Third Party Coordination Goes Awry - Meds Edition

A few weeks ago I had to figure out where to order my and my surrogate's meds from. ACRM recommended 3 pharmacies and called the Rx in to all 3, allowing me to compare prices and such. One of these pharmacies, Village Fertility Pharmacy, actually had the forethought to test my insurance coverage even though I told them it wouldn't be covered. Thankfully I was wrong, so we went with them (a huge bulk of mine were covered!) I ordered both mine and my surrogates meds, shipping to our respective homes. Mine took 1-2 days. 

Since we paying ACRM extra money (~$3100) to do "third party coordination", I naturally thought that if I ordered the meds, that they would do more of the "coordination" and stuff. Honestly, they have not done a good job with this. Repeatedly I feel like I'm running around like a crazy person doing the bulk of the coordinating. With my ADD and new job, this is terrifically difficult for me. 

When my GC came in for her appointment on Monday, they gave her a written Rx for her meds and told her to fill it. No one thought "hey, we've already placed an order with the IP a few weeks ago, maybe we should check on that." The reason I found out? The nurse copied me on an email to the GC that said "You don't need to pick up the Lupron in your original order." All of a sudden I was like "Is this a double order???" The nurse emailed me at first and said that maybe the fertility pharmacy sent the Rx to Kroger. I asked my GC, and she said no - no one told her  about the previous med order and ACRM just gave her the Rx when she went for her baseline ultrasound. She was suppose to start meds that day and not one red flag was thrown up. A few back and forth emails, and it was apparent that no one on their end was really keeping tabs on this. 

Truthfully I should have checked that her med order went through smoothly weeks ago when I got mine. I had informed my nurse that I had received mine, but then got violently ill and forgot to double check if our GC got hers. I had no reason to believe she didn't and I guess with all the balls I am juggling, that was another one I dropped. I'm terrible at organizing these types of things, which is why I didn't mind paying the extra money to the clinic to do so. And I really don't consider $3100 a small fee to do this. As I am sure you have already guessed, our GC did not receive her meds from Village Fertility and it upsets me that I feel like I'm having to do the bulk of "third party coordinating" while paying them a chunk of extra cash. (Yes, I know some of this goes towards the medical aspect, but we were also told it goes towards things like this.)

All of this resulted in frantic phone calls, in the middle of a workday, with my very public cube, to multiple people. This is sucktastic for me to have to do at a new job. Village Fertility Pharmacy said they did not ship the GC order because they had left 2 messages to set-up a profile for the GC and she did not call back. My GC said she never received the messages and I 100% believe her. I asked Village why they didn't call me when they couldn't reach her, and they admitted they should have. (As a side note: I am very forgiving when people admit mistakes and then do whatever they need to do to correct it - Village did this.) Village apologize and after I altered the order (minus the no longer needed Lupron and minus the already procured Estrace), they were able to ship out overnight. 

In the long run, I think the mess-ups of everyone (me, the clinic, and the pharmacy) saved me money, but that still doesn't give me a warm and fuzzy. Especially mid-cycle. I'll write more later on my HUGE upset about a screw-up in charges. It's a freaking shame because we adore our doctor over there. 

Mad Dash to the Finish Line

I don't know who Mr. Pipo is, but this image rocks.
You can get it here: http://commons.wikimedia.org/wiki/File:Mr_pipo_clock.svg

Yea, yea, yea. The ole "I've been a blogger slacker" post. The "I've been too busy" post. The "Too emotional with all that's going on in the world" post. Whatevs. Get to it.

We are on full throttle for surrogacy to start next cycle - which means hopefully the end of this month. (Crap - no drinking on NYE!) I've been a mess trying to get everything done in time, but we really wanted to pay as much as we can this year for tax purposes. Since I didn't work for 8 months this year, much more is applied. 

Plus, let's be real, every month for me counts now. My AMH is like .7 and my FSH is 12.7. Not good. Not horrible, but not good. This will be the last shot with my eggs - period. If this doesn't work I'll crawl into a hole until we are able to consider the donor egg option. 

