Thursday, April 28, 2005

Say what?!

Surely they can't be serious?

Three days after receiving the heinous, hideous denial letter, this was in today's mail:

"The Clinical Coordination Department of Blue Cross Blue Shield of Massachusetts, after careful review, is pleased to inform you that the request for service(s) made on your behalf has been approved.

Place of Service: Doctor's Office

Type of Service: IVF


At this time we approve medically necessary services for a total of 3 (days)(services).

If it is medically necessary for you to receive services beyond 9/25/05, your provider should contact Blue Cross..."


Unless I am reading this wrong--am I?!--they have decided to reverse course and approve the IVF. This letter does not make any reference to the ICSI, but, by gum, it sounds like we won't owe the whole kit and kaboodle, regardless. (And what's the going rate for a kit, with and without the kaboodle? I heard a rumor that the kabbodle is about $1500; a much less scary proposition than paying also for the kit.)

This piece of (apparently) good news abruptly made the world seem so much prettier and cheerier and sunshinier...


 Posted by Hello

...that I wished I could go back to Bridalveil Fall and take the picture all over again, since I couldn't properly appreciate it at the time.

. . .


On that National Parks note, we are heading down to L.A. for a friend's 40th and to celebrate the 1st and 16th birthdays of two of my nieces; then, on the way back, we plan a detour to see Joshua Tree. Hear the torrential So Cal rains have created a wildflower wonderland out that direction, though it may be a little late in the year. Regardless, we will almost certainly take several hundred thousand pictures of oddly-shaped, spiny tree-cacti and bore you silly with them upon our return.

35 Comments:

Anonymous oliviadrab said...

HOT DAMN!!! That's the best news! I hope it is the kit AND kaboodle, but anything helps.

5:11 PM  
Anonymous Dooneybug said...

Oh, that's great news! I spent much time today on the phone with BCBS only to find out the RE I've been referred to is out-of-network. Insurance companies are so difficult. They won't help you get pregnant, but by golly, they'll help your man get an erection. They love Viagra! Anyway, I'm happy that they are going to cover something. I hope you didn't have to go through too much with the insurance company to get this result!

5:29 PM  
Anonymous Jenn said...

Imagine that, an insurance company doing something right!

6:14 PM  
Anonymous Anonymous said...

Good news!

Emily

8:05 PM  
Blogger Suz said...

Congratulations!!! Excellent news!!!

8:38 PM  
Blogger Mudbug said...

Hooray! Double triple with sugar on top hooray! (And hooray for more pictures, incidentally).

9:09 PM  
Anonymous Anonymous said...

Wahoooo!!!!

Good news, indeed.

BEAUTIFUL photo, Bugs. Felt like I was right there.

Moogielou

9:12 PM  
Anonymous Leggy said...

What a great photo- wow! Can you find a way to make a job out of photography, because you are incredible.

I would keep pushing them on ICSI (or keep your mouth shut first and see if they just pay the whole thing). If they don't pay for ICSI, I'd appeal. The more of a stink you make, the more likely they'll approve.

9:16 PM  
Blogger persephone said...

OMG, I'm so relieved.

I think you might have a good shot at them covering ICSI too. My guess is the male factor played a role in their agreeing to approve IVF before you met their required minimum # of IUIs, and if they concede that, it seems like they should admit ICSI was indicated too. (Unless I'm misunderstanding?) Of course they might not admit it up front, but once you've got them on the retreat, keep pushing.

Your doctor might be able to reason with them, too. Last year my HMO agreed to cover MRI breast screening (rather than just mammogram & ultrasound) due to strong odds of a BRCA mutation in my family -- but only for one breast, on the excuse that I felt a lump on that side. My surgeon said flat out "That's ridiculous" and got on the phone with them. A revised two-sided MRI approval was promptly in the mail.

In the meantime, hurray for the reprieve! And so glad to hear a smile in your 'voice'.

10:31 PM  
Blogger ankaisa said...

At least something is going right! I'm glad to hear you are feeling better, but I understand completely how a BFN puts you down.

2:20 AM  
Blogger Zeeks said...

I've been in lurky lurkdom, but wanted to come out and tell you what great news that is. Yippie!

3:26 AM  
Anonymous Anon said...

Ok, not to be Debbie Downer, but check the date on the letter and call to clarify what they are approving. Insurance companies make money by screwing with you -- the letter may be approving you for MORE treatment (which is great!) but denying coverage for what you already got. If you are lulled into believing this letter reversed their earlier decision, then you will miss your appeal deadline.

