insurance nightmare (with a happy ending)

We have our health insurance through UnitedHealthcare, but our prescription coverage is through CVS/Caremark. CVS/Caremark has a specialty pharmacy (mail order) that supplies fertility, chemotherapy, multiple sclerosis, etc. medications. I have been so impressed with them (and the coverage for fertility meds is amazing ... Dr. Schmidt's nurses have told me that we have some of the best prescription drug coverage they've ever seen!) since I started the injectable meds. I just call them to order the refill, and they overnight (for FREE!) the meds to me so I get them the next day. I've never had any issues with them ... until this week.

After I had the ultrasound with Dr. Schmidt on Monday, I met with Carol (one of his nurses) to go over the new injectable meds (she showed me how to mix them, inject them, etc.). She told me that she was going to fax the prescriptions to CVS/Caremark that day, and I should call the next day to arrange delivery. So, I called CVS/Caremark on Tuesday afternoon. The person I spoke with told me that the medications required prior authorization. When I asked for more information about that, I was told that my doctor had to provide this prior authorization before the prescriptions could be filled. I called Carol and left her a voice mail explaining this (I was in panic mode at this point, since we were running out of time to get the meds to me so I could start them today). It was late afternoon at that point, so she called me back on Wednesday morning. She said that she had just waited on hold with CVS/Caremark for over a half hour before finally getting a live person. That person then transferred her to someone who assured her that the authorization would be faxed to her that morning so she could complete it and fax it back. I was really starting to panic, but trusted that the fax would be sent that day. Carol called me back at 3:00 and said that she had she spent over 2 hours that day on the phone, being given the runaround about this fax that she never received. She asked me to call CVS/Caremark at that point, and try to get something done from my end. I was so upset (not with Carol ... she went above and beyond). She gave me the phone number of the person she had been working with, and I tried to call this person. Of course, it went to her voice mail. I then called the number that I call to get my refills mailed to me, and the person I spoke with was not helpful at all. She said that my only option at that point was to pay out of pocket and hope to be reimbursed by them (NO guarantees) after the fact. She told me that the meds would be almost $3,000 out of pocket. I lost it. I was a crying mess at that point. There's no way I could come up with that kind of money on the spot, especially without a guarantee that I would be reimbursed. I cried all afternoon that day. I was so afraid that this wasn't going to be resolved by today, meaning that this cycle would be ruined. 

Side note: I worked three 13+ hour nights in a row this week (M-T-W), and was barely able to sleep on Tuesday or Wednesday during the day (because I was so worried about this). So, the sleep deprivation was not helping matters at all. 

I was driving to work at 6:30 on Wednesday evening when my phone rang. It was the person at CVS/Caremark. She was very apologetic and explained that since it's the beginning of the year, almost everyone's insurance company requires prior authorization for specialty (including fertility) meds, so the authorization department was very backed up. Fighting back the tears (unsuccessfully), I explained to her that I HAD to have those meds by today, or this cycle would be ruined. She said that she had gotten permission from the authorization department to call Carol the next morning (Thursday) and take verbal authorization instead of a fax. She assured me that once this verbal authorization was obtained, I would be able to order the meds to be overnighted to me for today. My tears of sadness turned to tears of joy (all of these hormones make me an emotional mess, and I am not normally a crier!!), and I thanked her profusely. I called Carol and left her a message explaining everything. She called me the next morning and said that she did the verbal authorization, and everything was good to go. I thanked her, thanked her again, and then thanked her one more time before we hung up. She has been amazing. I had left her a tearful voice mail at some point this week, and when she called me back, she said that she got tearful listening to my message. They all care about their patients so much ... such a refreshing change from some doctors out there. 

I called CVS/Caremark and arranged for delivery. I asked for the total due, and the person I was speaking with told me $200!!! What amazing coverage ... remember, I was going to have to pay $3,000 out of pocket!!! The person on the phone assured me that the meds would be overnighted that afternoon and I would receive them by 3:00 today. Things were starting to look up again.

