A little background: My sister and her husband are trying to have a baby. All tests have pointed to male factor. Basically a zero sper.m count. ZERO. The doctors dug a little further and have found tes.ticular cancer. The good news? It's early, and they're monitoring it. The bad? For any shot of having a baby, it involves IVF and micro tese. And removal of the tes.ticle.
I had an awkward, kind of uncomfortable conversation with my sister today. I really don't know if I did the right thing, or if I came across the way I wanted to. What I do know is that I want to know what you would do....
After my sister's cycle was cancelled last month, she headed south, for a vacation. I can't blame her, she had already scheduled time off work for retrieval and transfer, so why not? She left town on the 9th and just returned yesterday. She mentioned that she talked to the RE's nurse today about their next step. We both share the same RE, and the staff knows we're sisters.
I'm very fortunate that my insurance covers a lot of my medicine costs. I was shocked at how much they cover, when I received my meds in June. I'm well aware that this is a very rare thing. When the nurse called me in August and asked if we could order "me" some extra foll.istim, I readily agreed. (Yes, I know this is somewhat questionable...but it's my sister and her husband has cancer and this might be their only shot, KWIM?)
Her last cycle was cancelled due to poor response. She's 28 years old and after stimming for over a week, only produced 2 follies in her left ovary. Nothing in the right.
The nurse told her that her next cycle will be a "flare" protocol. At this point in OUR conversation, my sister casually mentioned that the nurse said she should call me.
This is where it gets uncomfortable...
Sis says she still has 2 vials left from her cancelled cycle, so she'd have the nurse just order what else she would need. I told her I thought that was a good idea, but warned her that even a half order could be pricey. When she asked me how much, I was honest.
"Well, my receipt said a full order was $4,600 without my insurance."
Silence.
"Oh, wow.", is what I finally heard her squeak out.
At this point, I started rambling about how I was sorry. Sorry that I can't do it again. Honestly I would do it every month if I could, but let's face it, I haven't even had my OWN cycle yet. I don't want to max out my insurance or raise any red flags, you know?
Am I being selfish? Am I doing the right thing?
I just worry.
What if my cycle fails? What if I do have a maximum amount of drugs allowed? Am I being selfish for not helping her?
Ugh.
I just wish that NONE of us had to go through any of this.
What do you think? What would you do?
You did the right thing. There are many issues that had you asked me would have convinced me to suggest what you did. You have to advocate for you. I know she understands. You went above and beyond. Really. If both your houses burned down would she give you half of her insurance $? Would you even ask? No. Would you hold it against her? I don't think this situation is any different.
ReplyDeleteIt does suck that you are both 'here' though. :(
-Christina,Apron Strings
I think I would've done the same thing as you. it's a sticky situation and if god forbid your cycle doesn't work and then you have to pay out of pocket for ivf meds...ya know?
ReplyDeleteThat's hard. If I had no maximums, I would do it every month, but you are right, you need to save it for yourself too. I guess I would have a heart to heart with her and say you have to go through it first and THEN, if/when it works, she can use the rest.
ReplyDeleteWhat a tough thing to have to go through. I'm sorry.
Personally knowing that my prescrition company is a ballbuster, I wouldn't do any more than you already have. God forbid the insurance company would get "wise", that is a pretty scary situation to be in. You could jeopardize your own situation.
ReplyDeleteVery tough, but if it were me, I wouldn't push it.
Ditto on what everyone else said. God forbid something happen to you and then your coverage is "all used up." It is a tough situation, but you gotta look out for #1 right?
ReplyDeleteI think doing it once is more than generous. I mean really, if your insurance company found out even about that one time, it might affect your prescription coverage even for other non-fertility related prescriptions, you know? Who knows, it might even be a reason for them to drop you from the insurance plan altogether?
ReplyDeleteHonestly, I am surprised that the nurse even suggested it because I would think that the clinic being involved in this could affect them as well--it is insurance fraud (and not that I think it is horrible that you did it or anything, just saying that there could be legal consequences for it).
You are incredibly generous, my dear. And you have done more than most would!
ReplyDeleteditto the above comments. I would save the insurance coverage for your own cycle.
ReplyDeleteThat is tough: I would probably do it once, but after that I'd be afraid it would come around and bite me in the butt (either insurance fraud or meeting my max etc).
ReplyDeleteI *so* understand what you did. And I would do it again and again if I could be sure that the insurance company would be none-the-wiser.
ReplyDeleteHowever, there is a good chance that your insurance company may figure out what's going on, and then you could be screwed, screwed, screwed.
So, I would maybe see if the clinic can provide any "samples", or if they have the contact information for the drug company's reduced cost program (almost every company has one). She could see if circumstance would qualify her for free or reduced cost meds. I'm not sure if they offer fertility drugs through that sort of program, but given their circumstance, it surely couldn't hurt to find out. But above all, I wouldn't let the clinic order any more meds for her under your name, because it could be devastating for you if anyone outside the office were to catch wind of what they are doing.
Man. What a sucky situation. Thinking of your sister and her DH right now...
You did the right and legal thing to do! I'm sorry for her and her husband, but that's no reason for you to get in trouble with your insurance. And it's completely unethical and unprofessional for the NURSE to tell your sister to hit you up.
ReplyDeleteSorry you were put in the middle of this!
This is such a hard situation! It is obvious that you have a great deal of empathy for her and her husband and you help her any way you can.
ReplyDeleteYou cannot risk this one, I would say, however. Hopefully you'll have a SUPER successful cycle and you'll have leftover stim drugs.
If you can give yourself a break, try not to feel guilty about it. I know you'll be a huge support to her no matter what.
Big hugs to YOU my dear!
Carrie
what an awful and uncomfortable situation ... So awkward. You did want you thin was right. The world is not fair and that is a hard lesson for us. I am so sorry that you were put in that moment ... AND shame on your dr's office for making you be in that situation
ReplyDeleteyou did the right thing, you need to look out for YOU!
ReplyDeletetwo words :
ReplyDeleteinsurance fraud
big no no..