Is That Even Ethical?

Writing this blog has been super therapeutic for me, but it’s also been incredibly difficult. Each chapter of this experience I write, I leave behind, the second I hit save. But before I can close the door on a distant memory, I pour out every single emotion I felt during that moment in time. That’s probably why this specific chapter took me so long to write.

I remember calling the Insurance Company, and getting through to the appropriate department that handles coverage questions. I was transferred to the Supervisor. I told her all about our situation, and I asked her if it was possible the insurance company would reconsider the mandate, and insure my case. She told me it’s happened before, but the chances were slim. I told her I wrote a letter, and so did my Doctor, both explaining why I was an exception to the protocol. She told me they didn’t want to see my letter. The decision was based off of medical coding, and perhaps the doctor’s letter might be beneficial.

Meanwhile, Michael and I were also in communication with his work’s insurance broker, Rona. She sincerely cared about our case, and went above and beyond to research similar claims that had positive outcomes. She reached out to her uppers for guidance, and provided us with direction. If we wanted to move forward, we would need to go through South Jersey Fertility Center’s billing department. They had the information the insurance company required to make the decision. This sat uneasy with me. I had to trust someone, who had no personal connection to me or my case, to fight my battle.

I hate thinking about that day. The day Sandy from the billing department called me. She sounded tired, and irritated. She told me 95% of the time the insurance companies will not budge. She told me if I went through with this claim, and the Medical Director denied me, I would go without IVF coverage for at least one year. I could go through a lengthy appeals process, but even then, I would most likely be unsuccessful. It was so harsh, so negative, and so disheartening. I didn’t feel like my individual case was being acknowledged. I was just being thrown into the mix of hundreds, possibly thousands of others that felt they too were an exception. Maybe they were, maybe they weren’t, but were not comparing apples to apples. Every case is so different. My case deserved to be evaluated thoroughly. “Did you even read Dr. Sawin’s letter? Do you know anything about me, or my case?” I asked her. “They can’t force me to do something that is going to hurt me, and possibly hurt my chances of getting pregnant in the future, that’s unethical” I said. She told me she was just giving me the facts. I didn’t appreciate her ugly truth. When we hung up, I felt defeated. I was pinned before the chime to swing went off. I called Michael and wept. I called my Mom and cried harder. How could life be so unfair? Maybe it was time for a second opinion. I called Penn Fertility in Philadelphia, and scheduled an appointment. I needed to make sense of all of this.

It took a few weeks, but I was finally able to get in to see one of the Penn fertility doctors. This place was impressive. They moved fast, and they did not mess around. My mom and I met with Dr. Garcia. We explained everything I have gone through so far. I then brought her up to speed on my battle with the insurance company. I told her I was afraid to open the case, because I was scared of being denied coverage. She was incredibly reassuring, and a breath of fresh air. “They can’t force you to move forward with treatments that are medically proven to be unsuccessful and dangerous for you,” she said. She told us everything we have done so far, everything South Jersey has done for us, is exactly what Penn would have done. We even discussed Dr. Sawin’s IVF recommendations, and she was on board with them all. “It sounds like you have a good team behind you already, but if you want to make the switch, we would be happy to move forward with you,” she said. I asked her about the insurance claim, and she told me she has a team that takes care of those calls. She brought in one of the young ladies from their billing department and explained our situation. This young lady had a ‘o hell no’ attitude, and right away was prepared to get the Blue Cross’ insurance nurse on the line to argue my case. I loved her drive. She told me Susan was who they dealt with from Blue Cross, and she’d be happy to give her a call on my behalf, and look into this for me. I told her I wanted to call Sandy at South Jersey first, and that I would be in touch.

Susan. I got the name I needed. I called Blue Cross, and by the grace of God and the help of one of the nicest insurance agents ever, I was transferred to this Susan lady. She told me she doesn’t usually discuss cases with patients, but I managed to keep her on the phone for almost an hour. I learned Susan also works closely with South Jersey Fertility Center. I told her all about my journey, and got emotional when I begged her to understand my plea. She too discussed the risks of opening a case that goes before the Medical Director, but shared some new insight with me. Before cases go to the Medical Director the nurses review the case. They can approve or deny right away. If they are unsure, that is when the case goes before the Medical Director. If a case goes before one of the nurses, and is denied, we do not risk the 12 month coverage freeze. She encouraged me to open the case, but make it very clear I did not want the Medical Director under any circumstances to review my case.

My next call was to Sandy. She was a completely different person. I told her all about my trip to Penn, and my discussion with Susan. I don’t know if she finally got around to reading Dr. Sawin’s letter, or couldn’t believe I had the support of one of the insurance nurses, or maybe she was just refreshed from coming back from the vacation I know she was on, regardless, she was happy and hopeful for me, and willing to do exactly as I asked.

I wrote a thank you letter to the team at Penn, and told them I was going to continue my journey with South Jersey Fertility Center. To this day, I am so grateful for their time, support, and feedback.

I was told it would take 10-14 business days before I heard a response. If I was denied, were we really going to fork out $25,000 + or would I suck it up and go through another two cycles of injections and IUI, so we could move forward with IVF coverage? Would I take a break all together from fertility treatments, and try naturally? I was so nervous. I had lost all control of the situation. It was in Gods hands. What would he decide for us?

I’ll never forget that Sunday in church. My Mom went with me, and thank goodness she did. The homily spoke about getting through difficult times, and being victorious in the end. Father Harte preached about trusting God to come through when we need him most. I needed him so bad, and I felt guilty for that. I wanted to be victorious. I wanted a sign. I wanted him to know I was suffering. I also wanted him to know, that as scared as I was that this was not going to workout in my favor, I trusted him. I knew deep down he had a plan, and I wanted him to know that if we weren’t victorious, I would still love him.