Show & Tell: The Price is Right Fertility Meds

Welcome to my contribution to Mel's Show and Tell.

Today I'd like to share a recent trip to the pharmacy for the medication I picked up for in an upcoming cycle. Little did I know that as I walked into the doors of the pharmacy I became a contestant in "The Price is Right".

It’s a true story. I’m not making it up I promise. Can you hear the music? Da dun dun daaa... Da dun dun daaaa…”Welcome to The Price is Right!” Here’s my nametag.

See proof?! I submitted my prescriptions at the drop off and waited in the comfy chairs. A few moments later, I hear from a deep voice, “Liv! – Come-on-down!”

The spotlights are dancing around, I hear a room full of applause as I make my way to the front.

Congratulations Liv, you are our next contestant in the Fertility Meds Price is Right game. We want you to take a look at this whole set of medications and you need to guess the total price. You have to be as close as possible without going over to be a winner.

Okay. I’ll give it a shot.Well, let’s see there’s Ov.idrel…I’ve had that before. And there’s two Gona.l-F pens. What dosage are they?

900iu’s. With 28 accompanying 29 gauge needles.

Alrighty. Looks like there are also some “supplements” of the extra supplementing kind. Oh, and I can’t forget about the sharps container right?

Oh, she’s a smart one! Isn’t that right audience?! Yes! Whistles, yells, and applause. Do you think you have your guess? Okay then. Here right it down…I nervously do the calculations in my head. Taking my pencil and writing in the air with my toungue sticking out of the side of my mouth. And then just like all the rest of the contestants I add a ’99 to the end.

Audience, do you think Liv has it?! YES!!!! More whistles, yells and applause.

Here’s my answer:

Then I hear the audience gasp simultaneously. Too high! That’s gotta be too high! They say.

Liv are you sure? You know if it’s too high you loose.

Well, that’s my final answer. (Wait…wrong game show. Oh, well)

The pharmacist (I mean game show host) slowly opens the envelope with the answer. The actual price of all of this medication comes to…

$1296…(pause)

More audience gasping…

99!

There’s an uproar of cheers!

Congratulations Liv! You’ve won! And here’s your prize – You get all of this fertility medication free!

::: :::

Yup. Folks…that’s exactly what happened, I’m not making this up. I paid $0 for my $1296.99 of meds. Insurance picked up the tab. Well, I should say there is one thing that didn’t happen as I described.

I paid $3.99 for the sharps container.

Who else wants to open a bottle of champagne to celebrate?!

::: :::

I am not making light of the fact that this is kind of insurance coverage is extremely hard to come by. I’m very thankful for it. I work for a large employer that just happens to be based out of a state with mandated infertility coverage. Even though I don't live in that state. Year to date I’ve paid $4000 and hit my out of pocket maximum and this is why it was $0.

It’s just something worth celebrating no? No be sure to check on what the rest of the class is celebrating.

What I Learned Today - IVF Consult #2

I suppose the one benefit of having RE consults back to back is that the last interaction is fresh in the mind as you have the next one. So, how did the "guest team" do today? Did they beat out the home team? Any strikes? See for yourself

• New Clinic (aka Innie Clinic as they are In Network as opposed to yesterday which for IVF purposes is mostly Outtie) is about the same distance away than the other office, so there's no real difference there. [0 points]


• They had a lovely fish acquarium with the exact same fish from Finding N.emo! (ha, ha...I know this one is not very important for narrowing down your RE clinics...but I can't help it!) [5 points!]


• Music in the waiting room [2 points!]


• The technition they had who took my blood pressure, weight, other stats was nice but drove me bananas when she took down my allergies. "How do you spell Tetracycline?" "Sulfa is s-u-l-p-h-a right?" No! Then I had to spell everything else! Cipro, C-i-p-r-o. Codeine, C-o-d-e-i-n-e. Darvocet, D-a-r-v... V NOT B! I should have just wrote them down myself. The only one she got right was penicillin. [Negative -2 points!!!!]


• New RE (aka Dr. Blue Eyes) is kinda a young guy, but very nice. I'm sure Dr. Diet Coke probably has a good 16-18 years experience in the field on him. And totally I respect her, but one of the things that drives me crazy is that partway through my questions she thinks she knows what I'm about to ask so she finishes my supposed thought and then answers. I find myself saying, "Yes, I completely understand - but that's not my question." Since this doctor hasn't endured 18 years of the exact same questions over and over again...he still has the patience to listen to my question fully before answering. He was also very thourough in his explainations. [50 points]


• The office adiminstration staff so far has not impressed me. First, it started the day before when I called them to confirm my appointment and give them a heads up that I was faxing over my paperwork...

