Monday, February 20, 2006

HMO stands for Horribly Mean Ogres


I should be in a really good mood considering I can sleep in tomorrow. Ohhhhhh, how I love to sleep. I crave it like candy.

One of the things I love about being in banking is how many holidays we observe. Mr. Blogger, being a Brit, however, cannot understand this concept of some people (me) getting a day off, and some people (him) having to work. In his country...EVERYBODY'S OFF DAMMIT.

Sorry Honey.

Anyway, I feel really pissed off and I've been trying to shake it all weekend, but it just seems to be festering.

You see, after I went to the OB/GYN appointment last week, wherein she could only suggest additional blood tests and couldn't remember anything we had already done, the point was for her to refer me to the RE/high risk doc. We were hoping that I would be able to get in by the time my blood results came back and then go from there.

But noooooooo.

I give you the following letter received Saturday...(verbatim here folks...CAPS INCLUDED)

Dear Blogger, Brooke A.:

We have received the request for service from the above provider/physician. This notice is to inform you the service is being denied. This determination was made based upon our review of your health condition in relation to Stupid Shits HMO conditions of coverage and/or medical necessity criteria, and in accordance with the terms and conditions of your Evidence of Coverage, Exclusions & Limitations section.

ACCORDING TO YOUR HEALTH PLAN, INFERTILITY CONSULTATION IS NOT A COVERED BENEFIT. PLEASE REFER TO YOUR EVIDENCE OF COVERAGE FOR ADDITIONAL INFORMATION.

Blah blah blah fucking blah.

Yeah, ok. No problem. That was just our last hope, is all. And we can't afford to finance that particular doctor privately. And we SURE as hell can't afford the $15,000 it's going to take for IVF (yes, I know the "getting pregnant" part isn't our issue per se, but IVF was recommended to us in that they'll weed out my best eggs, add them to MB's best swimmers, shove a half-dozen or so of the results up there, so my chances would be greater of at least ONE sticking this time).

Basically, my HMO can just go suck it.

We went out to dinner with Emily and G/\R*E tonight and Gary jokingly suggested placing a "Donate to My Infertility Fund" PayPal button on the blog. The man may have an idea there...hmmm....

Nah. I couldn't ask for it, even as badly as we need it.

I'm just so pissed that it isn't even approved to SEE the damn doctor, before we even get to any procedures.

So that puts us back to "just keep trying". And then what, I ask. Just keep miscarrying?

And I thought I was depressed Friday night when we got home from seeing Brokeback Mountain.

26 Comments:

Anonymous V-Grrrl said...

What is it with insurance exclusions anyway? Dental coverage isn't standard even though poor dental care is linked to heart disease and preventive dental treatments are cheap. They won't pay for eye exams and glasses, as if SEEING were some big perk reserved only for the freakin VIPs. And they think it's OK for you to have multiple miscarriages.....

Here's a question for Mr. Blogger: What would NHS do?

I think you should have a baby without the HMOs help just to SPITE them!!!

4:50 AM  
Anonymous M said...

It seems crazy - and grossly unfair :-( - that they lump your problem in the 'Infertility' bracket! You don't have a fertility problem! You are fertile! What you have is a recurrent miscariage problem! Why aren't you covered for that?

Can't you consult Emily's Doctor? She sounded brilliant. Anyway, don't give up! Argue, badger, and FIGHT!

And yes, the NHS in the UK - for all it's faults - would treat you for free. Not for infertility, which you don't suffer from, but for recurrent miscarriage! Different problem! >>>:-(

5:07 AM  
Blogger Mrs. Harridan said...

Yeah, my HMO covers only selected treatments, and the ones it does cover have all kinds of riders on them: bloodwork has to be sent out to Qwest, Ultrasounds have to be done in the adjacent hospital. Insurance companies blow, and yours sounds worse than most! Basically, they are in the business of making money, not paying it out.

I think you *should* put a donate button on the site. You get a lot of visitors, and everyone supports you in any way they can - why not ask them to donate a buck? At least it would be for a good cause; it's not like we would be bailing you out of credit card shoe-shopping debt! ;)

Hoping for a turn in your luck, meantime. Chin up.

7:39 AM  
Blogger Tink said...

This is HORRIBLE! Fucking American Insurance. I don't understand how they choose what is worthy of their help or not. I'm praying for you Brooke.

7:40 AM  
Anonymous TB said...

Bah! HMOs are the devil. Greedy bastards have no problem covering Viagra.

I'm so sorry Brooke. Is there any way you can switch to another health plan?

7:45 AM  
Anonymous Nancy said...

GRRRRR. I am steaming, smoke-coming-out-of-ears angry at this. Fucking insurance.

I'm with Mrs. Harridan -- I'd be hittin' that donate button if you added it. (I can understand why you don't want to, but I'd love to be able to help in some way.)

7:46 AM  
Blogger V said...

WHAT? This is un-fucking-beleivable!

So, just so my feeble mind is getting this right...if you were to get pregnant again, they couldn't refuse you going to a "high-risk" doctor, but since you aren't right this second, they're refusing to let you do the one thing that might help you not have more miscarriages? wtf? It's doesn't even make sense FOR THOSE money-hoarding insenstive pricks. Aren't they supposed to be focusing on preventative health thiese days? yeah...ok...whatever!

