Living in a Dream

Sometimes I just think too much

Archive for the tag “Essure”

Round 3: Where a shot makes it through the defense

Force is all-conquering, but its victories are short-lived.
-Abraham Lincoln

Victory maybe short lived, but I gotta say that it looks like this little one may have won a battle (hopefully not by losing the war). In other words- the giant is admitting that my procedure is not complete without the test. Took a few tries, but it looks like that has finally sunk into their heads. 😀

Funny thing though- I was reviewing their Membership booklet,you know that giant small print thing they send you every year or so, and I found a lot to laugh about. Mainly that they were claiming that they don’t cover contraceptives  like IUDs or sterilization procedures for men when the federal law mandates that they have to. Funny how they are trying to get around that. 🙂 But since I’m past that stage I don’t really care about that. Though if you are with the same company as I am you might want to start gathering up materials to send them to prove your case. Just a thought. 🙂

In any event-

I’m dancing around my office right now barely able to contain myself that this war against a giant might actually be won. 😀 I had to share with someone so I called Lyo first. I think he finds it amusing that I’m so happy about this victory. But after spending a few sleepless nights and untold amount of scenario running where I ended up the loser and in court over this….

Yeah. I think I deserve to have a few happily ecstatic moments. 😀

Round 2: Battered and Bruised

You learn a lot about people when you play games with them. –Laura Moncur

 

Well, the bell has rung and I’m standing up to a giant with little sleep as well as a short fuse. 😛

On the list of fun filled things to do today was getting up and finding my handbook for my insurance after finally getting to sleep after midnight (I think). I promptly looked up their stance on voluntary sterilization and found out that that it is only covered in full if the procedure is done In-Plan. Out-of-Plan you would have to pay. Now here’s the kicker. My insurance is ‘sponsored’ by the Catholic church.

I smell something funny about that. Since I couldn’t have the procedure done (thank the gods I already had it done before the switch) in their hospitals and clinics I would have to go Out-of-Plan to get it done anyways. I’d be pissed, but like I said I’ve already had the surgery. ~sticks tongue out at insurance company~

Then I looked up their Exclusion periods. The giant does have an ‘Out’…sort of. Electives are not covered for 12 months. Probably should have looked into this before I went in for the test, but…~shrugs~…I took someone at their word and this is what happens…frequently. 😛

So rather than dwell on the potential problem in the making I focused the rest of my morning on trying to determine what the Affordable Care Act says about sterilization.

I know I have some of the materials at home (which I’ll be going through again tonight) but I’m still trying to find out how they define the sterilization procedure.

According to the report that the HHS (Department of Health and Human Services) based their guidelines on defines it this way-

For the purposes of this study, the Committee on Preventive Services for Women
defines preventive health services to be measures—including medications,
procedures, devices, tests, education, and counseling—shown to improve wellbeing
and/or decrease the likelihood or delay the onset of a targeted disease or
condition.

And they define testing like this-

Testing refers to any process used to determine whether a condition is present
or to assess the status of a condition. Testing may involve questioning patients
(e.g., asking a patient about tobacco use), physical examination (e.g., mammography
screening to detect potential breast cancers), or examining blood,
body fluids, or tissues (e.g., to see if a cancer is present in a biopsy sample).
Testing may also require the use of sophisticated technology, such as computed
tomography and magnetic resonance imaging scans and other X rays,
or invasive procedures, such as heart catheterization to detect blockage of
coronary arteries. Tests may be used to
1. Screen individuals who have risk factors but no indication of having the
condition,
2. Diagnose a disease or condition in individuals who have symptoms and
signs but for whom a test will add certainty about the diagnosis, or
3. Monitor the progress of an individual who is being treated or being
considered for treatment, such as monitoring blood pressure over time.

Kind of sounds like my test falls into that category doesn’t it. I just need to make sure that the Guidelines still have those definitions. Otherwise I maybe picking a fight that will cost me in the end. But I’ll look and see none the less. 🙂

So being nice and polite (remember you catch more flies with honey than vinegar) I passed some of the information saying the test was a requirement of my procedure to the giant.

As of yet I have not hear back from them and probably won’t until nearly 5pm tonight. I think they go home at 5 on Fridays. Maybe they go home at 4. In any event I’m fairly certain that I won’t hear anything until Monday.

If/When I do I’ll have some other documents to send their way. 😀 And considering the way my application process went I think this is fair payback to the giant. They gave me a headache with their paperwork…I can do the same thing. 😀

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