tried doing my own research about what we owe. While waiting for the supervisor from the clinic to call me back, I called my insurance. It sounds like yes we did indeed max out our lifetime fertility benefits. Our Aug claims only had about $900 covered and the rest of the cycle was not. For some reason the clinic didn't submit the claims until December which is why we only received notification at that point. I don't know why we weren't told about the pending/denied claims earlier. I don't know why we weren't told about disbursement of the pre-payment for pending claims. The insurance person went over all the claims that we may owe that are still pending.

One piece of surprising news in all this: while on the phone with insurance, I was told that the Aug - Dec claims were denied but one of the claims submitted in January was covered. Huh? Thanks to some policy change that we didn't know about or realize happened, turns out the plan we signed up for was slightly different than last year and that change resulted in an entirely new plan which means that as of 1/1/19 our lifetime maximum for fertility benefits has been renewed. What!!!!! I didn't even know that was an option!

So we're still on the line for thousands of dollars until we hear otherwise but hopefully having a renewed lifetime max will mean that we don't have to put anything on hold. I'm still very upset with the clinic for screwing up our billing, but I'm holding out for the supervisor and give her a chance to fix it before going nuts on them. And I've also learned not to let things fester. If something is bothering me, I need to take care of it. I thought I was managing fine -- I wasn't crying, I wasn't actively depressed -- but clearly I was in denial that something was bothering me. I will need to be more aware in the future to prevent another meltdown.

Monday, February 11, 2019

Hats

I'm feeling more anxious than usual today so I decided to deflect unpacking it and look at hats instead. I didn't watch the Grammy's last night but I saw some snippets on social media and woah. Apparently hats are back in. I don't need anything nearly as glamorous as what J Lo was wearing, but I really liked that black hat with the satin sash on Alicia Keys.

I love hats but hats don't love me. They're all made one size and it's just a bit too small for my head, giving me a headache if I wear them more than a few min at a time. The plain straw fedora I wear at the pool was purchased at a Big & Tall men's store a few years ago when I saw it passing by the window a few years ago.

All the hats online (Amazon) are one size. Other stores online might have better sizing but no free return shipping. I can't get stuck with a bunch of hats that don't fit. I've tried local stores in the past but who goes to stores anymore. I would go to a store if there were legit recommendations. So where do people buy hats?

Wednesday, February 6, 2019

Schrodinger’s Pregnancy

I was responding to a post on my fb support group from someone who just had a transfer and was kind of going nuts with her emotions asking if that was normal. The immediate term I thought of was Schrodinger's cat and how the 2ww is basically Schrodinger's pregnancy: you're pregnant and not pregnant at the same time. I was so tickled with this thought that I googled it and found this blog post from 2013 on the concept.
What makes this experience unique, compared to situations of waiting in unknown like waiting for results of a job application, is that the box of indeteminancy is located within your own body. That box that contains one truth and the experience of living with two, that is placed in the intimate space of your self....  Every twinge, ache, or fluid becomes a potential messenger–sending us word of what has happened that we cannot know.
It's so well said and makes so much sense. There is literally nothing to do but wait. Wait and try to manage expectations while preparing for possible disappointment.

Monday, February 4, 2019

The Curve

Over the years of fertility treatment I noticed something about myself. There's a definite bell curve to
my emotions and how I relate to others depending on where we are in our own cycles.

For me, the peak of the curve is transfer day. Leading up to it I feel happy and relaxed, not jealous at all of anyone. Family occasions are easier to get through, I'm more patient and tolerant of comments. In my mind, my happiness is just around the corner with all the hopes and dreams riding on the upcoming transfer. When transfer happens, the peak plateaus while we anxiously wait for results. If the results are good, the peak rises a bit; but as always has been the case in the past, there was always a significant dip when the transfer didn't work or when the pregnancy ended in miscarriage. Each time we lost a pregnancy, the dip went a little lower and made it harder to climb back up. Almost as though the baggage of previous losses weighed us down and helped gravity sink us even deeper.

This thought only popped into my mind yesterday as I was folding laundry. It was so strange to realize something so fundamentally simple and obvious.  It completely explains why it has made riding the upswing of the curve so difficult. As soon as we got the all clear weeks ago I should have been thrilled but I just couldn't enjoy it because I know what it's like to be in the depression of the dip and I'm terrified of being there again.

None of this was news. It was just very interesting to me to realize this about myself. Maybe now that I realize it I can do something with it.

Friday, February 1, 2019

Yay

The last week and a half were stressful. Just a lot of stuff going on. Having a lot of stressful things behind me makes me happy.

I really love The Good Place. Last night we caught up with S3 finale and we're still texting each other quotes from the show and giggling. It's such a good show and the character Janet brings me so much joy. I loved Parks and Rec and I hope this show continues on for a long time. Well done, Mike Schur (creator of both).

It's been a month since I focused on better eating and I'm down 13.6 lbs. It was a recent gain after I was on antibiotics multiple times in the fall so I'm glad it's gone. It was alarming at how quickly it can get packed on. It wasn't a steady decrease: it was down some then up some then up and down a few more times until this morning I felt I needed the accountability and finally stepped on the scale. I know I shouldn't equate happiness with the scale but that's easier said than done. Also, in my usual worrier-self I let a moment of doubt creep in thinking, "Oh no, unexpected weight loss can be a bad sign of something seriously wrong" but then knocked it down with reminding myself that I've been purposely eating mainly vegetables and protein, and a lot less baked goods. Plus I had the stomach bug last weekend. In any case, the scale seems to fluctuate so much that tomorrow might be a completely different story. Today I am pleased.