It REALLY pisses me off how insurance companies act like they are public assistance....I mean you pay....for what? this?

Grrrr! I'm sorry!

8:06 AM  
Blogger Arabella said...

Put up the button. I will contribute.

Alternately, have you considered investigating IVF research in your area and seeing if you qualify
to participate in any studies? Maybe exploring surrogates would be an option? Can you appeal the denial? I mean, really--inability to conceive is not the same thing as repeatedly miscarrying.

There's a million ways to persist in this. Hang in there and let us know if we can be of any help to you, even if you just need someone to vent to!

8:09 AM  
Blogger The Gradual Gardener said...

I'd contribute too. You should put up the button. Attach a notice that any contributions are "In lieu of baby shower gifts" if that makes you feel better about it.

And as for the HMO...Would they prefer to continue to pay for miscarriages?

8:32 AM  
Blogger mama_tulip said...

((((Brooke)))) I'm really, really sorry.

Put up the button.

11:17 AM  
Anonymous Jess said...

The state of infertility insurance in this country sucks. Beyond sucks. Move to MA; here companies are mandated by the state to help those who are having trouble conceiving. Most clinics have people on staff whose job it is to counsel people about the financial aspects of ART; you could probably sit down with someone and get some hard answers as to how much it would cost, and some suggestions for defraying that cost.

Good luck.

11:22 AM  
Blogger Annie, The Evil Queen said...

I hope you have the energy to persist in having this covered. HMO's are exhausting. Do I understadn correctly that if you get pregnant again, they will let you see the doctor? I hate trying to decipher those insurance letters. You're in my prayers.

11:36 AM  
Blogger No name said...

It is just this sort of situation that scares the crap out of me when we consider moving to the USA. [sigh]

I'm so sorry, Brooke.

Put up the button. I will gladly help out any way I can.

11:49 AM  
Blogger DebbieDoesLife said...

I hate HMO's - they are the Devil's Spawn.

Fight 'em. I had good luck years ago when we were on one by just being a pain in the ass. They will always give the form letter blah, blah blah but you can argue.

I think they arguement that it isn't a fertility issue is a way to get around that little rule. Also, discuss with the doctor that they next time you do get preggo than will she agree to refer you to a specialist immediately?

good luck, sweetie.

2:04 PM  
Blogger Rock said...

Yeah - I agree with Debbie - don't stop at the form letter - I don't understand all this conception lingo but sometimes the squeeky wheel gets the grease...

2:45 PM  
Blogger little sister said...

HMOs won't cover abortions, sometimes won't cover birth control pills, and now won't cover fertility treatments? but they cover viagra?!?!? WTF!!!

((((Brooke)))) this just ain't fair!

3:37 PM  
Anonymous Mom said...

You receive the best advice - what smart caring people who write to you! I'm with all of them. They seem to realize what a smart caring person you are too. Do what you have to. I'll be calling tonight. Love!!!

3:45 PM  
Blogger wordgirl said...

If men were the ones who got pregnant...we would not be having this conversation. End of story. Everything denied to us would be provided for them. The patriarchy hates us, sisters. Don't give up, Brooke.

9:00 PM  
Blogger Ditsy Chick said...

Oh, but BIG Corporations and HMOs are the good people. As V-grrrl says, they won't pay for eye care, dental care, our premiums have gone up astronomically and they don't cover fertility treatments, but they will pay for adoption. That's right, can't have one of your own? Tough, but if you want to adopt, now that is a different story....aren't they NICE?

Put the button up, we'll help you get preggers, just to spite the bastards. Or at least, get you a lottery ticket so that you could actually pay for the treatment.

Which begs the question, does the doctor really need that kind of money to help people get pregnant? They're really, nice too, aren't they?

9:32 PM  
Anonymous m-i-l said...

Just checked back to see the comments and realised I'd goofed! The 'M' comment is me, M-I-L! Sorry!

The opinion seems to be 'put up the button'! Can't hurt, but I still think you should fight to get treatment anyway. Rock is right! Be that squeaky wheel!

2:10 AM  
Blogger Stephanie said...

I have decided that if enough of us say "Put Up The Damn Button" you just may, so I'm saying it. :)

8:08 AM  
Blogger Mignon said...

I'm so sorry, Brooke. I'm angry for you and wish I could get up in someone's grill about it!

m, aka m-i-l ;) , has a very good point. Their classification of your case as an infertility issue could be an error that a good doctor could help correct. And I say a good doctor, because I think yours is lame and do you have any friends around that can recommend another?

12:45 PM  
Anonymous MB said...

Yes, yes, and YES! Fight their damn letter and FIND ANOTHER DOC!! You need someone advocating for you, not forgetting about you!!

Hope things turn around asap!

4:52 PM  
Blogger Melanhead said...

HMOs drove this one guy to set himself on fire on a freeway in So Cal about 6 years ago - remember seeing that? That was crazy.

Whatever you do, DON'T do that Brooke.

7:14 PM  
Anonymous V-Grrrl said...

Yeah Brooke, don't set yourself on fire because third-degree burns arent' covered, only sunburns. ; )

7:24 AM  
Blogger G/\R*E said...

Yeah Brooke,put up the button....

2:02 PM  

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