Wednesday, June 27, 2007

Skipping the update....

Well, not really. This week I went to yoga 3 times, and 5 walks (for a total of 21.1 miles!). I'm not weighing myself. AF is due on Friday... and I am going out to eat every night this week (summer celebrations, grandparents visiting, boss in town, husband's best friend visiting). I have been eating well at these meals, but it's the salt I don't know about. And unknown sodium + PMS (potentially, right!?!) = freaked out about weight gain Cece.

I got the official letter in the mail from the insurance company rejecting my claim. If I had the ectopic on the month we did the IUI - it would be no question to move onto IVF. The fact that it was the month AFTER the IUI is the issue.

With the list of problems I have had with this doc and his office, I find myself wondering if I should switch to another office. He has been insensitive and callous at times. I am of the mind that I would rather have honesty from a doctor than someone pussy footing around stuff.... but sometimes he is brutal. And, with all this IVF stuff, has been giving us false hopes. So, if we get pushed off until October, I think I'm going to consider stitching. Anyone have recommendations for a good RE in the Boston area that takes Tufts heath insurance?

6 comments:

Mary Ellen and Steve said...

I see Dr. Elizabeth Ginsburg at the Brigham and I love her. She doesn't sugarcoat anything. You won't get any warm fuzzies from her though, so if that's what you are looking for then she probably isn't for you. She is the clinic director, so she's definitely good.

chicklet said...

I unfortunately have no names to give you but if I can give unsolicited advice (sorry, I know better but can't help myself!) - switch docs. If you're not happy, move. This is too big a deal to spend it with someone who pisses you off or isn't completely honest. I just switched my docs and while I dont' have an appointment until mid-July with the new one, just ditching the old bitch really helped. I didn't want her to be a part of this anymore and getting her out, well that feels better in itself.

Samantha said...

I don't know what to tell you about the docs. I've been going to a clinic that I'm less than thrilled about because I'm tied in a warranty program. If you don't have that financial tie, and if you have some time because of insurance pushing you around, maybe it would be worth exploring other options.

mamacate said...

I've been out of town so am just catching up. If I may, WHAT THE FUCKING FUCKING FUCK FUCK KIND OF FUCK IS THAT FUCKING SHIT? FUCK!

Ahem.

That is clearly, clearly an error, and although it has been quite a number of years since I was in the mix, this is not the way Tufts behaves. I had BCBS, but my bestest IVF buddy had tufts and she had wonderful experiences with them. Talk to them and ask to speak to the ivf/infertility coordinator who processed your claim. The clock does NOT get reset with a pregnancy loss. This is within the letter of MA law (assuming your employer is not self-insured--they have a little more wiggle room, but not much). The clock gets reset after a LIVE BIRTH. In fact, recurrent pregnancy loss (I realize that's not your problem, but still) is explicitly INCLUDED in the definition of infertility.

Brigham is good, Ginsburg is supposed to be good (she may even have done my transfer the time it worked, but I don't remember her). Brigham is a REAL cattle call, so you have to be prepared for that. We can talk more about the pros and cons of the different clinics, at least based on experiences from 6 years ago. But DEFINITELY switch docs. There are about 100 ways this guy is no good. Really, I'm gonna kick him in the shins if I meet him.

The last thing is to get in touch with RESOLVE. They have a help line, and I think they have an official insurance counselor. Last resort is the insurance commission, but I wouldn't hesitate to mention it as an option--this is straight up illegal. I doubt it's Tufts fault, though. RESOLVE can get you in touch with people who are in the process now and know how the different clinics are TODAY, and that's really valuable, plus they can help you navigate through the insurance BS. You're also not the only one dealing with this "lose weight to do IVF" crap, and hopefully you can connect with folks who have been down that road and understand the research.

After all that? Hon, I'm sorry. You deserve better than this. Don't forget, you can always call.

mamacate said...

When I said processed your claim, I meant processed your pre authorization. And then I was going to say that the policy is probably to be found on the provider side of the Tufts site. And so it is: http://www.tuftshealthplan.com/providers/pdf/mng/Infertility_Services_Revision.pdf

So that's what I meant. Except for the part about when I said FUCK? I meant FUUUUUUUUUUUUUUUUUUUUUUUCK!

PS: Feel free to edit me if you want this blog to be PG-rated.

mamacate said...

So I think the link got cut off

http://tinyurl.com/3bualv

And I read it and you should be covered under 3e2d and 3e2e. 3e2d does not specify that the ectopic needs to be subsequent to the infertility, and 3e2e doesn't specify that the ectopic needed to occur DURING a treatment cycle, just while in treatment, which I believe you were (it was a rest cycle after clomid, right?).

Anyway, that is not going to stand up to any scrutiny whatsoever, but you might have to get along with your Type A self and tell them how it's gonna be.

FUCKERS.