They are sneaky, awful bastards. Make notes of any conversations you have with them and be sure to get the name of the person you talked to.

My 2 cents....

5:13 AM  
Blogger wessel said...

It's more likely a case of the left hand not knowing what the right hand is doing. In a big insurance corporation, that sort of thing is par for the course. I'd say, don't question it! LET THE BILL GET PAID FIRST. If they find out later that they made a "mistake," they can come back and ask you for the money (you don't have to give it back, but they might drop you if you don't). But if you question them too much now and they all get to putting their tiny, moronic little heads together, they may find they made an error and not pay it after all. Just let them cut the check and don't worry about the rest.

5:55 AM  
Blogger Julie said...

Mozel Tov! Now put that letter someplace safe and fireproof. Like the safe deposit box in the bank.

When you are done your IVF and are holding your little baby in your arms, frame that letter :)

6:01 AM  
Blogger mutt said...

Coming out of Lurkdom to say "YIPPIDY SKIPPIDY DOO" Im so happy that your insurance had a change of heart :)

6:11 AM  
Blogger VHMPrincess said...

THAT IS SO WONDERFUL! I'm so happy for you!

7:06 AM  
Anonymous Molly said...

AWESOME!

What a huge relief!

7:51 AM  
Anonymous akeeyu said...

WoohoooooOOOOoooOOOOOOooo!

But also, um, what Anon said. Just in case.

8:05 AM  
Anonymous susan / holdingpattern said...

GREAT NEWS! I hope, I hope that it's for real.

9:27 AM  
Blogger Wavery said...

Yup, that'd do it for me too.

9:49 AM  
Blogger Anna H. said...

Now *that* is some good news...

xxoo

9:57 AM  
Blogger Mellie said...

So glad you got SOME good news. I hope it helps ease your mind so you can enjoy yourself on your trip. BTW, how can you be both a beautiful writer AND a beautiful photographer?

2:16 PM  
Anonymous Day said...

Woo hoo!
I too have BCBS of MA, and it takes some time for them to come around. I have a love/hate with them as they always keep me waiting. But they always come through.

I work in the insurance industry, and know firsthand that to renege on a written promise of coverage is an act of bad faith, punishable by triple damages. That means if they fail to pay the bill, they'll owe you the kit and kaboodle times three. The ICSI was doctor recommended, ergo, covered. Swear it. So enjoy the time away!

Also, WE LOVE YOUR PHOTOS. They are anything but boring, so please, click away while you're gone.

3:41 PM  
Blogger Cricket said...

Insurance! That's one reason I stay clear as best I can.

I remember once chipping 2 teeth (yes, I was drunk) and the insurance would only pay for the bill for fixing (bonding, cheap fix) 20% of the first tooth, none on the second. They said they only paid for the initial injury, nothing subsequent. I had to hope to not be in a car wreck, needing both a spleen removed and a leg cast.

I hope you get the $ for both - I agree, ride it out to see what they pay.

As a picture lover and a painter, I adore the pic. Peace.

7:10 PM  
Blogger amyesq said...

FanTAStic! You are way overdue for some good news. Have a wonderful trip - I wish I would have known you were heading down our way! I have heard the desert is marvelous right now.

9:21 PM  
Blogger Pamplemousse said...

Bugs, fantastic news on the insurance front. I can feel your spirits rising already.

Good trip you have planned. I saw a photo of the desert in bloom and it was a sensory overload so I cannot imagine how it would be in person.

I am looking forward to all your fab photos already.

4:00 AM  
Blogger Sandy said...

Beautiful picture...long overdue and good news. Yay on both counts!

5:10 AM  
Blogger K|nneret said...

Awesome! About time those insurance fools did something right. About time you caught a break.
I can't wait to see your lovely pics.

10:48 AM  
Blogger Kristin said...

Oh my God, what a gorgeous picture. So glda the insurance company is cooperating a little bit.

4:39 PM  
Blogger Internal Spring said...

BCBS of any state is just crazy like that - fantastic news - great state, great IVF mandates there - wish I was back in that great state.

5:49 PM  
Anonymous thisgirl said...

Great news Bugs, congrats.

9:22 AM  
Blogger TigerJen said...

Fabulous news!!! Wahoo!!! I can only imagine how relieved you feel.

9:59 AM  
Blogger ThreeBees said...

WOO HOO! That is great news Bugs!

10:49 AM  
Anonymous Anonymous said...

Yay! I am so so happy that this good news has come for you, sweets.

Karen/Naked ovary

2:18 PM  
Blogger April said...

Finally. Dear g-d do you deserve some good news for a change.

11:41 AM  

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