Tuesday, September 12, 2006

Hen's teeth

Pulling hen's itsy-bitsy sharp little teeth ... had they any, of course, which is precisely the point ... might be easier than getting info out of Cal Pacific about our scheduled fetal reduction.

Howsomeever (as my grandmother from Kansas used to say), I finally did get a phone call from someone there this morning, though I'll admit I don't know who, exactly. Her name went by in a high-pitched, girlish squeal, and I just didn't care enough to make her spell it for me. (I'll just call her Tiffany, shall I?) In any case, after a lot of back and forthing, Tiffany finally vouchsafed me the information that the whole thing is going to be somewhere in the neighborhood of $2000. Now, mind you, despite the laundry list of costs she quoted to me for the various aspects of our visit, she didn't have the exact cost of the nuchal ultrasound, and told me I will have to call up the hospital section of their clinic to get a price on that. She did at least give me their number. I suppose that's service, of a kind.

Also, she quoted me a price of $238 on the Papp-A and expanded AFP blood tests, which are part of the Integrated Test for Down Syndrome and other things (the third leg of said Integrated Test being the actual nuchal fold ultrasound). We went on to other things, then I circled back and asked her if the Papp-A was useful for a multiple pregnancy, since someone had mentioned to me that they thought it gave false positives for multiples.

"Oh!" she squeaked. "I don't know if it works for multiples."

We had already gone over the fact that I was having a freaking REDUCTION, thank you, since I am carrying four fetuses at the moment. And yet the idea of my dealing with multiples had apparently not crossed her mind. All I can say is that I really hope this young lady is not in fact one of their supervisors.

She did eventually hook me up with one of their genetics counselors, a lovely woman who seemed sharp as a tack and kind as a mother's hug. I fell for her instantly, in a very platonic way, and if all of Cal Pacific's employees were like her, it would be an impressive place indeed. This young woman, call her LB, straightened out the mystery about the blood tests. She told me that the Papp-A test would not be an option for me, since if you are carrying more placentas than the number of fetuses you are testing for, you get false positives, etc. I currently have at least four and maybe five placentas in there (depending on how fast that empty one is degrading), but we would be testing for twins, and so the markers would be useless. So the Papp-A is out. LB said that the expanded AFP, which is typically done in weeks 15 - 20, might give me some answers. But it all depends on whether we are down to the proper number of placentas by then, as to whether we can profitably do the AFP. In any case, the expanded AFP by itself will not give as complete a picture as it plus the Papp-A (and the nuchal fold ultrasound) would. In the end, LB told me that if anyone tried to take blood from me on the 25th, I should shoo them away.

This whole thing about trying to get prices from Cal Pacific has been really odd. They act as if in the history of their clinic, no one ever asked them this before. Although maybe they haven't. I suppose that their actual paying customers might be few and far between, with the majority of their work being paid for by insurance companies. Their confusion at being asked doesn't leave a very good impression, though. (However, their willingness to give us a 35 percent discount if we pay up front does sweeten the whole thing for me, at least a little.)

In other news ... I had it out with the nurse-dragon at my HMO yesterday. Except she wasn't a dragon at all, unless you think of a cute little stuffed toy of a dragon; she was perfectly lovely. Somewhat astoundingly to me, she actually tried to be helpful rather than obstructive. Nurse Helpful (as I believe I shall call her) even volunteered to make some phone calls to see if she could find a way for the HMO to pay for the reduction at Cal Pacific. (Didn't work; the HMO has a contract with UCSF instead.) And when I told her that I wanted one of the two female OB's my IVF doc had recommended to me, she mildly pointed out that since both of them work part time (being busy raising families themselves), it would be impossible for her to guarantee me appointments with them. (Drat them both anyway, by the by -- what business do they have actually raising families and having a life? I ask you.)

Nurse Helpful and I finally worked out a compromise. My supervising OB will be one of their so-called "high risk" docs, who also happens to be head of their prenatal department. However, for pelvic exams and such, I'll see one of the two women OB's. This seems like a lot of rigmarole to go through, I'll admit, but one of the phobias I have not yet been able to rid myself of is that of male doctors staring up my cooter. It makes me nutsy, and worse than that, it makes me nutsy for a couple of days in advance of the actual appointment. I cannot believe it's good for the developing kiddos for me to be having panic attacks for days on end.

I'm afraid that my endless questions put me well past my allotted time with her, but Nurse Helpful was very gracious about the fact that our appointment ended up lasting an hour and a half. The whole thing ended with a bit of unintended comedy. As I left, she gave me a scrip for the standard pregnancy blood tests, and a urine test. (I don't know what the urine test is actually for; I hope nothing important, as things turned out.) I took the paper and headed down the hall, starving, dying of thirst, and with a bursting bladder. (Don't forget, I'm gestating here. Everything is on overdrive these days.) I had food out in the car, so I decided to just pick up a drink in the next building over, then go to the lab for the blood. Oh, and on the way, I just ducked into the restroom to take care of the bladder problem.

You've spotted the issue here, haven't you? I didn't, until after I had already peed, washed my hands, and was in the next building over, sucking down my Creamy Italian Raspberry Soda (with whipped cream, of course -- as I said, I'm gestating here!) -- when it occurred to me that perhaps I should have held onto some of that golden liquid. Oh, dear. Then I sucked on the soda even faster.

I made them take my blood first, and then let them give me a cup (which I got to take to the restroom down the hall, out amongst everybody -- it kills me that they're nuts about privacy everywhere else, but are apparently fine with you toting bottles of your own pee along a public thoroughfare). I actually stopped along the way, sat down, pulled out a magazine for a few minutes and drank my soda, hoping I was producing something while I waited. Then I went to have my try ... and was, well, somewhat successful. The instructions said not to fill up the cup past halfway. I have to say I followed instructions -- it certainly was not filled up past halfway.

But the main thing that little episode did was to make me feel like the biggest jackass in Christendom. Member of Mensa, hah. I don't dare tell any of my fellow Mensans about this -- they'd make me take a retest!


Blogger casey said...

I can never understand why medical personnel don't know the absolute ins and outs of their work and their BILLING. Is it a mystery? Do they charge different people different rates? Does it change the price to have a procedure done in the heat of the day, rather than later in the afternoon, so they are forced to include a line item for air conditioning in the final tally? WTF!

It makes you feel like it's not science, when, in fact, the financial aspect should really be nailed down.

(Great, though, that you're getting 35% off. I have heard that suggested to people doing any medical work w/o insurance...negotiate the same rate that the HMO's or PPO's would get. And it looks like you have!)

12:15 PM  

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