Frustrated...

I get that insurance companies rule the world. I really do. But, I'm sick of it. I've been trying for over a month to get a referral to an "out of network" provider (Dr. B) and it's just not going to happen. I was told that even if I managed to get Tricare to accept the referral, it will only be for a second opinion as they had to code Dr. B as an RE and not an RI. IF I get it, it will only be good for one appointment as an evaluation. THEN, if I want to do treatment with Dr. B, I have to re-submit the claim and the Lt Col I've been working with on this said they most likely won't approve it since I have an RE here already. Basically, I either do the endo surgery with the doc out of Birmingham, or I pay 100% of it out of pocket to have it done the way I want.  I also asked her if I could see a doc in Chicago that is also an RE/RI that IS in network and she said Tricare will still say no because I'm not located there. I'm frustrated.  I feel like I'm out of options.

I've had endo surgery twice. Once with a doctor in AZ and I was able to get pregnant with Skittle six weeks later. I did the surgery again in TX and I was unable to get pregnant. I believe the way I had it done in AZ is the way that Dr. B recommends it be done. The doctors here in AL and the ones I saw in TX do it the way he doesn't recommend (for those with autoimmune issues).  If I do the surgery in NY, the cash discount price (low end) starts at $20,000. (!!!!)

The only hope I have left for this is that my current RE said she would be willing to work with Dr. B...would she learn to do the surgery for how he wants it done? She's willing to do the protocol he recommends as well as order the blood work.

God is bigger than insurance companies. He's bigger than my fears about money and surgery.  I just need to continue resting in His promises. He is faithful and just. Always.

Dr. B Consult!

I just got done talking with Dr. B (the endo specialist out of NY) and I wanted to write it out so I can remember our conversation.

He went over my history (I had previously emailed him a fairly detailed run down of my past) and he said I most likely have immune issues/egg quality issues/and endometriosis wreaking havoc on my reproductive system.  I've agreed to do the necessary testing he requires as well as doing a LAP.  He did mention that not just anyone should do the surgery, but that I needed someone that specializes in endo to preform it. He said it's not worth it to just have my RE do it.  So, I'm currently waiting to hear back from their insurance lady and to figure out how to go about getting this surgery done.  He said he doesn't know of anyone qualified to do the surgery in AL but he has several he can recommend that takes Tricare....coordinating all of this seems daunting but I believe it's worth pursuing, not only to try and have another baby, but to have a healthy future.

He said that I was still young (BLESS HIM!) and that I didn't necessarily need to do IVF.  Once I've done the testing, he can prescribe meds through my current RE and I can try naturally since I've achieved a natural preg in the past (I would still need to be monitored closely since I'd be on Lovenox, Progesterone, etc).  Guys, that was music to my ears! I do NOT want to have false hope but I feel like this is a huge positive step in the right direction. 

He recommended that I start taking omega 3's (which I already do), turmeric (which I already do), Coq10 (which I already do) melatonin (which I already do), Myo-Insoitol, Pine Tree Bark: Pycnogenol, and resveratrol. 

I'll write again when I know more...

Follow Up

Here's the recent low down.

I was able to get in to do a video conference with my RE earlier than I thought, which was FAB as originally it would have been 8 weeks after the new patient appointment (and the doc requested 3 weeks).  Basically, that CA-125 test wasn't high enough for my RE to have any concerns about it being linked to ovarian cancer but was high enough to show active endometriosis.  That was what I was expecting and it did put my fears to rest.  She DID recommend that I do the endo lap surgery now (yep, EXACTLY what I said I needed) and to do IVF the next cycle after.  She went ahead and ordered a ton more blood work for a recurrent miscarriage panel (hello another 13 vials of blood).  I got the results as we were out of town in Houston. 

Everything was in normal range except two.  I was not surprised in the least to know that I have the MTHFR gene mutation (c677T single mutation, heterozygous) but I was shocked to learn that I also have PAI-1 4G/5G deletion/insertion allele promoter polymorphism (also heterozygous, one copy of each).  The two of those mutation together is more cause for concern vs. just having one.  Guess what?  It causes recurrent miscarriages and implantation failure due to clotting factors. I was told that if I was to get preg naturally (uh huh it's been 4 years my friends) that I'd need to call them the minute I find out so I can be put on Lovenox/Heparin and low dose aspirin to thin my blood.  If I do IVF, I'll be put on those for my entire cycle.  I'm surprised I wasn't tested for these things sooner...but I guess it's good I'm finally getting some answers. So, not only do I have a really hard time getting preg, I have an even harder time staying preg.

My AMH (Anti-Mullerian hormone) level is decent for my age.  Anything over 1.06 is correlated with a better response to ovarian stimulation, so that's good for my chances with IVF. 

Next week is my consult with Dr. B.  I'll keep you posted....