An Old Spoon

(I’m linking up with the Stirrup Queens today for #MicroblogMondays. Head over there if you’d like to read more #MicroblogMonday posts!)

Microblog_Mondays

I have heard many stories from my mother-in-law about my husband as a little one. Apparently, he really gave her a run for her money, employing all sorts of tactics such as holding his breath until he turned blue, climbing on top of the refrigerator to get to the medicine bottles, and refusing to eat anything at all for long periods of time.

After we had been married for a year or so, she gave me an old plastic spoon shaped like an airplane, the only utensil that had successfully convinced her stubborn baby boy to actually take a bite of food. She had held on to the spoon for all those years and gave it to me so that we could someday use it with our own babies.

I took the spoon home and placed it in the back of our silverware drawer, thinking it was cute and that we would eventually pull it out and use it. The thing was though, as time went on, that little blue airplane started to look sadder and sadder, until I hated seeing it sitting there, unneeded and unused, each time I reached for a fork or a butter knife.

That old spoon is now buried deep inside a storage drawer, hiding out in a safe place until an unknown time in the future. I suppose we’ll take it with us wherever we move, and someday, maybe, we’ll have a use for it.

Spoon

Bills

So… I just need to vent for a minute. This gets long and ramble-y (sorry), but I just needed to get it out there.

There are are many things in this world that I don’t understand, but one of the most frustrating for me is the US healthcare system. Here’s a recent example from my life:

I have had two separate HSGs done in the past few months, first with an OB-GYN and then with an RE (Reproductive Endocrinologist). Even though I was repeating the same test, these were two vastly different experiences, both in the outcome and in the way they were billed. Despite not covering infertility treatments, my insurance does provide coverage for diagnostics, so I had been told by each doctor’s office that the HSGs should be fully covered.

For my second HSG, the one with my RE, this turned out to be true. My insurance company was charged $1,138 for the entire procedure, and they paid every penny, except for the $40 copay that I have with each appointment. Maybe it’s a testament to the fact that the billing office at the fertility clinic truly knows what they are doing in this area or the fact that they work hard to help their patients navigate the finances of infertility, but this was a relatively painless procedure, physically as well as financially.

The first HSG was a completely different story. Not only was the test a failure, but trying to work out the billing has been ridiculous. The initial bill was higher than the one from my RE, which I suppose was to be expected because this HSG took place in a hospital, so I had bills from the OB-GYN, the radiologist, and the hospital itself. The total sent to my insurance company was $1,959. I still haven’t figured out all of the details with how this HSG was coded, but somehow it was submitted in a way that resulted in the insurance company considering it a surgery to treat infertility, and therefore they only gave me partial coverage.

Between the three different bills for this first HSG, I ended up being held responsible for $1,088, while insurance covered the rest. Now, I know this is just a drop in the bucket in the world of infertility treatments, but it seemed like a pretty big drop to me. It all adds up so quickly, and I was not happy to receive these bills after being told by my insurance and my doctors that it would be completely covered. From what I’ve seen online about how much to expect an HSG to cost, my bills seemed pretty high anyway. (Also, how was the RE able to code everything so that it was completely accepted by my insurance, while the OB-GYN’s office wasn’t? I am still trying to wrap my head around the fact that my repeat test at the fertility clinic, the one I worried my insurance would think was non-essential, was completely covered, while the first one wasn’t. They were the exact same procedure!)

Anyway, I had a bill from the OB-GYN for $750. This charge was apparently for the catheter and the dye insertion, which is a big chunk of what my insurance refused to pay for. When I called the billing office to see if there was any way the codes could be changed so that the insurance company would accept it, I was cheerfully told that it should have been covered 100% – they had even checked this with my insurance beforehand – and that the insurance company must have made a mistake.

And thus began a 2-month long roller-coaster of negotiations that I have (hopefully) just ended.

When I called my insurance company, they informed me that based on the codes put in by my billing office, there was nothing they could do. They hadn’t made a mistake at all; my plan simply didn’t cover the procedure. Of course, they couldn’t tell me why it was considered a plan exclusion, because they weren’t allowed to discuss what was in my file; I would have to check with the doctor’s office for more details about how it was coded.

When I called the billing office again, they told me that an HSG wouldn’t have been covered anyway, because it was more than a simple x-ray. Clearly, it’s more of a surgery than a radiology test. (Even though this was the opposite of what they had told me before! Even though my second HSG was covered! And does anyone want to explain to me how an HSG is a surgery? That makes no sense to me, either.) They said that they would send a message to the insurance company and see if there was anything that could be done. This would take 4-6 weeks, so I’d have to wait patiently to see what happened.

I felt like everyone was giving me the run-around, and no one was actually trying to figure out if there was anything that they could do to help me. Then, sometime last week, I got a new version of the bill in the mail. Apparently the OB-GYN’s office hadn’t gotten anywhere with the insurance company, but they had decided to give me the discounted rate that the insurance company would have paid if they did cover the procedure. (This also makes no sense to me – if the insurance doesn’t cover it, why do they have a set price for a discounted rate? This is a private health plan, so I don’t think they have other versions that would include infertility. But, who knows, maybe they do?) So, now instead of being billed for $750, I was being asked to pay about $530. Better, I guess, but still a bit pricey.

