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Here's my update. AF showed on Tuesday morning and by Tuesday afternoon was normal flow so I guess April 19th was cycle day 1. I have a Rx for one more round of clomid which I picked up yesterday. My Dr. told me to touch base with him if I hadn't conceived by the end of the second cycle. So, I called him on Tuesday and told him I wasn't pg. He suggested I call the RE I saw when ttc Curtis. I called the RE on Tuesday afternoon and found out that they had to retrieve my file out of storage so it would be a week before I could make an appointment and then it was about a 2 week wait. No big deal. I asked her if I needed a referral from my OB/gyn and she asked what insurance i had. I told her Aetna and she said they didn't accept Aetna. When I saw her 4 years ago, we had Blue Cross. I asked her what my options were and she said I could pay out of pocket (yeah right!) or I could find another RE. Let me also tell you that when I was seeing this RE we lived in Troy a 1/2 hour away. Now, we live about 7 minutes from this RE.
So, yesterday I looked online to see if there were any RE's around here that accept Aetna. Wouldn't it figure that the only 3 that accept my new insurance are all back in Troy where we used to live? Quite ironic!
Anyways, this morning I wrote down info on all 3 and started calling. I wanted to see if they were accepting new patients and get an idea of protocol seeing as how I have 1 child and I didn't want to start over from scratch. Well, the first one I called wasn't open yet and it was 9am. Sorry, I'm not a patient person. I need someone who opens earlier than that!! We all know we want answers immediately! lol The second one I called I wasn't thrilled with the receptionist. The third one was awesome. Even the receptionist was knowledgeable on procedures, insurance, told me that they wouldn't start over with me as long as I was able to get my records. She said they understand their patients want to be pg as soon as possible so they wouldn't him and haw around figuring out what to do with me. I then called my OB/GYN and told them I needed a referral to go see this new RE. She wasn't sure I needed a referral with Aetna, but she said she'd do it anyway.
So, then, I called Aetna and asked if I needed a referral. They said yes and that in order to get infertility benefits I would have to enroll in their infertility program. No big deal. She gave me the number to call. I called them and they asked me a series of questions. Then she floored me and said, "I'm sorry at this time you don't qualify for infertility benefits because you've had a successful conception in the last 12 months." I was completely floored. I didn't fly off the handle, but regrouped and instead said, "but both pregnancies ended in m/c, so how is that successful?" I said to her that there must be something we can do. She thought for a minute and told me that the only way around it was to get a referral from my primary doc (not ob/gyn) to go see an RE for "repeat pregnancy loss". Then, after a consultation or two if the RE deemed that my "repeat pregnancy loss" was from an infertility issue (for example a hormone defficiency) then the RE could send them documents saying my repeat pg loss was from an infertility issue and they would enroll me in the infertility program immediately.
So, I called my primary Dr. and they said that they needed documentation from my ob/gyn faxed to them saying that I needed to go see an RE for repeat pregnancy loss. Then, my primary doc could get a referral from insurance. So, then, I called back the new RE who I made the appointment with and explained to her what was going on and she said they would definitely still accept me under "repeat pg loss" and that I would just need to explain to the Dr. at the consultation that somehow we needed to find a way to get classified as infertility and into the infertility program through insurance. She said it probably wouldn't be a problem. By the way, my primary Dr. is associated with Beaumont Hospital and the RE I want to go see is associated with Henry Ford hospital. So, the woman (Anna) at my primary docs who does referrals told me that Aetna probably wouldn't approve me to go to this new RE because they weren't affiliated with Beaumont hospital. Hence, another call to Aetna to find out if it's okay to have different docs with different hospital affiliations. Aetna said it wouldn't be a problem. Oh, the RE that I called first, I ended up calling them back because they are a Beaumont affiliate but they're not booking appts. until July.
So, as of right now, I went to my old RE this morning and signed a medical release for my records. That will take about a week (hopefully no more) and they will call me when they come in. If I have them sent to me I have to pay $15 plus $.50 per page. If I have them transfered to my new doc it won't cost a thing. I didn't want to send them to the new RE yet until I get my referral approval to go to this one, so we left the release info blank until they call me and tell me they're in.
My Ob/gyn has faxed over records to my primary doc and my primary doc has requested a referral from insurance. I temporarily have an appt. with a new RE on May 2nd. That would be ideal because that will be around O time, so if I do get pg this cycle, I imagine that I will still be considered a patient with them and they'll follow me through week 10 - 12 doing blood tests and u/s to make sure the pregnancy is viable. That gives me a great sense of comfort.
Okay, so that's my day in a nutshell (well not so much) but I just wanted to keep you updated on what's going on!
Thanks for listening and thank you so much for all of your encouraging words. It really does help!
Wow!! A woman on a mission - don't stand in her way! I'm so glad you were able to keep your composure & solve all those obstacles thrown in your path. That was the absolute best way to handle it and you're getting great results. Crossing my fingers everything goes smoothly!!
I am going through a very similar situation. I found a RE in Grand Rapids. It's the only one that participates with my insurance. It is an hour and a half away from my home! I figure it will be worth it when I get pregnant.
My insurance will cover any doctor costs. Procedures will vary, and there is a spending cap of 1000.00 per year! Basically I will have to cover everything but 1000.00! From what I am learning, that could be a lot. My first appt. is May 16. I have one more month to try on my own. It's all very overwhelming. I am glad you posted what you did. I am learning from your experiences. So thanks for sharing and vent anytime you want to.
By the way, I have been sick too for about 2 weeks. It's winding down now. I ended up with bronchitis and an ear infection. I took some antibiotics and feel a lot better. I hope you do too very soon!
Well, I got good news yesterday afternoon. My referral to the Re based on repeat pregnancy loss was approved. Now, I just have to hope that my old RE can retrieve my records from storage before May 2nd and that my new RE will find that my repeat pregnancy loss is due to infertility issues and I'll be all set!