I have to say that having my first 2 surro cycles in India did not prepare me for the complicated mess I would  have to endure here in the US. In India we just had to show up and they directed us for everything else. Here we are on are own and have to stay on top of things like a frenzied squirrel. Crimmy, I'm even going to have to give myself shots. With my ADD, this is not encouraging. 

Some of the things I've been juggling: 

• Coordinating 4 individual schedules with tight deadlines on when specific things have to be done. Guess who's schedule always gets the shaft (to be expected.)
• Countless phone conversations occurring middle of the day, for a length of time, that has me leaving my trusty cubicle to go hide talk in a conference room. Lest my cube mates get to hear me go on-and-on about the FDA required STD tests I have to take. "Yes, I need you to add Chlamydia  Gonorreia  HIV, Hepatitis  PPD, ... to my blood order. Oh I'm sorry, you want me to repeat that LOUDER for the 3rd time? Ok."
• Working with 3 different pharmacies to find out which can give me the best price, without sacrificing reliability/comfort level of getting all the right things at the right times. All of this again on the phone during business hours. All pharmacies have been given the Rx by doctor and are ready to ship ship ship. "Yes, I'm confirming the order. OH WAIT, you are with whom?"
• Phone interviewing lawyers with experience in surrogacy to see who can meet our tight deadline (are you sensing several themes yet?) 
• Going BACK AND FORTH with my new primary care physician office to try and convince them to add STD blood tests to my blood order for my physical. This way there is a chance insurance will cover it, but I had to go back and forth with them for about 2 weeks. Otherwise it's a couple grand out of pocket.
• Getting a physical so that additional items will be covered under insurance that wouldn't under my RE.
• Multiple doctor visits. Blood drawn yesterday AND today because I had to use 2 different labs. Trying to juggle all these without raising a flag (hopefully) at my new job has been an incredible feat. I'm a contract employee and want to go perm when my contract is up in April. 
• Psych evals - and while I appreciate the "concern" over my emotions, it really was a total waste of time/money for my husband and I. Everything that was discussed in the group session we had already discussed with them privately. I totally "get" why you would want to have one with the surro and the surro spouse, and even a group one, but I don't think every IP couple needs to have this done. Especially if you've been through the process before (even in another country). Thankfully the doctor put the ones for hubby and I as a "family counseling" code - hoping insurance will at least cover that. 
• Trying to get surros insurance documentation to make sure there is no surrogacy exclusion. Not their fault, but company's fault it is taking so long. 

There is more I am sure, but between balancing that and everything else in my life, my brain is kinda fried at the moment. I still have Christmas shopping to complete. Hell, I haven't even gotten all my cards out yet. 

On a Happy Happy note. Insurance covered a HUGE portion of my fertility medications. The pharmacy (Village Fertility) checked on a whim for insurance coverage (even though I told them it wouldn't be covered) and apparently a big chunk was. Had to pay just a little over 1K out of pocket - which is awesome since it was looking to be about 6.5K. She explained that even though we have BCBS for medical (THE SUCK for infertility treatments), the pharmacy is different and is quite good. Covered under Medco, formerly Express Scripts. I guess the lesson is: always check to see if insurance will pay. Even when you are sure they won't. 

On an unhappy note - I had no idea that the attorney was going to be so much. 2500 for the surro agreement (REQUIRED) and then another 4K if we make it to the second/third trimester. They have to go to court and petition that our names are put on the birth certificate. Otherwise we would have to adopt our own child. GAH! Oh well, I guess we should totally HOPE/PRAY/RAIN DANCE that we are so fortunate as to get to shell out the money in the future. That would be a good thing - right?

That's it for now. And to prove how busy I am at the moment, I'm going to publish this after only "checking" it once for mistakes. That's HUGE for me. Normally I read it and change it 10x. THAT'S HOW BUSY I AM. Or crazy. You choose. 

