July 29 – End of July

Hello out there. It’s been a while since I posted last. I was feeling down and I felt like it wouldn’t make anyone feel better if I did a bunch of complain posts. I have been healing and trying to deal with our loss.

It’s been 2 months.  I have been doing much better. I looked up the stages of grief. I was stuck in the anger phase for a long time. I was having ovary pains and I don’t know why, but I read that physical pain manifests itself to help with the mental pain. Whatever the reason, the pain has stopped. Yay! I can finally work out without pain.

Emotionally I am still very raw. Just yesterday hubby and I walked past a BuyBuy Baby store (the one we went into to buy a couple items after we found out we were pregnant) and I had my recurring stress dream of running from tornados.  This is the first time that I dreamed my hubby was helping me though. Last night before bed my hubby hugged me and we talked about the baby loss. How hard it has been. I actually said out loud how hard it was some days to just get out of bed.  It was nice to admit to myself that I most likely was suffering from depression.

I pushed through but some days are still harder than others.  Today there was a pregnant team mate in the office (normally she works from home) and the team mate who recently had a baby (who works from home part time) gabbing away about baby showers, labor, pregnancy stuff. I put my headphones in and blared some Maroon 5 “This Summer’s Gonna Hurt.”  I hope that soon I will be able to be “normal” again. I know we will get there.

On the getting healthy front, I haven’t been doing very well. I gave up soda for 3 weeks and then started drinking it again. I started working out but went too hard out the gate and got burnt out. I need to start slow. I just wish it wasn’t summer right now. Yes, in the other parts of the country summer is the best time of year. Here in the valley of the sun, it is hell. LOL.

I feel fortunate that my doctor is as good as she is though. One of the girls in my online support group was about 7 weeks and they told her she was miscarrying (same as me). Her doctor said it was not ectopic. The night before her d&c her tube ruptured. It turns out it was an ectopic pregnancy. She almost died. I can’t even imagine what she went through. They also waited after the tube ruptured to do the surgery and she lost her ovary due to blood loss. I am thankful for having a competent doctor.

My friend once described life as being like the weather. One minute you are standing in the sunshine, the next you are in the rain, another there is a thick fog around and then sunshine again. I think I am coming out of the fog and heading toward sunshine once again.

Tornado-2014

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July 4 – Independence Day

It was a lovely 3 day weekend. Well mostly 3 day. I had a couple of hours of work to do in the morning. My hubby was off for 3 full days. We spent the morning doing things around the house. Cleaning up the yard, pulling weeds, etc. When I came across a mostly dead bird in our yard.

The poor thing was exhausted and wouldn’t fly. I had to fight the dogs to keep off of it. My hubby who works in pest control and it used to having to remove birds from traps and such, told me to put it into a trash bag and throw it away. I sadly grabbed a bag, put on some gloves and picked up the birdie. I put it into the bag. Almost immediately I started to tear up. How could I take this poor bird and put it in the trash while it was breathing? I couldn’t. I brought the bird out front and took it out of the bag. I set it on the ground and hoped by some miracle it would fly away. It just laid there panting. I picked it up and brought it to the common area in our neighborhood and hid it behind a bush near the trees.

I started to cry. The poor little bird. That was all it took. I went inside and sat on the couch and wept. This was the weekend I had planned to fly back home for a quick visit and I was going to announce our impending arrival to my family. I had dreamed about it. But after the nightmare we went through, I had almost forgot. It hit me all at once. A wave of emotions. I was so sad. While my brother flaunts his new baby all over social media and via texts. I sit here crying, remembering that our dream was shattered.

I composed myself and we went on to have a fantastic rest of the day. We went to dinner and a baseball game. We went to the Hard Rock Café. They were slammed. It was good though. Then the game we were so close and right behind home plate. We sat in the section where there is a waitress who takes your order and then someone brings you the food. Pretty neat!

Our home team won and there were even fireworks after. It was a great evening.

This journey is so tough. A little thing almost ruined my whole day. But I didn’t let it. We are strong and we will get through this.

Oh, I also finished my rebuttal letter to my work’s HR department. Felt good, but I won’t really feel better until we get the coverage.

