after spending the past several days making a zillion phone calls between my ob/gyn's office and the lab to have records faxed and get details on IUI procedures, plus reading online and in books and talking to folks who have firsthand experience in such matters, it was the insurance company that finally pushed me to actually think about our current course of action. go figure.
i called aetna this morning to find out about our deductible for fertility assistance; i knew we have $5000 per calendar year once said deductible is paid, but i wanted to make sure the deductible itself wouldn't cause us to go broke. and the representative i spoke to on the phone not only spent way more time and effort than i expected in our conversation about deductibles, but also offered me some advice about the whole situation. he kept saying throughout, "i mean, i'm just telling you what i know from my position, but you can do whatever you think is best..." but, in the end, i'm listening to the insurance guy.
for those of you who have been following along, you may remember that in the fall my ob/gyn referred the hubby to this private lab that doesn't take insurance for his semen analysis. it was only $125, and my doc suggested them, so we went with it. when those results came back iffy, my doctor proceeded to refer us to a urologist for next steps. this guy also wasn't covered by insurance (not just our insurance... ANY insurance) and was considerably pricey for even a consult. at that point i looked online for urologists the hubby could see that might actually be covered, but found none. i kind of shrugged and figured that fertility stuff wasn't widely covered and that we'd just have to suck it up and do a lot of our own research. no biggie. we're good at research.
so we did. we read about the sperm dna test and knew that we wanted to have that done. since we already knew what we wanted, it made sense just to go back to the same lab. thus we've been dealing with this lab, with varied amounts of satisfaction, since then... and planned to go ahead with the IUI through them as well. this was based on one very rushed conversation that the hubby had with a urologist who works with the lab. that is the only actual medical advice we've had since the initial referral for semen analysis.
but again... i didn't think we had many other options. we knew once the deductible was paid the rest of the costs would be covered, and it just seemed like the easiest route. in truth, i wasn't thrilled about it... particularly because it felt like we were simply going about it on our own. they're a private business -- you tell them what you want and they do it. of course they have medical knowledge. i spoke to a nurse. (what she told me didn't agree with some things i'd read about IUI, but i was willing to let that slide.) but when i talked with a friend of mine who had (successful!) IUI, she mentioned some other possible issues that we might need to explore, and i started to think that having an actual doctor advising us would be really, really nice. but again, i didn't think we had that choice under my insurance plan.
i have to say now that it does seem ridiculous. i live in new york city and i have fancy university insurance. i mean... really.
which is pretty much what the aetna guy said to me today. when i asked him about the deductible, he told me that the out-of-network one was $575, which is what we'd pay going through the lab. but then he said, "i'm just curious... what's the benefit of using this lab rather than an in-network doctor?" when i told him i didn't think there were any and he asked for my zipcode, he replied, "oh... no way. you're in new york." in an instant he pulled up a list of 111 specialists covered by my medical plan all within 5 miles of my house that could provide us with the same services as the lab. 111, when i found zero! how could this be the case? well, because he knew the correct terminology to plug into the search bar for these sort of things: "reproductive endocrinology," of course. in a thousand years i never would have come up with that. THIS IS WHY I NEED MEDICAL PROFESSIONALS. even medical insurance guys know more than i do.
so in a split second of decision-making, i called one of the offices that had a website i liked and good reviews online (http://www.kofinasfertility.com/index.html), had a pleasant conversation with a woman on the phone, and scheduled a consultation for tuesday morning! the deductible for in-network doctors is only $150. AND they're real doctors! with offices in places like brooklyn, where i actually LIVE!
this means, most likely, that we won't do the insemination this cycle... because i will probably ovulate next week. but, in the end, the advantages of having a doctor to guide us through this AND saving a bunch of money will outweigh an extra month's wait time. i am feeling much more calm and confident about the whole thing now that we're not flying by the seat of our collective pants. i mean, i know we don't have all the time in the world. but we certainly have the time to be smart. right? right.
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