This morning, I got an email from CVS/Caremark saying that my prescriptions could not be processed because they were not authorized. WHAT?!?! The tears flowed again as I called them to find out what was going on. I waited on hold for almost a half hour before getting a live person. The person I spoke with said that the meds had indeed been mailed out yesterday, and the email was a mistake. As she was waiting for the shipping information to come up on the computer, she said there was a chance that the meds were delayed in transit by bad weather, and I wouldn't get them until Monday. *Cue tears again* I sat there with tears running down my face, waiting for her to confirm a delay or no delay. She put me on hold for about 5 minutes, and finally came back and said that my package was in Columbus, and it would be delivered to me by 3 PM today. I should have been ecstatic upon hearing this news, but I knew that I wouldn't relax until that package was in my hands. 

I had a bunch of errands to run today, but when I pulled into my driveway at 4 PM, that beautiful package was sitting on my front porch. I felt the stress and tension disappear from my head, neck, and back muscles. What a stressful week. 

I gave myself the first injection this evening. OUCH! Up until now, none of the other injections really hurt at all (other than the initial pain of the needle going into my skin). This one burned and stung like crazy as I injected it into my abdomen. Yikes! It's going to be a long 10 or so days of injections. Oh well ... if this gets me pregnant, then it will be worth every ounce of pain.

I've been having significant ovarian pain (both sides, although the right side is worse) since yesterday afternoon. I spoke with Cathy (one of Dr. Schmidt's nurses) today regarding the pain. She said that it was most likely caused by my ovaries producing several follicles. I haven't had that pain at all until now, so I am feeling optimistic that the meds may be working better this time.

I recently realized that I have become "that person" ... the one I swore I would never become. I have known people who went through fertility treatments, and I have spent plenty of time reading posts in online infertility support groups. I used to think some of these women were a little nutty ... becoming so focused on getting pregnant that they lose sight of other things in their lives ... figuring out several weeks ahead of time when ovulation will be occurring and making sure that their schedules are open during that week since you don't know until the last minute when insemination will be ... dreaming about being pregnant ... etc. Indeed, I have become that person. It's kind of comical, I guess. I know that I am not alone. So many people struggle with infertility, and they feel the same things I'm feeling. I just wish I could figure out a way to accept the fact that I may not get to experience pregnancy. I'm not at that acceptance stage yet. Dealing with infertility seems a lot like grieving. There are five stages of grieving ... denial, anger, bargaining, depression, and acceptance. I have experienced each of those so far, but I haven't gotten to the acceptance part. I get so angry and sad sometimes, thinking about how many babies are born to parents who don't want them. Then there's us (and all the other couples who struggle with infertility), who would give anything to have a baby. It all just seems so unfair. I guess life isn't fair, though ... right?

I think about my parents and how much I want to give them a grandbaby. They would be the most amazing grandparents. I think about Brian and what an amazing dad he would be. He is a kid magnet. He attracts kids everywhere we go. Kids think that he is just a big kid. :) I think about my sister. She would be the most fabulous aunt. I just feel so out of control in this journey. I have no control over this situation. We can do everything that an infertility textbook says to do, and we still may never get pregnant ... and if that happens, we may never even know why we couldn't get pregnant. It's all just so surreal.

Enough rambling. I'm trying to stay optimistic. There's no other way to be. 

new protocol and once again feeling hopeful ...

I had my baseline ultrasound today. I am always touched by how genuinely sad Dr. Schmidt is when he sees me at this time every month. He also thought that last month was really going to be the month. He told me today (as he does at this baseline ultrasound every month) that he wouldn't be putting me through all of this if he didn't truly believe he can get me pregnant. That is always so reassuring to hear from him.

Dr. Schmidt decided today that he is going to try some different meds on me this month. I am going to take the Femara pills (like last month) today through Thursday, and then I will start the new meds on Friday. I will be taking 1 vial of Menopur and 2 vials of Bravelle (subcutaneous injections in my belly) each day until it's time to ovulate. The dose may be increased if my follicles aren't responding appropriately. These meds contain FSH (follicle-stimulating hormone) and LH (luteinizing hormone), while Follistim only contained FSH. Dr. Schmidt is hopeful that these new meds will make me produce more and bigger follicles. He also thinks my estradiol levels (this is what is checked each time I get bloodwork during the next couple weeks) will be higher than they have been all the other cycles, and this is also a very good thing. Both of these meds are made from the purified urine of postmenopausal women (and one of the books I read said that these postmenopausal women are actually nuns somewhere in Europe!!). Craziness!!

