ill gotten gains

I am slowly starting to understand the U.S. health care system.  Too slowly, as today’s most recent debacle proved, but I am making progress.

For random specialized services and drugs (including trigger shots but NOT including oral ovulation inducers or progesterone (? ok..)), my insurance requires prior authorization, which takes 5-7 working days to be processed.  Prior authorizations can only be submitted by the clinic, not by me.

Apparently no prior authorization requests have been sent for any of my upcoming services.  I do not know why.  I have a phone appointment with the financial coordinator tomorrow to discuss what needs to be done.  I am pretty sure this is going to eff up my upcoming cycle, unless there is something I am missing.  Maybe just make it a bit more expensive, since I think only the baseline ultrasound would be affected by this timeline. I should be able to get approval prior to trigger and IUI.

Other exciting things you can find out when you get someone other than your clinical care coordinator to look into things: no one submitted anything for my call with the genetic counsellor (which would have been covered at 50%).  It’s no good to claim it after, the authorization has to be requested before you go through with the procedure/meeting/etc.  You don’t have to have authorization in your hands, but you do have to have requested it (wait, maybe this will solve the concern above re: this cycle, hmmm).

I am tired of sucking up costs incurred because my clinical coordinator is a dip.  I’m tired of running into road blocks I didn’t know existed, and timelines that suddenly compress because of things I thought were under control being, in fact, entirely neglected.

I’m so early into all of this, and already I am angry and tired and frustrated and sad.  I haven’t even had a cycle at the clinic yet.


Leave a Reply

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s