I’m a week into my IVF cycle, which means I started my Lupron last Friday.  I don’t do birth control pills because they make me crazy, and for no good reason, Lupron doesn’t.  As much.  Anyway, since I’ll be using my Chicago clinic, I’m doing “outside monitoring” at my local clinic.

Apparently, patients doing outside monitoring can’t be trusted, because even though my clinic is in my Blue Cross network, they refuse to send my claims in for me.  I have to pay up front.   I had to ask for an itemized bill last time, which you would think they’d give me, knowing I’d need it to send in my own claim.  Blue Cross suggests that being in-network means that they should process my claims for me, but they refuse. I don’t know yet if they are charging me the Blue Cross-negotiated fees, since they are making me pay up front; and if they are overcharging me, I don’t know how I’ll deal with that, since I’ve already paid.

I’m not sure I even have a chart.  If they do have a chart for me, it’s not where the other charts are; no one can find it.

It’s strange.  Usually, you go to the clinic and they tell you what drugs to take, and when, and then they tell you when you’ll have to go in for bloodwork and ultrasounds and stuff.  But since my Chicago coordinator is pulling the strings, she tells me when to go to my local clinic.  I have to go on Monday, so I called today to make an appointment.  Since I am, apparently, not a “real” or valued patient, my request to come in for ultrasound / bloodwork on Monday struck them as odd.  Even though that’s just about all anybody comes in for, particularly since they’re probably on the “batch” system, where every patient is at the same place in her IVF cycle.

I was transferred to a coordinator, who I have talked to several times, and who has received the mysterious “orders” from my Chicago clinic.  Once she finally could make sense of my bizarre request for this routine check, she asked if I could come in at 8:30; which I cannot, because (and I say this guiltily) I have to drop my son off at daycare.   So she says, “Can  you get here before 9?  If you can get here before 9… well, the labs have to go out the same day, and I can’t guarantee you’ll be seen.”

Seriously?  You send your stuff to the lab at 9?  No, actually, I checked – they send their stuff out at 11.

(for the non-IVF veterans: the clinics usually like to get lab results back same day so they can tweak meds, and in some parts of the cycle, one day matters).

Fortunately, the ultrasound tech and the blood drawing person have been extremely nice and professional.  Thank heavens for that, since one is supposed to be penetrating me with a foreign object, and the other sticking me with needles.

I’m slowly figuring out something that lots of Americans already know: all patients are not alike.  I have certainly experienced bored receptionists and snippy nurses and condescending doctors, but this is different.   Even though Blue Cross pays them for the services they do render, apparently I’m their red-headed stepchild because they won’t be making very much money.  Maybe they mark up their retrievals and transfers even more, and that’s where they really make the dough.  It’s not so much rudeness, although that’s certainly present.  It’s also the subtle ways that they make sure I’m excluded.  I don’t really get appointments, just vague remarks about what my chances are of being seen at a certain time.  You would think that if outside monitoring was so bizarre, they would remember me, the oddball, but no.  As with any bad customer service, I have to start from the beginning with every person I’m transferred to on the phone.   I already have “belonging” issues, so that makes it worse; but there is a definite pecking order among their patients, and I’m low in it.

I remember a few years back when a young friend of mine without insurance discovered she had some female trouble requiring a minor procedure.  She had cash money to pay for whatever needed doing.  Several of her friends and I eagerly recommended our cherished gyns and ob-gyns.

Our friend could not get in the door to see any of our doctors, because she was uninsured.  Even though she could have paid full price, every single one  refused to see her.

I was appalled, and embarrassed.  In the end, my friend got compassionate and professional medical care from Planned Parenthood, and they were the only doctors who would see her.  That is just another reminder that PP is not the evil “abortion mill” that certain elements would have you believe.

There are plenty of people out there like my friend who are completely uninsured, or paying out-of-pocket for their infertility treatments or whatever.   I’m finally getting a taste of the shoddy treatment some of them are getting.  I’ve heard horror stories of monitoring clinics that didn’t bother to call with beta numbers, or send out labs on time and I shouldn’t be surprised if that happens to me.   I’ve been a health insurance princess for most of my life, and this is an eye opener for sure.  Money is king in health care and I don’t know why I kid myself that it isn’t.

The only thing I can do is try to be as nice as humanly possible.  Some of these people will be the ones calling to tell me my beta results, or shoving the ultrasound probe back and forth inside me to find the gestational sac or the heartbeat.  I really need those people to be nice, and compassionate.

But I also have to remember that I do have insurance, a husband, a child, and frozen embryos.  In other words, I am seriously encumbered with good fortune, and if my clinic doesn’t roll out the red carpet, I’ll survive.

and blog about them… by name… and put them in the “clinic feedback”  file of my listserv… and complain to Blue Cross…. (evil chuckle).