Modest Goddess

I've put my impending embryo transfer on hold indefinitely, thanks to, to paraphrase Helen Hunt, those goddamn motherfucking H.M.O. bastard pieces of shit. Perhaps it's not politic of me to call them that, because they are the ones who will determine whether those three embryos of mine are ever transferred into my uterus. But someone at my HMO is out to get me. That is the only explanation I can come up with for the fact that they claim I have exceeded my $50,000 lifetime maximum for infertility coverage, when THEIR OWN RECORDS, on THEIR OWN WEB SITE, show this is not true.

I started getting notices of rejected claims a couple of months ago: one for $2,000 here, one for a grand there. I phoned the HMO and politely explained that no, there was no possible way I had exceeded my maximum. A supervisor was kind and patient, looked over my claims and agreed with me. She faxed me all my infertility-related claims, and I duly added up all the money the HMO had paid out to doctors and labs for infertility over the past year and a half: $22,000.

I sat back, assuming the error was fixed. My clinic said great, just get that nice lady supervisor to send a letter saying that I am still covered. I called her. They called her. I called her. They called her again. I called her again. I called her some more. But the nice lady supervisor, who had given me her name and phone number, has never returned my calls since. She stopped returning my calls right after I told a surveyor from the HMO that I was satisfied about my interaction

with the supervisor. Thinking I was.

Apparently, two separate audits claim that the HMO paid $67,000 for my infertility treatment. I have no idea where that figure came from. Anyone who looks at my claims on my very own HMO's Web can see what they actually paid my doctors: $22,000.

I call again. I spend 25 fruitless minutes on the phone with someone I can barely hear, then get cut off. (I think that was my phone's fault.) I call again. I get a guy who tells me that an audit shows that blah, blah, blah. I ask if he'd mind going through my 2006 claims with me for starters, just to see if the numbers added up. We do, for over an hour, and they don't: $4,000 actually paid, versus the $10,000 they claim to have paid. He, too, promises to fix the problem and call me back in a few days. It's a week and a half later. No call. No return of the message I left him.

I call Monday. I ask for another supervisor. She tells me that two audits show blah, blah, blah. I beg, plead for her to review my claims, and she promises to do so, "because you're so adamant." She promises to call back around Wednesday. Here's Wednesday. No call.

I just finished watching "Sicko," which contains the trenchant reply from a former claims adjuster about people "falling through the cracks" at HMOs: There is no crack! "They made that crack and are sweeping you towards it," he says. That's galvanized me to get this company in any way I can. They're keeping my future children hostage!