Friday, November 02, 2007

what's new... (updated)

Happy Belated Halloween. Happy Samhain as well, and Dia de los Meurtos too.

Bliss had a great park party the day before, but I think he wore himself out spending 4 hours almost entirely on a merry-go-round spinning thing. On Halloween we had plans to trick or treat at the local businesses in a small nearby town but 5 minutes after we left we had to turn around because he said he was going to throw up. This was BEFORE he had had any candy. He decided not to go out at all and we got in the bath (it always makes him feel better). Then when we got out he was playing and seeming to feel better and then he began crying that he wanted to go, so we got ready and left again. This time half way there (it is about 20 minutes) he said he was sick again and needed something to throw up in. I grabbed my Trader Joe's bag that is plastic-like and gave it to him and pressed on as I knew he just had to get there. He put his head in the bag (it is a stiff bag, no suffocating hazard) for the entire rest of the drive. When we got there he perked up and we ended up having a really nice time. When we came home we ate and I let him have 8 small pieces of candy after which he said "no more for me" and then we spent the rest the night sitting on the front porch together talking and handing out candy. I have a "No Candy No Treats" policy and he thought it was a good one.

Yesterday I got my schedule which made me very very happy.

Nov. 5 - shot class
Nov. 12 - start Lupron 10 units
Nov. 14 - take last BCP
Nov. 19 - decrease Lupron to 5, start Gonal F 375,
start Menopur 150, and start Dexamethasone (25 days)
Nov. 27 - take AM Lupron then go in for U/S and find out HCG time & ER date, Embryology class in the evening

ET will likely be first few days of Dec.

They called in my meds and I got a call from the pharmacy this morning. It seems the Gonal F, Menopur, and HCG were not covered with them as they are only in-network for my RX benefits and those meds would be covered by my in-network pharmacy that covers my major medical. So they forwarded the Rx and I called the new (to me anyway) place. They were very nice and told me they would process everything and all me on the 6th to let me know what my coverage and co-pays were. That is great but I need to know now. On my insurance website it says these drugs are covered except for $30 co-pay. So I next called my insurance and they told me that all was ok and the pharmacy the first one had forwarded me to was the correct one and that it should all be covered and they were not even seeing that there was a co-pay. I still think there will be but I am happy to hear them tell me I will be covered since I had assumed I would be this whole time. I then asked if they could check the predetermination status since it had been sent in over 3 weeks and they have only 30 days to respond. She put me on hold then came back and said they had not gotten any predetermination requests. I got a fax number that was supposedly a direct one and then hung up and called the clinic. I KNOW they sent the stuff so I let my clinic know what they said and gave them the number and am currently waiting on a call back. It is not an awful thing, we already know I have coverage. The thing we don't know is if any specific parts of IVF are not covered, and I would really like to know that prior to the procedure, not that it would change anything but still.

So that is what's new with me.

UPDATED: Shortly after I posted I got a call from the new pharmacy saying now 4 drugs weren't covered, even though the previous pharmacy said it was only 3. They told me they needed me to get a letter from HR and from the insurance. WTF????? I called my insurance again and they said I was covered and I spent the next hour and a half talking to various people with my insurance company. They were then closed but still helping and finally said that we had to wait until Monday to get this straightened out. Then after all that time and all these different confirmations the first guy says "well we shall see if these meds are covered and get this figured out on Monday." He is one of the ones who had assured me they were covered. Three other people did as well, but shit, now I am worried all over again. I then went online to re-look at my coverage online because I can put in specific drugs and get cost projections, well it is temporarily unavailable, of course. I have cried and yelled and sighed for the past 2 hours on and off and now, as always in IF land, I wait.

7 om's.:

lady in waiting said...

Oh good, I am so glad for the update. But you didn't say what you and Bliss dressed up as! Reading the story about the merry go round and his reaction almost made me throw up :) Poor thing! I'm amazed he was able to eat any candy and keep it down.

Your IVF schedule is right around the corner. I can't believe in a month you are going to be in the 2WW! The pharmacy and meds stuff can be sooo annoying. I have to pay out of pocket for alot of stuff too, unfortunately.

Thanks for your comment. I am a bit worried about the slowdown but I guess it could be worse. Hoping it was just all the drama going on in there and now it's ready to make a recovery! Hoping anyway.

bleu said...

At the party Bliss was Superman as it is an easy over the clothes costume. I was Frankenstein with this blow up thing I got last year.

On Halloween Bliss was Curious George and then half a monkey when he got hot and then the underwear bandit when he insisted on no more hot stuff. LOL I was nothing that day as we were going from business to business and there were tons of kids and the Frankenstein costume is pretty bulky for a crowded sidewalk.

Anastasia Beaverhausen said...

How wonderful!!!!! It's exciting!!!!!!

owl said...

Crap, why does this stuff always happen on the weekend?
why does this stuff always happen at times when things are already stressful enough!

I hope you get some answers soon and it all turns out to be ok.

I am jealous you get to have classes about embryology, I want to go to a class about that!

lady in waiting said...

very cute costumes!! i love the curious george and then half a monkey scenario. bliss sounds like quite the little character :)

calliope said...

insurance stuff is the WORST!
I hope you get some good answers today.

& also- if for some reason your insurance isn't going to cover your meds I would give your clinic a call. Many RE's have meds available to donate- you just have to know you ask/beg/cry for them.


gold star said...

poor little bliss - sounds like halloween ended up really sweet, though.

Hope those drugs are covered. Sometimes it seems like the more time you're willing to spend on the phone with your insurance company, the more they'll cover for you.

Good luck!