So, once again, I am feeling optimistic. I love that Dr. Schmidt likes to change up my protocol when the last one didn't seem to do the job. These new meds sound more promising than any of the ones I have taken before. I am SO hoping that this will be the month. After my period started on Saturday, I calculated what my due date will be if I get pregnant this cycle (I do this every month). If I get pregnant this time, my due date will be my sister's birthday ... October 29th! I think that is good luck. :)

So, my next ultrasound and first blood draw of this cycle will be next Tuesday, 2/1. February is my birthday month, so I hope this will be my best birthday yet! :)

ramblings

I got my first period when I was 10 years old. Ever since then, I have had very irregular periods accompanied by bad cramps. I spent the majority of my teenage years and a good part of my 20's taking birth control pills to regulate my periods. I always dreaded that time of the month.

Since I started going to Dr. Schmidt, I have developed a love/hate relationship with my period. For the most part, I still hate my period ... now more than ever, since it means another failed cycle. But there have been a few times during this process when I have anxiously awaited my period. This week was one of those times. After my blood test on Tuesday confirmed that I wasn't pregnant, I wanted my period to start right away. I waited and waited, and it finally started a couple hours ago. This is the beginning of a new cycle, and I am happy to have a fresh start. Of course, I am going into this new cycle hoping that this will be "the one". With each progressive cycle, I feel a little less optimistic. I guess you could call it self preservation. When I don't get my hopes up as high, they can't come crashing down as much when I don't get pregnant. Of course, no matter how hard I try to not get my hopes up, they go way up anyway. I guess that's human nature. In any event, I will see Dr. Schmidt on Monday morning for my baseline ultrasound. I will also start either the Follistim injections or the Femara pills that day. I'm guessing he will have me start with the Femara pills again, since I seemed to respond well to those last month. 

Here's to a new cycle ...

confirmed: not pregnant :(

I got a call from one of Dr. Schmidt's nurses this morning ... the blood test confirmed that I am not pregnant. Very sad. :( Now, I just have to wait for my period to start, and then we will start over again. We are going to do one more cycle of IUI. If that doesn't work, we will meet with Dr. Schmidt to discuss our options. I'm guessing we will be looking at IVF (in vitro fertilization) if this next cycle of IUI doesn't work. Now, I am going to hurry up and wait ...

big fat negative :(

Today was the big pregnancy test day. I was beyond excited that I made it to the test day without my period starting. My cramps from Friday seemed to subside over the weekend, and I began to think they were pregnancy cramps instead. I got more and more excited as the weekend went on. I even bought the extra expensive pregnancy tests this time ... the ones that actually say "pregnant" or "not pregnant" instead of just the one or two lines. I was so sure this was the month that I would see "pregnant". It wasn't meant to be. The test was negative. When "not pregnant" showed up on the little screen, my heart sank. As always, my hopes and excitement were crushed very quickly. I called my doctor to report the negative test. My voice shook as I told the nurse my sad news. She was sad for me and said "it gets harder every month, doesn't it?". She couldn't have said it more perfectly. It truly does get harder and I feel sadder every month. The nurse told me to go get a blood draw today just to confirm. I did that this afternoon. So, tomorrow I will know for sure. I am very sad today.

I hate cramps

Well, it's about that time when I stop feeling so optimistic and can no longer ignore those dull, all-too-familiar cramps. I started to feel them yesterday and kind of denied that they were there. Today, they are hard to deny. I have a feeling 1/1/11 may not have been such a lucky day after all ... :(

good books about infertility

I forgot to add in my last post that I have been reading some really good books that deal with infertility. I have read one in its entirety, and skimmed the other two (with the intention of reading them soon), and I have been very happy with all three. It is very comforting to read that others have been in my shoes and ended up getting pregnant. I also learned some new things (this was a pleasant surprise, because I have researched infertility ad nauseum on the internet). In case anyone reading this is struggling with infertility or knows someone who is, here are the titles (and links to the books at Amazon):

Waiting for Daisy: A Tale of Two Continents, Three Religions, Five Infertility Doctors, an Oscar, an Atomic Bomb, a Romantic Night, and One Woman's Quest to Become a Mother

Navigating the Land of If: Understanding Infertility and Exploring Your Options

So Close: Infertile and Addicted to Hope

Happy New Year!

