HMO my goodness!

Goals goals goals!!

Now that we’ve started this very huge slow moving ball rolling, I’ve had to make a litany of phone calls to get all my shit together for our next cycle. It was a bit of a roller coaster but I’ve made my peace with it and I’m ready to set up goals and get my body and mind ready for round 2.

First, I had to call the PGD clinic again to make sure everything was all set there. We had a really good talk and she said that they do accept my insurance and that I wouldn’t have to pay anything, they would bill my insurance. I was over the moon!!! Then when I got the email from her it said that they don’t accept HMO policies… which, of course, is what I have. I think at that point I figured out what the saying “taking the wind out of my sails” meant. That’s exactly what it felt like. But I took the day and dusted myself off. Called my clinic and had them switch me to another PGD lab. This one charges $2400 for 8 embryos and $250 for every embryo above that and then $350 for the courier fee. And the good news is that I can self submit a claim to my insurance and they’ll likely refund everything except the courier fee.

Then today my nurse told me that I had filled out some of the consent forms incorrectly and that my PCP sent over the wrong physical exam report. Fixed the consent form issue lickatty split but now I have to make more calls to the PCP to get them to send the correct forms.

And finally, my nurse requested that I do a karyotyping blood test. Not sure if I’m spelling that correctly. Anyway, luckily they can do that on Saturday so I’ll do that then.

So I feel like we’ve accomplished a bit this week and now I can set up some goals for the next cycle. I’m still really sad that the PGD lab takes PPO policies but not HMO and there was a PPO policy available but I didn’t take it because I didn’t understand the difference until now. Apparently PPO is more flexible but generally more expensive and I actually read somewhere that “If you prefer to have your care coordinated through a single doctor, an HMO plan might be right for you. If you want greater flexibility or if you see a lot of specialists, a PPO plan might be what you’re looking for.” Why didn’t I read this when I was signing up? ARrrggh!!! I was really sad yesterday, even writing it now is making me sad again and I need to look ahead so we won’t dwell on it too much.

I suspect it will take me about 2 months to save up the money so I’m going into super save mode again. I’ve done it before with our last cycle so I’m not too worried about it. I’ll also be out of probation at work I think I’ll be ready to talk to my boss about coming in late on monitoring days. Yes, it’ll take about 2 months to work up the nerve.

Here are my goals:

  1. Save up the necessary money.
  2. Successfully follow the ketogenic diet plan I’ve been trying to follow
  3. Try Insanity workouts again (ugh, do I have to… okay that’s not the right attitude.. gotta hustle!!)
  4. Plan at least 6 fun cheap things to do on weekends so I can keep my mind occupied. That’s about 1 thing every two weeks until we can start. Luckily we have things lined up for the next 3 weekends so that’s cool.

I think that ought to do it for now. 2 months isn’t far away. I think I can do it if nothing expensive comes up haha. Now if you’ll excuse me, I have some subscription boxes I have to cancel *sigh*.

Yay for Friday tomorrow!!

16 thoughts on “HMO my goodness!

  1. I’m not sure where you live or what your insurance is like, but I know most places here have Open Enrollment for health insurance in October, to change things for the next year if you want to. Maybe you can choose to change to a PPO for next year, so that you will have more flexibility with things next year if needed? Good luck with all the insurance stuff, it sure can be a pain!

  2. I would be very cautious here in terms of coverage. The statement: “And the good news is that I can self submit a claim to my insurance and they’ll likely refund everything except the courier fee” sent up a red flag for me.

    If a clinic is telling you to self-submit a claim, this means they are out of network with your plan, and HMO’s do not typically have coverage for out of network services. Have you spoken with your insurance company to find out the coverage?

    Amy M. is right to mention open enrollment. You might want to find out when your plan renews for the year – if you sign up for a PPO, there is likely to be a deductible to meet before services are covered, so you will want to be aware of that.

    I have experience in insurance, and it sounds like you are doing your homework. I hope this goes smoothly and successfully for you!

  3. Sounds like a good plan. Its nice to come up with a good plan. It makes you feel as if you are accomplishing something even before you start anything! I’m gearing up for the same rounds of phone calls too. And I think an insurance agent makes her way over to our building every once in awhile, so I’ll have to start writing down the questions. Sometimes this is like working a part time job to get everything needed accomplished! Your doing good girl!

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