Money, Get Away

"Money, get away
Get a good job with more pay
And you're OK."

Clearly The Pink never went for infertility treatment. Which is weirdly funny given their nickname.

We are entering our third and final cycle with my eggs and with a person close to us doing the surrogacy (without charge). Approximate cost: 35-40K. That's not a typo. That's how much it will cost us out of pocket. Paid in full by months end. In addition to all we have already spent.

And now, all of a sudden, a little voice inside me is very scared. To spend this much money and use my long shot eggs. Actually I'm quite terrified.

Where Can I Get My Drugs?

No seriously. Who has the hook up? I need advice on who the cool [read: GOOD], reliable, fast online/mail order companies for fertility meds? Fairly certain that the email I just read from our clinic was saying that I will need to order mine (and our surrogates) in the next few days.

Here was the reply when I asked about getting the meds:

Once you are ready to get started, I will send this prescription to a mail order pharmacy and they will call you to set up payment and shipment of the medications.  You will need some of them within 14 days of starting a cycle.  The others you will need a few weeks after that.  I would recommend getting the meds as soon as you are ready to proceed.

Honestly I don't know if that means 14 days before my next cycle or 14 days after my current cycle start - which now that I think about it, is the same thing really. Since my period started on Sunday, that means I need to get the full list and make the purchases.

I hate having to rush rush rush everything, but it looks like that's where we are now. Have no idea about what happens with being able to claim this on taxes for anything that spills over to next year. I know you have to reach a minimum percentage of your income to claim medical, but can you only claim what is OVER that percentage, or do you to claim the first part too? I'm trying to figure out how vital it is we make our Dec 31st deadline. It's vital from an old eggs perspective, but I don't know how much it will end up costing us if we can't claim it all on our taxes this year.

Any tidbits you guys can throw my way I would really appreciate. The last two days of trying to balance 4 individuals' schedules for treatment, make sure everything is asked/answered for our upcoming cycle, work, getting a plumber out (yay! We have water!), make a community meeting that we will be a named plaintiff in, more work, AND cart my 12 year old Min Pin back and forth to the vet for dental surgery (9 extractions!) has my head spinning.

(BTW - my Min Pin is a total hillbilly now. All of his front teeth, bottom and top, were rotting due to age and not enough space, and had to be removed. He won't show me now and is working the cheese angle.)

No wonder I need a good hook up for meds. Give me a heads-up and I'll keep it on the D-Lo. 

In Today's Surrogate News...

image from: here

The long awaited surrogate news is here! 

Our surrogate and her husband are still gung-ho - YAY!!!! Ms L went for her hysteroscopy and HSG testing Thursday and Friday. We haven't heard the official news from the clinic yet, but she is under the impression that everything came back great. Double yay! I'll let myself have that little bit for now.

On the flip side, my surrogate and her husband, both whom are very close to us, are having trouble quitting smoking. If she doesn't quit soon, then it will be a no-go. Quitting smoking is super-tough and she feels awful that she hasn't been able to quit yet. Was there myself once-upon-a-time and it sucks.

We went ahead and asked them if they wanted to try Chantix (we'd pay for it) and made sure with our clinic that it would be ok for them to take. They both wanted to give it a shot and we were happy when our RE said it was ok. We were about to go meet them on Saturday when our water heater expansion tank sprang a leak. Fortunately showered just minutes before the leak was discovered... 

Anytime you find a large puddle of water on your floor you should probably be concerned, but honestly I was more concerned about meeting with Ms.+ Mr. L. We called a friend and my dad to ask some questions, turned a faucet valve that was connected, let hot water run out in the sink, placed a bucket under the leak, and left to go meet them. 

Meeting went great - picked up Chantix Rx and then grabbed dinner with both of them and their little one. Afterwards we had a get-together at a friend's house where it was pretty paramount that we show our face. It's a close friend (he introduced us!!!) and we think we weren't invited to his wedding a month ago because we have been soooooo MIA - we hadn't even met his now-wife until last night. They had been dating for a little over a year. When we returned home much later we found the leak still going strong. A little digging around outside and in the garage led to the discovery of another valve to turn off ALL water. The first one turned out to be just for hot water. 

