I was "misinformed"

This week was somewhat busy.  Meds were ordered, insurance pre-authorizations were put in place, I had a follow-up with my doctor, bloodwork was drawn today, and I started estrogen priming today.

My bloodwork showed that I ovulated so that allows me to start the estrogen priming phase.  This is just to even out follicle growth and reduce the likelihood of a cyst.  So all is good there.

On Monday, the rest of my meds were ordered.  The pharmacy called me and told me that I had exhausted my $10k lifetime max for meds.  Huh??  I wasn't expecting this news since the insurance rep told me way back in January that I was starting with a clean slate as far as infertility expenditures were concerned and that I was at $0 for both meds and medical amounts.  It wasn't that big of a deal with my pharmacy - they were just going to order different variations of the same thing to make it cheaper for me and closer to what I was expecting.  One thing was for sure though - I had depleted my meds max.  Ugh.

So then I got on the phone with the insurance company.  I spent an hour (45 minutes of which I was on hold) trying to verify the amount applied toward my med max and trying to figure out how the infertility medical benefit was managed.  I told them about the conversation I had in January regarding my lifetime expenses and was told "Ummmm...unfortunately ma'am, you were misinformed".  W.T.F.?!?!?!  I was told that my meds had indeed reached the limit and my medical would likely have a similar issue.  I asked for a review on the med amount and they will get that back to me in 2 weeks.  At that point I had to get back to work.

I called them back later and spent a similar amount of time on the phone again - I do NOT have unlimited minutes on my cellphone, mind you.  Grrrr!  So in terms of medical costs, the rep told me that she showed $0 applied toward my lifetime max BUT if I knew that to be incorrect, then it would probably be incorrect once the claims were run.  Huh??  Lol...just LOL!!  The lack of information that these insurance companies give it's customers is just unbelievable.  "Well this is what we 'think' it will be, but we could be totally wrong."  That is asinine!  So they are doing a review on the medical amount too which will also take 2 weeks.  The thought of waiting 2 weeks while being on stim meds to see how much of my $15k+ IVF cycle was going to be covered combined with the fact that the rep told me in January that I was ALL GOOD and had a ZERO BALANCE was just too much.  I flipped out on the rep.  2 hrs of pent up frustration and anxiety for the future came spilling out.  For some reason the rep decided to help me research the issue a bit more in depth.  She looked up all my claims dating back to 2012 and came up with a number just short of $5000.  That just doesn't seem right to me at all.  But she said that those were the expenses that she was seeing and costs applied toward infertility depend on a couple things (hence the reason for it taking 2 weeks to figure out).  When they say a cycle costs $10k, first there is the in-network discount, then there is the coding.  So for my last cycle, only a fraction of the $10k cycle fee was actually paid - the rest was an in-network discount.  Then there are things like ultrasounds, bloodwork, anesthesia, other lab fees, that are not technically infertility related.  So I don't know.  I bet the amount on my tally so far is like 3x that $5000 number - but hey - it's under $25k.  The worry I have is that my max now includes diagnostic services as well.  So back when we were just starting to figure out what was going on - all the HSGs, hysteroscopies, doctor consults - that will all go toward the max amount.  So I just have to sit tight and wait.  At least whatever response I get in 2 weeks will be official and indisputable.  Pretty bummed about all this though and it REALLY stressed me out on Monday and Tuesday.  Hubby says I should talk to my HR dept about it since they decide on the med insurance plans and options.  Maybe they could fight for me.  I may do that but I did not have the time after spending hours on the phone with the insurance company.  Hubby also kept reminding me that outside of talking to HR, I can't do anything about it which is true.  But still - I want to KNOW how much this will cost!  It could be way more than we bargained for.  All in due time I suppose.

So for now, since we indeed cannot back out or anything at this point, I'm trying to focus on the bright side and starting to plan our trip.  If my period comes when it should, we will get to NJ on the 28th and stay until the 3rd or 4th.  Our doc thinks we have an excellent chance for success.  Meds are all here and ready to go.  Started estrace today and expecting my period to come Wednesday or so next week.  Then on day 3, it'll be go time!