Dingy Desk clerk: Oh, well you don't have to do that
Me: Yes, but it says right here to send my paperwork in advance. Besides, I think the doctor is going to need my records and test results from the other clinic for our consultation.
Dingy Desk clerk: No, just bring it tomorrow. We can do it when you come in.
Me: Won't you have to verify my insurance?
Dingy Desk clerk: Yes, we did that already...Oh, here it is - you will pay 80% after you meet your $3000 deductible.
Me: Could you call my insurance again? That information is not correct.
Dingy Desk clerk: No, that is correct - I called them myself.
Me: Well, that doesn't make sense - my insurance is either 70% out of network after a $6000 deductible OR 90% in network after a $3000 deductible. So, I have no idea where 80% is coming from. Oh, and by the way I've already met the $3000 deductible.
Dingy Desk clerk: No, it's 80%.
Me: Can you have someone call again?
Dingy Desk clerk: No, but you can call them and ask, but they told me 80% after you meet your $3000 deductible.
Me: But, I've already met my deductible.
Dingy Desk clerk: Okay, well just 80% then!

five minutes later...
Me: Hi, this is Liv. I was speaking to someone a little while ago about my insurance coverage but I didn't catch their name?
Dingy Desk clerk: Yes, that was me.
Me: Okay, I just got off the phone with my insurance and they told me it was 90%. Please update your records.
Dingy Desk clerk: But, they told me 80%.
Me: Yes, I understand. Regardless, they have record of your clinic's tax id calling in today, and they have it recorded that they told you 90%. Not sure what happened there, but if you could just call again if you're uncertain it should be 90% that would be great. Thanks! [-10 points]

The next day (today). I requested to speak to the insurance coordinator to verify some things and ask some additional questions after we completed the consultation. I expected to be taken to someone's desk who would then hand me their business card when he/she was done. Nope! I was taken to...Dingy Desk clerk in vivo!

(Dr. Blue Eyes handed her my folder said, "Could you go over insurance coverage with-")
Dingy Desk clerk in Vivo: (cuts the doctor off) Okay. Sure.
Me: Can you confirm with me my insurance coverage?
Dingy Desk clerk in Vivo: Yes. Well, your insurance doesn't cover any infertility testing or treatments. So, I just need to tell you that you are going to be completely responsible to pay all of the costs.
Me: (who has been shaking my head from the words doesn't cover any and scoffed at "pay all of the costs"...) No, that is not correct.
Dingy Desk clerk in Vivo: (who should have used this opportunity check the FOLDER!) Yes, well BS insurance provider doesn't covery anything.
Me: Who's record are you looking at? Because it's not me. My name is Liv, and I don't have BS insurance provider
Dingy Desk clerk in vivo: Oh, right....Your covered 90% so you will simply pay 10% of the total cost.
Me: Well, I'm only $588 from my total out of pocket maximum, so it will only be 10% up to a total cost of $588 and then 100% right?
Dingy Desk clerk in vivo: Yes.
[So, I'm going to deduct 5 points for not reading my folder and telling me I had 0 coverage...But, I will grant 5 points back for getting it right in the end. Then 100 points for being IN-Network.]

Did you guys catch that? As long as I stay in network, $588 dollars is all I will pay for the rest of the year! That's for up to 3 IUI's, 3 IVF's including ICSI. Who else wants to do a HAPPY DANCE!!! Hot Diggity.

• Their live birth success rates are higher than my beloved Outtie clinic. (Which I don't think is a knock against Outtie, but is favorable for Innie clinic) [10 points]


• Dr. Blue Eyes is less experienced, does have pretty good credentials and is partnered with a highly experienced tenured RE. [Net 0 points]


• I have no way (unless anybody has any other ideas) of evaluating the BIGGEST part of their IVF services - THE LAB. Well, besides the CDC stats. As Nishkanu expertly pointed out it might not be worth the cost and not to mention emotional savings bank if the RE is good but the Lab not being so great. Anything else I can use to evaulate besides the CDC stats?

Okay, so I'll leave you guys with that information for now. I'll come back and give you my final verdict. For now I must go to bed!

What I Learned Today - IVF Consult #1

Gonna-quickly-run-through-what-I-learned-today-because-I'm-sleepy-and-I-have-to-do-it-all-again-tomorrow.

***Please forgive my rants (and future rants) about frustrating insurance and subsequent predicaments. I so realize I am truly blessed to have any coverage whatsoever***

• I had my IVF Consult with existing RE, Dr. K (aka Dr. Diet Coke as she always has three at her desk) This was also the meeting I needed to make the determination whether I was going to use this clinic or not given the fact that their lab stuff is independent and out of network.