I hope the Chantix works. It helped me quit smoking years ago, but I know some people report serious side effects and can't take the medication. Chantix is not covered under their insurance either, but Mr. L's doctor gave him a $75 coupon. Oddly enough, Ms L's only have her a $40 one. Weird huh? We were able to use the $75 one. 

Now we go full speed for the other things. On the schedule of phone calls tomorrow is lawyer (required by our clinic), blood work for all, and psych tests for all. Wait what was that last part??? Yea, our third party coordinator said that we would have to ALL have a psych eval. Having a psych eval doesn't bother me (it probably should!), but after 2 failed surro cycles in India I really don't understand why it is necessary. I sent an email to our third party coordinator asking about the necessity (ie. requirement), of this for my husband and I. If it isn't required then I really don't see the need to spend additional monies on it. We didn't have it in India and I don't feel like we need it now. (The surrogate did have one in India and I understand why it is required here.) 

And I'm not sure how we haven't really talked with the financial coordinator at our clinic thus far, but I guess we need to schedule that as well. Sigh. At least then we will know better what to expect. Our original information from the clinic did not include costs for surrogacy. That becomes an entire new list of line items. 

I don't know how I'm going to take off all this time from work. All day psych evals? Appointments at an attorney office? More medical stuff? I don't know how our surrogate is going to be able to take the time off either - though of course we will give her money for any missed work. She starts a new job next week and while we are both super-duper tight with her boss, I think it's still awkward to take time off when you first start at a company. Even if the boss is totally ok with it. 

Sigh. So that's the update. Prior, I steeled myself to expect the worst with her hysteroscopy/HSG tests and now I feel unexpectedly elated. Even after feeling all doom-and-gloom about the cigarette stuff for the last week and a half. I'm still going to be cautious about getting too excited with regards to that, but I've let myself be hopeful for the weekend.

Course not having water it beginning to suck. Guess I should put "plumber" on my list of phone calls for tomorrow. Wouldn't that be funny if that was the phone call I forgot to make tomorrow? (I refused to pay Sunday plumber rates.) My BFF called earlier and said we could take a shower at her house if necessary. Since she could smell me all the way from there... She's a keeper. :-) 

Spot Check Part 2: Calming down

Right now I've calmed down enough to realize my spotting yesterday may  have been caused by the sonogram on Thursday. It has happened before with a sonogram. I don't know why it didn't occur to me till this afternoon when I was at a baby shower and was relieved to see no blood on a ladies room break. (Sorry to be so graphic.)  Or it could have been a minor nick on the cyst. I think if it had burst at 5cm, then there would have been a lot more blood.

Must have been pale as a ghost last night and my wonderful hubby helped calm me down. All I could think of was how I had some how messed up my last chance. I'm still a little worried, but not massively freaked out like I was last night. Tiny, tiny spot this morning, but then no more blood today. I was so freaked out last night I took an extra BCP. I may take extra ones till the 5th just to be sure.

Thinking that my side effects (like dizzy) may be merely from the cyst itself. (Or the freak out!) Not surprised that I had one as I had started cramping on occasion. I'm not bleeding today, so I'm hoping and hoping that the sonogram caused it. If I'm ok till Monday, then I will be able to breath a sigh of relief. If I'm not, I will contact Dr. Patel in India. As long as I am not bleeding, I will try not to worry.

In other news, if all goes well, I will have my cyst aspirated in India. Not ideal (will be alone initially and I will have to undergo general anesthesia), but I don't have much of a choice. Was able to confirm that my OB/GYN had been talking about laparoscopy and Dr. Patel said that she would have to cancel the cycle if I did that. Dr. I's staff (and he) were using laparoscopy and aspiration interchangeably (they most certainly are NOT) and after a series of confusing discussions with his staff, I was finally able to clarify with him on Friday morning. Apparently he DOES NOT aspirate, and told me that an infertility clinic would have to do that.