IMG_0771

Here is a copy of my rebuttal letter edited to exclude my employer’s name:

July 3, 2015

<HR Person> and the Benefits Medical Review Committee,

After reviewing your response as to why <employer> decided to not cover infertility benefits in the past, I did more research to help explain infertility to the firm and address the more pressing concerns. I will be addressing the points presented individually. The items mentioned were costs, health savings accounts, adoption and the employer healthcare benchmark. First I will address the potential costs to the firm.

Let’s explore the options for infertility treatment and their costs for those who have not experienced it personally. As I mentioned in my first letter one in eight struggles with infertility and <employer> employs approximately ##,### associates. We can estimate there could be as many as #,### associates who silently struggle with this diagnosis. If we unknowingly assume that all #,### associates that could have infertility issues need in-vitro fertilization, or IVF, as a treatment then we could be overwhelmed by the potential costs. Luckily this is not the case.

According to the American Society for Reproductive Medicine, or ASRM, “IVF has received a great deal of media attention since it was first introduced in 1978, but it actually accounts for less than five percent of all infertility treatment in the United States” (https://www.asrm.org/awards/index.aspx?id=3012). The National Infertility Organization, Resolve shares that “there are a few absolute indications for needing IVF, such as absent or damaged fallopian tubes, desire for preimplantation genetic testing, severe male factor, or unsuccessful attempts with less invasive treatments. If one of these indications does not exist, there are often less invasive, lower cost fertility treatments available that give patients a good chance of success…[For example] ovulation problems affect up to 20% of women who are having trouble getting pregnant. A common treatment for women with irregular ovulation is ovulation induction (OI). With OI treatment, a woman takes an oral medication, like clomid or letrozole, and then may have an ultrasound to determine how the ovaries responded to the medication” (http://www.resolve.org/family-building-options/ivf-art/infertility-does-not-always-mean-ivf.html). In fact ASRM shares that “Most infertility cases — 85 to 90 percent — are treated with conventional therapies, such as drug treatment or surgical repair of reproductive organs” (https://www.asrm.org/awards/index.aspx?id=3012). For this treatment the woman will have to take clomid for approximately five days per cycle and “the average cost for clomiphene citrate (Clomid): $10 per pill or $50 per month” (https://www.fertilityauthority.com/costs/infertility-treatment-costs).

Another treatment option that generally comes before IVF is IUI, or intra-uterine insemination. This is a less invasive procedure where sperm gets medically washed and inserted into the uterus with a catheter, which may be accompanied by a triggered or natural ovulation. The average cost of this procedure is $865 (http://www.resolve.org/family-building-options/making-treatment-affordable/the-costs-of-infertility-treatment.html). As you can see, there are many treatments options that won’t “break the bank” and that are less impactful to our bonuses and insurance premiums. Next I will discuss the recommendation to utilize the health savings account.

In my first letter I shared that with a health savings account it would take three to four years to accumulate enough to cover IVF costs with the IRS maximum contribution in 2015 at $6,650 for a family (http://www.shrm.org/hrdisciplines/benefits/articles/pages/2015-hsa-limits.aspx). As you can see from the following data, presented by the Center for Disease Control, waiting four years could severely change the success rate of infertility treatment:

The CDC collects success rates on ART [assisted reproductive technologies such as IVF] for some fertility clinics. According to the CDC’s 2012 ART Success Rates, the average percentage of fresh, non-donor ART cycles that led to a live birth were—

  • 40% in women younger than 35 years of age.
  • 31% in women aged 35–37 years.
  • 22% in women aged 38–40 years.
  • 12% in women aged 41–42 years.
  • 4% in women aged 43–44 years.
  • 2% in women aged 44 years and older

While the health savings account is a nice benefit and very helpful, by itself it is not a timely solution. Next, I will address the recommendation to check out the adoption benefit that <employer> offers.