I'm also starting to accept the eventuality of the transfer. At first I was caught off guard because after months of delaying we finally got the all-clear. I wasn't expecting it and wasn't ready. I'm still too superstitious to calculate gestation weeks or due date post-transfer, but right now I feel guilt-free estimating and calculating when trimesters would be based on a hypothetical transfer date. Thinking that it might work and going through the positive what-ifs brings me happiness. I know it's a dangerous game but impossible not to think ahead like that if you're trying to convince yourself that it will happen. Why else would you go through it again?

I know the risks. I know what could happen. I would be lying if I said I wasn't scared.

But I know we can't succeed if we don't try. So we have to try. We have to do our part to help it succeed. Our part is having faith and going through the procedure again while hoping for a different outcome than the last 6 times.

Also, it's Shabbat and superbowl weekend! I have no skin in the game - I have no idea who is playing or how the game is even played but I know I like superbowl food and Maroon 5.  Shabbat shalom!

Sunday, January 27, 2019

Mental break

I'm comfortable enough with tech and I try new things when they make sense to me. What doesn't make sense to me is putting everything in my life on the internet, especially when a lot of us barely have a rudimentary grasp of cyber security.

Just now I was browsing Amazon and saw a Smart Wifi Instant Pot. Are you serious? It's not enough that your alarm system, your doorbell, and your lightbulbs are all connected to the internet and therefore hackable; you need to share your dinner with the hackers as well? What has this world come to??

Last weekend I finished the book The President is Missing where they paint a picture of what the US would look like if the internet was hacked and deleted. Your money would be unavailable because all records of your accounts would be wiped clear; the hospitals wouldn't have electricity because everything is on the grid so not only could they not perform procedures, they wouldn't even be able to verify your insurance; water filtration systems would go down; grocery stores wouldn't function. Chaos. Mayhem. Third world country conditions.

Why did we get here? I understand connecting everything is more efficient. But it's more efficient until it's not. At this point we don't even have the non-internet processes in place as backup.

I'm guilty of it: I'll hop in the car, plug in an address on Waze and let it lead me to where I need to go without any prior preparation. When I first started driving 18 years ago, I remember having to plug in the address on mapquest and printing out directions. Printing them out but still from the internet! I don't know a world where I had to rely on an atlas (or something else???) to get from point A to point B.

Every week we unplug entirely for Shabbat and it's just become so routine and habitual that we don't even notice it. Religion aside, if anyone feels like trying it I highly recommend it. Even if it's just for family dinner time, or an evening -- it doesn't have to be all or nothing. Not only does it help me be present where I am, but it's also a mental break from juggling multiple things.

That's not to say that I don't jump right back on my phone as soon as it's over - I certainly do. There are times it can feel disconnecting. What happened in the news? Is everyone I know still ok? Did my favorite instagrammer post new stories?? You know... the important things. But I recognize that when I'm distracted on my phone and someone (read: husband) tries to talk to me or ask me questions, it can get annoying and I snap at him because I want to finish what I'm doing on the phone. That's not ok. Barring an actual emergency, there's no reason to prioritize anything on the phone over people who are in the same room as me. The weekly break is another added reminder of that. It's what I need to help unpack the past week and prepare for the week ahead and I really appreciate the mandatory mental vacation.

Shavua tov! (Have a great week!)

Monday, January 21, 2019

Tu B'shvat


In addition to being MLK Jr, day, today is the Jewish holiday of Tu B'shvat (literally translated as 15th of the Hebrew month of Shevat) and known as the birthday of the trees. It's a fun, no pressure, no obligation holiday where we acknowledge the beautiful world we get to live in.  Many of MLK's historic quotes are about faith and courage so it seems appropriate that when I needed a little extra support, they happen to fall out on the same day.

You can learn more or find some great themed recipes and even a whole themed menu of Tu B'shvat online. I love it because of a few reasons. You can celebrate it simply by snacking on some dried fruit or going all out with platters and blessings and projects if that's your thing. I also like that it's a time to pause and appreciate the beauty of the world. There is so much beauty but sometimes we literally lose the forest for the trees when we're bogged down by the daily minutia.

Happy birthday, trees!
You can plant a seed in the ground, water it appropriately, leave it in the sunlight for the correct amount of time, and do everything right but ultimately a tree grows because of Hashem. At some point He needs to take over and make the magic that enables nature to follow through. 

As very personal symbolism, I can't help but think of the similarities to frozen embryo transfers. Everything is set specifically: lining is measured carefully, medication and hormones are all regulated, precise timing is scheduled. Ultimately, though, it will only work if He deems it fit to continue on and become an actual human.

As we get ready for our seventh FET, I can't help but reflect back on the first six that failed, four in miscarriages. I'm terrified and I'm excited and I'm worried and nervous and hopeful. We've done so much in the past year just to get to this point and now that it's almost here I feel like it's a speeding train heading my way. Either it will take us aboard a wonderful adventure or will hit and crush us once again. But even under all the anxiety and worry and feelings of lack of control, there is an underlying hope and wanting to believe that we may have a chance. Every tree starts out as a sprout and that spark of hope feels like the first step we need to get started in being mentally prepared for the next try.

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