We have a really good infertility clinic here (ACRM) that we have used for all of our initial tests, but the chance I would be able to get an appointment in time are very slim. Not to mention that it most certainly WOULD NOT be covered under insurance. My old company insurance covered some things, but my husband's BCBS covers next to nothing for infertility. The mere fact something is done at an infertility clinic usually means they won't pay for it. The money we have spent at the infertility clinic does not even go against our yearly deductible.

Just as well. My husband did not have a warm and fuzzy about my having it so close to international travel. And my travel to India is not direct - it usually takes about 36 hours of travel time. I don't sleep well on planes, trains, or automobiles (all of which I have to take), so it's best to do it in India. Dr. Patel said she would do it and she did it last time. Pretty sure she didn't even charge us extra. Hopefully it doesn't affect the cycle.

Please keep your hopes/prayers/warm wishes for me that it was just a result from the sonogram and that I will have a successful cycle in Anand. 

RAAAAWWWWRRRR

Ok, confession time: I'm a tad afraid that my hormones are making me feel a little roid ragey. I'm not used to taking birth control pills (BCP) and I'm certainly not used to taking DHEA, both of which contain hormones. This morning I feel unusually weepy, and often I feel unusually RAWR!!!! Add that I am probably PMSing and it's a mighty good thing that hubby is at the office today.

I'm hoping it will level off soon; the bad parts, not the good parts. On the good side I think I am getting darn good sleep at night (not normal for me) and I don't feel exhausted during the day like I normally do. DHEA is supposed to help people with chronic fatigue syndrome and I am wondering if the deeper sleep at night is why. How long has this been a problem for me? My mom still tells stories how she worried I would be kicked out of kindergarten because of my requirement for 2+ hour naps.

If the Fedex man likes me today, then I should receive my Melatonin. Hopefully that won't throw me back to wanting to sleep all the time. Sigh.  I wonder if I should go back to acupuncture. It didn't seem to help one bit and I wonder if the occasional massage wouldn't be just as effective (and appreciated more.) Then again, the acupuncturist also could help me wade through the RAWR.

If someone had told me a year ago that I would be taking all kinds of weird supplements and dropping $100 a pop to the local acupuncturist, I would have told them they were off their rocker. Next thing you know I'll be traveling to a rural town, in a foreign country, without my husband, navigating the intricacies of basic every day things, for the privileged of shots in my belly. Oh wait...

TSA killed my laptop

On my trip to India, we opted for the pat down instead of the scanner as we always do. Trying to have a baby, we do not need anything working against us. When doing an opt out, you are not allowed to carry your things to the pat down area - TSA agents will do that for you. At least that's the way it works in our airport.

Going through the security line, we noticed that one of the TSA agents was yelling at everyone for a variety of things. If you dared forget to take even a sliver of paper out of your pocket, you were yelled at in front of everyone. I received my pat down and started putting my things back together when I noticed my husband was one of those people. We travel very frequently and he carries non-metal things in his pocket all the time - never previously a problem. This time it was. As my husband does not take it well when people in positions of power are abusive, he argued with the TSA agent, but then eventually was allowed through. 

After he went through the metal detector, he was brought over to the pat down area. I was still gathering all my stuff, but was distracted as the TSA agent began to yell at other people. Had my attire back together and started putting all of my things they had brought over back in the bags. 

After my husband's pat-down, I noticed he was visibly distressed. Not surprising. In the airport there is a TSA stand where you can see agents sitting down, talking, doing paperwork. My husband gathered his items that the agents had brought over and headed to the TSA stand. 

At the stand, he stated he wanted to file a compliant, but the agent stated that she would take his complaint orally. Since we had an overseas flight to catch, we didn't want to investigate if that was enough or if we should insist on filing a form. After all, they could always throw it away if it was what they were trying to avoid.