• How much is really lab vs. doc when it comes to IVF anyways??? Answer: lab/surgery group: 85% Highly Educated Reproductive Endocrinologist: 15% (not including meds)


• What 2009 Liv would have told 2008 Liv when researching RE's LAST year... ask the question above whilst researching RE's!!! Oh, and out-of-network coverage doesn't mean 70% vs. 90%...it means 70% after a $6000 deductible. Oh, and put a $500 bet on the Kentucky Derby horse with the 50 to 1 odds, because then the above...wouldn't matter.


• Insurance covers 3 IVF including ICSI, and PGD testing, (and supposedly meds...awaiting confirmation) up to 90% . This just through this year as I have met my in-network deductible of $3000.


• The only part that is in-network with Dr. Diet Coke RE office is only $2400 of a $12-13,000 expense.


• I have no shame in saying "vaginal suppositories" when speaking to the insurance company when inquiring about covered perscriptions.


• I actually learned nothing new from my RE IVF consult. I already knew how a Lupron vs. Antagonist protocol worked, ICSI (which may or may not be necessary), and the risks of injectible medications. I also already knew about a study they were a part of that offered $2000 payment towards costs. And I found out about that completely independently from their information.


• Despite covering 3 complete IVF's including ICSI and PGD...My insurance company DOES NOT COVER FET. Makes absolutely zero sense to me. They said it was b/c they put it in the same category as surrogacy. (can you feel my anger? I'll post more on this later...)


• They also do not cover any of the freezing/crypreservation of embryos should we have leftover fertilized from fresh cycle


• It will cost me $5000 FREAKIN' dollars if I use Dr. Diet Coke RE office whom I know and love. Yet even with this $5000 cost, it still goes against my 3 lifetime limit.


• Supposedly new RE is completely In-Network for everything. I'm still leary of this, and the practice as I have no other information to judge them by....until I check it out myself. Wish me luck.

Ode to the RE: I Ain't Sayin' She's A Goldigger...

This is dedicated to all of my sistah's (and bro's!) who have had to endure the stress of financial strain during the heartache of infertility.

Ode to my Infertility Doc to the tune of Jaime Foxx's Gold-digger

She take my money
When I'm in need.
She's a triflin', doc indeed
Oh she's a gold digger, way over time
N' over-charges me.

Now, I ain't sayin' she's a gold digger...But she's makin' me broke, broke.
Now, I ain't sayin' she's a gold digger...But she's makin' me broke, broke.

C'mon Ya'll
Holla "We want Full Coverage! We want Full Coverage!"

Okay, I realize that was an awful rap to the tune of Jaime Foxx's Gold Digger. But, it's what I think about when I hear the song. Cuz that's how I roll.

Actually I really like my RE. I feel bad even implying, "She's a gold-digger" because she is a fantastic professional surrounded by some fantastic medical health providers and office staff. But, I recently found out something that might need to have me change clinics and of course RE's.

When we first had the chat with the insurance person about our "complicated" insurance I asked her to give me an idea as to what IVF will look like. I remember her pointing out that some of the lab work required for IVF will be out-of network. My initial gut reaction to this was that it wouldn't be that bad. I'd gladly pay them out of network costs if it meant staying at that clinic I remember thinking...and besides that just means we'd have to pay 30% not 10%. Well, it's actually 30% after a $6000 deductible. I have no idea what this looks like in more realistic hypothetical terms. [whoa...did I just say realistic hypothetical??? Is that an oxy moron or what? Why does that somehow seem so appropriate for the lovely world of ART? I digress] I have asked the billing group to get the final numbers prepared for me for the day we have our appointment with Dr. K.

Dr. K doesn't know it yet, but in our conversation we will inevitably be putting her on the spot as to why we should continue IVF with their clinic, when I could go to the other clinic with full insurance coverage for all services including labratory. I suppose I'm going to have to tell her as well that we have another appointment scheduled with the other clinic the next day. I'm going to keep it as professional as possible yet remind myself that I'm the one that hired them and if I need them to remind me as to why I hired them and why I should stay I'm not overstepping my bounds. I'm doing the responsible thing in reaching my family planning goals. I'm just glad it occured to me to check with another clinic to see if they would also be out of network, because I think I was so smitten with my clinic that I convinced myself that if they had their lab out of network then I'm sure everyone does too. Nope!

It can be hard to make a decision to change clinics when I've grown so accustomed to this one. I'm not going put too much stock in the fact that the other place has a greater success rate because my clinic has a tendancy to work with patients that have complicated diagnoses. Plus the current clinic does have some great benefits. I just don't know if it's worth spending that much more money for the additional benefits as well as the additional expertise if I haven't been diagnosed with a complicated problem.

Stay tuned...I'll let you know how it goes...

Meanwhile, due to overwhelming popular demand... be sure to sign in to "The Life of Liv" later this week for my next performance will be to the tune of Madonna, "Acupuncture Virgin: Poked for the Very First Time!"