Adoption is very noble path to parenthood, and the adoption benefit here at <employer> is very generous.  There are many things to consider when adopting but I will talk about two of them.  The first thing to consider is the finances. The average cost of an adoption is eight to twenty thousand dollars through a private adoption agency (https://www.childwelfare.gov/pubpdfs/s_costs.pdf). The five thousand dollar reimbursement from <employer>, plus the federal tax credit of $13,190 in the year 2014 (http://www.irs.gov/uac/Top-Ten-Facts-about-Adoption-Tax-Benefits) still leaves quite a sum to be accumulated in order to pay for this parenthood path. In addition to the financial hurdles, there are the emotional hurdles. You must be ready to selflessly adopt someone else’s child, bring them into your home and love them. You have to be ready to give up on the idea of a traditional family. Give up on the idea of your children having your eyes or your significant other’s nose. There are many things to consider and you have to be ready for that path.  You cannot “just adopt” because you have difficulty conceiving without medical treatment.  In fact, suggesting adoption before someone is ready for that option is considered impolite in the infertility community (http://www.resolve.org/national-infertility-awareness-week/25-things-to-say-and-not-to-say.html). Finally, I would like to discuss the employer healthcare benchmark.

It is true that we are in the majority for not covering infertility treatments, as stated in your reply. But I ask, why should we not in the forefront of providing superior benefits to our fantastic employees here at <employer>? Additionally, I think the firm should consider that “the American Society for Reproductive Medicine (ASRM) and the American College of Obstetricians and Gynecologists (ACOG) and the World Health Organization (WHO) recognize infertility as a disease” (http://www.resolve.org/about-infertility/what-is-infertility/). A disease that can be treated.

I hope that my research to address your main concerns will help make the decision to consider infertility treatment coverage for possible inclusion for 2016.  Please let me know if you would like any additional information on this issue. I am happy to help in your research or to provide my personal testimony.

Thank you for your time and consideration in this matter,

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June 30 – Advocacy Slaps me in the Face

My hr department finally replied to my request. Below is the most insulting, rude response I have ever heard.

Hi <employee>.  Thank you for the follow-up, I apologize for not getting back to you sooner.  I was researching why the benefit was not considered (as I was not at the firm when that decision was made) as well as checking with the latest benefit market surveys. 

In reviewing the market surveys, I saw that 59% of the employers surveyed (over 2,500) in the 2014 Mercer National Survey of Employer-Sponsored Health Plans cover the same detection and evaluation benefit that we offer under the <employer>  plan for infertility.  Only 26% of employers cover in vitro fertilization, so we are in the majority of excluding that level of coverage.  There has also been very little movement of employers to add this coverage in the past couple years. 

Regarding why <employer> has chosen to exclude the coverage, when we evaluate coverage under our medical program, one of the items we consider is the number of individuals that would use the benefit.  We want to offer a variety of benefits to ensure all those paying premiums have the coverage for the services they would use.  When you look at the cost of the IVF treatment in comparison to the number of members that would benefit, it doesn’t fit within that philosophy. The <employer> medical plan is self-insured, meaning once a participant hits their annual deductible, the firm pays for any additional services, not the insurance company.  The insurance company simply processes the claim and withdrawals the payment from an <employer> bank account.  Based on the statistics sent in your initial letter, if we were to offer the IVF coverage, we would easily add $50-60 million dollars to our annual medical spend, which would not only impact the rates that all 23,000 associates pay, but potentially the bonus levels and profit sharing contributions at the firm.   This is why it has been excluded in the past and at this time, why it will remain an exclusion. 

We do offer an adoption assistance benefit as well as the opportunity to save pre-tax dollars in a health savings account to pay for elective medical treatments, such as IVF. 

I am sorry this is not the response you were looking for, but I hope it at least provides an explanation into our coverage considerations.  Please let me know if you have any additional questions.

What I read was: we are in line with other employers by not adding the coverage, it’s too expensive and god forbid it affects bonuses, just adopt or wait. Sorry.

Yup. So now I am trying to come up with responses to these arguments that would support adding despite these things.

In addition to my work insulting me, my mother called to asked my opinion on my baby brother’s class schedule for his high school beginnings. Why does she ask me for parenting advice? I guess I am more maternal than her. Then she went on and on about how great of a father my brother is, how cute their baby is, how much I need to fly out and spend time with my niece,etc. I just stopped listening in the middle. I explained her to why I couldn’t fly out. Not only is it emotionally painful but I was just laid off in March and just started this job. I can’t exactly take time off. What a week.