It was in right before we landed in Paris (our layover) that we realized his laptop was never returned to him. As the plane landed, we rushed to talk to the stewardess, but there was nothing she could do; they don't even have TSA overseas. Then it hit me as we got off the plane: my laptop had not been returned to me either. One is a mistake - two laptops not returned is something else all together. 

In a flurry of long distance cell phone calls, we were able to contact my brother and his wife to get the process started of trying to get our laptops back. They found out the number to our airport TSA and the general number. Even though it was still the middle of the night in our original airport, I left a message for the manager of TSA customer service for that airport. (Big surprise - he never called back.) 

Fortunately my brother was able to retrieve the laptops the next day; he was really on top of it. While he was picking them up, he heard the lady in lost and found drop a laptop. He asked if it was one of ours, but she insisted it was not and opened up another laptop stating it was that one. My brother was all prepared to give his ID and the passwords to the computers, but no need, the employee said he had "an honest face" and let him take both laptops without any proof what-so-ever.

When he got home he booted the laptops up to make sure they were the right ones. They were, but unfortunately mine would not boot. Rather than having him send the laptops to India like we originally planned, we decided not to risk more damage and vowed to take care of it on our return.

Well I've returned and it's not good. My 6 month old laptop is fried. For the first time in my life I took my computer to a repair shop (I'm an IT person), because it was clear that it needed tools that the average IT person does not have for data recovery. After days of trying different methods, the data recovery shop had to inform me that none of the data was recoverable and it was the worst case of damage by dropping that they had ever seen - and they see a lot. 

Normally I back up my hard drives, but with all of our recent unexpected travel (we've had a lot) and medical things, I just didn't get it around to it. I am sick to my stomach over what is lost forever. Not to mention the weeks and weeks worth of work on it. My computer has been shipped off to HP in hopes that in the very least it will still be covered it under warranty and that I will not have to "drop" another $600-$800 on a new one. 

Now the computer shop tells me that not only do they get A LOT of PCs that TSA has dropped, but that it is very common for TSA not to return things to people who are flying. Apparently if it goes unnoticed, all items are auctioned after 30 days. How many guesses do you want on who goes to those auctions... 

WILL UPDATE MORE AS MY CLAIM AND COMPLAINT PROCESS PROCEEDS. It is not a fast process from what I understand. Their website claims 3 weeks to even acknowledge your compliant and 6 weeks to resolve. 

Eggs in a basket

For some reason our daily fruit package from our hotel in India always reminded me of a uterus. Don't judge, I have a great imagination and my thoughts were consumed with my lady parts already. You can even see where I pressed the cling wrap with my thumbs to try and get a better look and some tiny round fruit beneath the bananas whose name escapes me now. I'll call them the ovary fruit. (Thank goodness my Fallopian tubes don't look like that!)

With wandering thoughts today (and because it has been mentioned to me more than one at my precious age of 40), I looked up some egg donor info today. Not because I'm worried, just to prepare myself with some info should I need it.

Holy. Crap. 

According the American Pregnancy Association, the costs for just the egg donation is another 15-20K. If we do it here in the US, then costs for egg donation + surrogacy + all the other expenses that go with it run around 120K (and that's ONLY if the IVF cycle is successful!) If we do it in India, the costs are much less, but the complications are way more. If I want an egg with my ancestry, then it gets SUPER complicated. 

Do the process in the USA where it costs more and you chance a lower success rate by using frozen embryos or find an egg donor that is willing to travel to India (and probably go through a huge culture shock.) If we use an egg donor in India, then I have zero chances of having an egg donor with similar traits to me. In India we also run into the problem of my husband not being a US citizen and thus our child would not be. Getting the baby a visa with the HOPES that the US would approve me for adoption (and then citizenship for child) is a nightmare that might test me more than I am able to handle. (What happens if they say no after the fact???) Alternatively I can dash all hopes of any remote resemblance and we wait for the long process of US citizenship for my husband. 

Crap. 

Come on little embryo! You're the only prior egg left in my basket.