Insemination went well this morning. We arrived at the lab at 7:30, and Brian went in to do his thing. :) I waited in the car. It's fun to people watch during this time. We were one of the first cars to arrive, so I watched several others pull into the parking lot after Brian went in. With each car that arrived, I watched a guy get out and head inside while his partner stayed in the car.

*Going off on a tangent for a minute or two ... this whole process is so surreal to me. Guys really have it easy (relatively speaking, since I know for certain that no part of dealing with infertility is easy) in this whole infertility journey. They get to do something that is enjoyable, while we girls have to endure quite a bit. Each cycle, there are at least 5 internal ultrasounds (each of which is very unpleasant, and no matter how many I've been through, I always dread them), and each ultrasound is preceded by a walk to the lab next door to have blood drawn. Then, there's the actual insemination process. While I wouldn't call it painful, it's certainly not very comfortable to have a catheter inserted through the cervix and up to the top of the uterus. Oh, and don't forget all of the side effects from the numerous medications ... severe moodiness (poor Brian is so patient with me), bloating, cramps, hot flashes so bad that I want to jump out of my skin, emotional swings, etc, not to mention daily injections in the belly. Don't get me wrong ... every minute of this will be worth its weight in gold if I get pregnant. And then there's the month-to-month emotional roller coaster ... each cycle starts out with so much hope and optimism, which ebbs and flows until insemination. Leaving the office after insemination, I feel so incredibly optimistic, and while I'm telling myself over and over not to get my hopes up, of course my hopes are up in the clouds. Then, the agonizing 2+ week wait begins. Those days drag like you wouldn't believe. Then comes the devastation of seeing that dreaded red spot on the toilet paper or in my underwear, even before the big pregnancy test day arrives. The crushing realization that another cycle has resulted in complete failure is such a sad and lonely place to be. Oh, how I long for the month when I actually reach the pregnancy test day without bleeding, and oh.my.gosh, see a BIG FAT POSITIVE!!!! Oh, the tears of joy will flow. I am getting teary just thinking about that day. Even in my darkest moments of this journey, I DO believe that day will come for me. I have to keep believing. Once I stop hoping and believing, this journey becomes futile. *End of tangent (even though I could go on and on ...)


So anyway, about 20 minutes later, Brian came out and got in the car. I never quite know what to ask him about his experience in the lab. He answers my questions, though some answers come more reluctantly than others. :) In any event, that part is done, and it's time to go have some breakfast and hang out until we have to be back to the office at 9:00. We went to a nearby Bob Evans and enjoyed a leisurely breakfast. We headed back to the office at about 8:45, and sat in the waiting room with about 8 other couples. I have to say that this whole experience has brought Brian and me so much closer. Our relationship has reached a new level since we started this journey. Dealing with infertility has certainly brought us sadness and stress, but I feel like we have bonded so much, too.

After about a half hour, the nurse called us back, we went to a room, and I did the usual "strip from the waist down and sit on the exam table with the paper sheet over my legs". Dr. Schmidt came in a few minutes later with the vial of liquid gold. :) He is such an amazing doctor. He has such a calm, comforting nature, along with a great sense of humor. He is terrific, and I am so thankful that he is leading us through this journey. So, it was time for me to assume the position ... one foot in each stirrup and all my girl parts exposed. ;) He inserted the speculum (he warms it up first, which is really such a nice little touch) and then inserted the catheter and slowly injected Brian's super sperm (as Dr. Schmidt calls it!) into my uterus. Then, he gave me some parting instructions ... "Lay here for 10 minutes, and the next time I see you, I want to be doing an ultrasound to look at your placenta and growing embryo". :) That sounds like a good plan to me!

So, I will have my blood drawn next Saturday (1/8) to check my progesterone level. I just remembered that I meant to ask Dr. Schmidt about taking progesterone supplements, since my progesterone has been low the last few cycles. I completely forgot to ask him today. :( So, I will call on Monday. Hopefully it won't be too late to start taking them at that point. The big pregnancy test date is January 18th. :)

Brian said to me when we got home today, "Wouldn't it be cool if we conceived our baby on 1/1/11?". Yes, it would be very cool indeed. The only thing left to do is lots of hoping and believing for the next 17 days ...