I finally got up the courage today to call the billing office back. I was starting to think that I would probably just have to pay up, but I wanted to ask one more time why it had been coded the way it was and why I had been told that it would be covered if it wasn’t. After getting nowhere with the first person I talked to, I finally got through to the billing manager. She gave me the same speech, telling me that this was how they always coded HSGs and that the insurance just didn’t cover it. I finally said that I understood that there was nothing they could do for me, but I was confused why I had been told, when I first called all the way back in November, that it should have been covered and that the insurance had made a mistake. Why was I hearing different things every time I called?

She changed her tune at that point and said that there actually was something she could do. She said that my insurance company must have tacked on a lot of extra costs for overhead because the HSG took place at a hospital. She was actually surprised to see how high my bill was, since most other insurance companies apparently have a site-of-service differential that would have been used to reduce the cost to about $100 dollars, but mine doesn’t. (Or just didn’t use it? I’m not sure.) So, she said that she could reduce my bill so that I would only be paying $100, the same as what they would normally charge to a different insurance company.

So. On the one hand, I am VERY grateful that the charge has been reduced. On the other hand – I don’t get it! Why is the amount that my doctor bills me set by my insurance company, if my insurance has already refused to pay for the procedure? Why were hospital overhead charges tacked on to my bill if the bill was not for the hospital at all, but for the regular OB-GYN office? (I have completely separate bills for the hospital and radiologist.) Why do uninsured patients automatically get higher rates than insurance companies? And if the billing office really did have the ability to reduce my $750 bill to $100, why didn’t they do this in the first place???

Here’s another example of frustrating heath care costs – my husband’s first semen analysis, which was ordered through a different OB-GYN and conducted at a local andrology lab, was billed to us at a price of $630. We were able to get it covered by insurance eventually, after a lot of back and forth with the insurance company, but we still paid $240 with the deductible and copay. This is a ridiculous cost for a simple lab test! After switching to an RE, we found out that the self-pay price at our fertility clinic is only $25.

It seems like such a mess to me. I know there’s a lot I don’t know about insurance and health care, and I also know that all these people I’ve interacted with are probably trying to do their best in their jobs, but the cynical part of me feels like they are just arbitrarily making up numbers to charge me, hoping that I don’t notice and call to challenge them. I don’t understand why the prices are so different from one provider to the next – or from one insurer to the next – and how insurance companies can accept or deny the same procedure based on how it’s presented to them. I know that good healthcare is expensive and worth paying for, but so many prices we have been given seem so outrageously inflated.

I’m deeply grateful that I have health insurance coverage at all, but it is always, always a frustrating experience to have to deal with billing issues. Infertility – or any health issue, for that matter – is difficult enough without also having to face a crippling financial burden and having to be your own advocate in the face of impenetrable medical companies that seem to be watching out only for their own bottom line. I don’t know what the answers are, but I can’t help but feel that there has to be a better way.

Edges

We had my husband’s brother, his wife, and their 8-month-old baby staying with us for about a week at Christmastime. We were happy to have them; it was really nice to see family and spend time together. In all honesty, though, it was also difficult to navigate having someone else’s baby in our home for the holidays when we had been struggling so much throughout the past year.

I know that it was also difficult for my brother- and sister-in-law. They know what we have been going through, and I know that they would never want to hurt us or flaunt their situation. I also know that they have their own set of challenges, and it would not be fair for me to resent them or their baby.

For most of their stay, I think I did pretty well. It was surprisingly not difficult to set my feelings aside so that I could focus on just enjoying the holiday and being with family. Every once in a while, though, it was hard. I knew from the start that our week would revolve around the baby and his schedule, because babies are pretty demanding little people, but it still was hard to have our schedules dictated by a baby that did not belong to us. It was hard to have our home filled with all of the baby supplies that we desperately wish we needed for a child of our own. It was hard to have so many constant reminders of what we don’t have but want so badly.

The first morning they were here, I woke up to my alarm, as usual, to take my basal temperature. As I lay there listening to the beeps of the thermometer, I also heard the gurgles and babbles and cries of the baby in our extra bedroom, the room that was supposed to be for our own little one, the room that we use as an office because it’s less painful than having it sit empty, waiting for a baby that never comes. That first morning, I remember thinking how surreal it was to have the life I was actually living so starkly juxtaposed with the life I wished I were living.

My experiences with infertility have left me feeling pretty broken, and I know that they have etched sharp and jagged edges on my personality. It’s so easy to become bitter and jaded, and that’s been a real part of my experience recently. This is not the person I want to be, but in some ways, it is the person I am right now. I’m working to overcome this, working to let the softer and more humble parts of me rise to the surface more often. It’s hard though, and I know I need to be patient and compassionate with myself as well as with those around me. I am a work in progress, an imperfect person just doing my best to keep my head up in spite of the challenges life has thrown my way.

So, even though it was hard at times, I am grateful that our family members were willing to travel so far to come visit us. I am grateful for the happy memories we made together, and I hope they outweigh any negative ones. I am grateful that they were willing to share their little one with us, and I am glad that it provided us with a reminder of why we are continuing on this path, why we are still fighting to have a baby of our own instead of giving up and moving on. And, as cheesy as it may sound, I am grateful for family and friends who love me, jagged edges and all, because that is truly what makes this life worth living.