The baby factory

The biggest problem with going to an enormous IVF clinic is that it's a bit like a baby factory. You're herded around from nurse to nurse, procedure to procedure, following the protocol. But if you're doing anything a little bit off protocol, everything slooowly grinds to a screeching halt. Take today's visit. It started off fine. I sat and waited on the extremely uncomfortable seats for an age, read Time, skimmed a few other magazines (yes, it was a very long wait), then got called to phlebotomy. The nurse took my blood, I signed my initials that that was really me, and I went back to the waiting room to wait for the ultrasound tech. And I waited. And eventually I got called, did the usual for the dildocam which effing hurts me on cycle day 2 because my left ovary is always hiding somewhere just underneath my shoulder, or so it feels. The tech pronounced my ovaries good to go, with no cysts. Then I waited for the IVF nurse. By this time my back was pretty sore from the awful seats, but hey, at least I was following protocol.

But then, once I saw the IVF nurse, things started to go a little off. The doc and I had discussed adding progesterone suppositories to my meds, but he'd forgotten to write it in the computer. So of course the nurse didn't quite believe me. And to complicate matters further, the usual progesterone suppositories are formulated using peanut oil, and I have a peanut sensitivity. The doc had said we could have some suppositories made up at a compounding pharmacy. The nurse wasn't quite sure what the doc had been thinking about, and just looked blankly at me and repeated the word "compounding" with a puzzled expression as if she'd never heard of the concept. I asked her to please discuss with the doc, and she said she wasn't sure if he was in that day. I pointed out that I'll be on birth control for a while, so it wasn't as if I needed all my meds ordered right this second and it could wait until tomorrow or whenever he came back. I am supposed to be going on birth control pills for 6 weeks due to a trip out of town in the middle of July. The doc had OK'd that, and I remember seeing him write it in the almighty computer. But she just couldn't quite get that point either, because they usually only let patients stay on BCP for 5 weeks. So we had to spend some time discussing how the doc was aware of my plans and had approved them. I kind of thought that if he OK'd it, we could do it, seeing as he's the founding physician and chief doc there, and all. I mean, presumably he's the one that wrote their rules, so if he doesn't have authority to bend them, I don't know who does.

The kicker came, though, when I wanted to delay payment of the full IVF fee (nearly 10 grand) until after my next visit. Now, if my health insurance was kind enough to cover IVF, which they're not, I am quite certain that the clinic would not get paid until sometime next year. OK, fine, they charge more if you're using insurance to make up for this, and for the fact that insurance wouldn't pay the full amount, but still. If I had qualified for the shared risk plan (of the buy 2, get 1 free variety), the shared risk financer would not pay them until the end of the treatment cycle. But not only do they want self-pay patients to cough up in advance, they have to cough up a month in advance. Or in my case this time, 6 weeks in advance.

So the nurse said I had to speak to the front desk staff about delaying payment. The front desk staff refused to let me delay payment, because the rule was that I had to pay NOW. This instant. I stonewalled. I did my best puzzled "but I was allowed to last time" spiel. They called accounts. The accounts lady refused to let me delay payment. I pointed out that last time I'd been able to delay payment (that one involved a little white lie on my part about being surprised about having to pay that quickly, and not having the money). She checked in the computer, and sure enough, it showed that I was telling the truth. She said she'd have to check with the supervisor. I stood my ground, and said that I didn't see why they should have the money for doing nothing for the next six weeks, when I could still be earning interest on it. She said they might be able to compromise with me, but she'd have to speak with the supervisor. I said fine, and they're going to call me this afternoon. So, I paid my outstanding balance for the embryo freezing from last time, said they could get my payment authorization over the phone if I had to pay the rest of the amount today, and left. I am now officially the awkward patient of the day.

I know, I know, I'll probably have to pay the entire amount today, because rules is rules, especially at the baby factory, but hey, you don't get if you don't ask. You never know, if I'm lucky, maybe a little compromise will enable me to stretch the payment over a couple of months, which is always good for the cashflow situation.