Saturday, December 8, 2007

The Element of Surprise & Managing Expectations

Yesterday at my pre-op appointment, I had to put down a $2,000 deposit. I expected this expenditure because the surgery coordinator had walked through every piece of our payment for the D&C with us when we scheduled the surgery. I knew it was a deposit and that we would have to wait for the clinic to mail us an insurance claim form which we would then send off to the insurance company and hope for the best.

After the appointment, it was down to the lab for the zillionth blood draw of the year for an ironic HCG test (like there's any chance of actually being pregnant right now...). The lab tech drew blood and then said "that will be $90." Okay, I know $90 is NOTHING in the grand scheme of things. It is probably the smallest amount we have paid for anything during this journey. But I KNOW there was no mention of a $90 charge for an HCG test as a pre-requisite to the D&C when we talked to the surgery coordinator. She mentioned the cost of the anesthesia, surgery center charge, doctor's charge, etc., etc., etc., but no $90 charge for a pregnancy test. It is so amazing that there is always an element of surprise to everything we do with this clinic (is it like this at other clinics?). I've mentioned the element of surprise to various nurses before and the comment is always some excuse about how they can't predict all of the variables that may occur in any one cycle (I will come back to this excuse). But this was not a variable in a cycle. This is a standard test that is REQUIRED before ANY D&C that is done for ANY reason.

Every time something like this happens, I'm haunted by something our RE said at our first consult. He mentioned that some patients are comforted by how controlled every thing is in his clinic, that they don't have to chart temperatures, track dates, etc. because the clinic does that all for you, tells you what to do and when and you just "show up." He seemed to believe a lot of women LIKE giving up control and letting the clinic "take the reigns" and take care of everything. I didn't think too much of this conversation at the time, having just come off a couple of failed IUI cycles with my OB where I felt like everything was up to me (and I failed miserably). But really, I like to be in control of my own destiny (who doesn't?), which is what makes this infertility stuff so frustrating in the first place. This is the first time in my life that I can remember not having the ABILITY to make something happen if I really wanted it to happen (other than wanting to have ESP as a kid and staring at a pencil on a table for hours at a time willing it to move with the amazing power of my brain).

So back to the many variables of a cycle conversation(s). The main RE at our clinic has been doing this for approximately 20 years. I know the human body is complicated, but don't you think he's probably run into most if not all of the variable responses to the different medications and protocols by now? I also know each person is different and each person's reaction to different medications is different. HOWEVER, I keep thinking that they have some huge file somewhere that tracks all of this stuff and wouldn 't it just make PERFECT sense to put all of this information on their website where you can search for different scenarios (enter your protocol, age, etc. and see all the "maybe's" of what could happen--good and bad). And then you could prepare yourself for all of the possible things that could go wrong and prolong your cycle, cancel your cycle, cause a pregnancy to fail, etc. Maybe this is just my simple mind's way of expecting some way to process information and manage my own expectations. Maybe it's the accountant/consultant in me who has been taught to manage other people's expectations with some dose of reality. They must not teach this very well in the RE world.

The lab tech who asked me for the $90 unfortunately had to deal with my not so positive reaction of "HUH?!! What is this $90 you are referring to? I was NOT told about this $90. Why is everything such a friggin surprise in this place?! Over and over and over!!! It is always SOMETHING. Jeez!!!" To her credit, she took the rant well, was very sympathetic and I could tell she felt really bad. She said they get this type of reaction A LOT. She also pointed me to the comment cards in the lobby (which I had never noticed) and assured me that the comments do get addressed. I plan to fill out about 50 of these comment cards.

What would you put on a comment card that certainly won't fit nearly as much as I've written above in this post? How do you express the frustration, anger and amazement in just a few short words? It reminds me of those posters we used to see in certain teacher's classrooms about writing your complaints in a tiny, tiny box. It's a joke.


Jen said...

Trust me, I know about the $90 HCG tests. I think we spent about $1000 before I finally had the ectopic declared one.

But did everything go well for the D&C? Are you all pre-opped?

Denise said...

Hey, Jen. Yep, I'm all pre-opped and ready to get this thing over with!