Thursday, September 5, 2013

Road Block

It's September and it's been 7 months that were seeking an infertility OB to help us conceive. After months of follicle monitoring and having a semen analysis done, my OB decided for me to undergo hysteroscopy procedure. My last post on our TTC journey was Dra. Aguilar wants me to get an approval from Medicard about the procedure.

So last July 24th or was it 26th that I went to Cardinal Santos Medical Center and made a beeline to the Medicard coordinator. On the main entrance you will see some cubicles on your right with seats provided for outpatients waiting for the approval of their respective HMOs. Armed with the medical certificate from my OB I went to the Medicard table and explained my situation. Turns out that I need to have an ultrasound printout and admittance form filled up by my OB before they can accommodate my request for approval.

Cardinal Santos Medical Center
(Photo Credit: http://www.yellow-pages.ph/)

Dra. Aguilar's office schedule in Cardinal Santos is MWF 10am-12nn. It's quarter to 12 so I decided to pay her a visit to discuss the things I need to acquire before having the hysteroscopy procedure. In her office I met Lizette, her secretary. Unfortunately my OB is not in her office and went out since they only have 3 patients during that day. So I relayed to Lizette my situation including the approval needed for Medicard. She sent a SMS to my OB and we waited for her reply. Turns out that since I'm her patient in Friendly Care, she doesn’t have the records on her laptop at her Cardinal Santos' office. I will need to see her on her clinic schedule in Friendly Care. Oh well, at least I tried resolving the issue right there and then.

August 1st, I went to Friendly Care so I can discuss with Dra. Aguilar my concerns and the documents needed by Medicard. For the print copy of my ultrasound, she referred me to a sonologist within Friendly Care; I had a TVS and have to pay Php 800 since Medicard didn't approve the request of the nurse to shoulder the ultrasound. After having the printout copy Dra. Aguilar gave me a request slip to have a urinalysis, CBC and ECG done. She wanted to make sure that I'm not pregnant and everything is okay with my vital stats before the hysteroscopy.

August 17, I went to Medicard clinic in Festival mall for the Urinalysis, ECG and CBC. I presented the request slip signed by my OB however the diagnosis or the reason for that procedure is not stated so the nurse/staff in Medicard have to ask me some questions on what is the cause for the request slip. I have to wait for Medicard's call regarding my situation and after 5-10 minutes, the staff told me that the lab tests will not be shoulder by Medicard since the root cause is my endometrial polyp. According to Medicard, polyp is a pre-existing condition thus for the first year of my membership it is not covered. Anything that has got to do with polyp, procedures or lab tests will not be covered and I have to wait for next year (2nd year of my membership). Bummer! I know that this is the sign that my request for hysteroscopy through Medicard will not be approve.
Photo Credit: http://www.affinitydentalclinics.com/
I decided to go ahead with the lab tests despite of having to pay for it. For the three lab tests, I spent around Php 600+. The prices are discounted since I'm a Medicard member. After a week I went back to get my results. Everything is normal but it seems that I won't be using the result of my lab tests. As if by a cue, my OB sent me a SMS which is unusual for her to do. She's wants to know if I will proceed with my hysteroscopy as she has another patient waiting to be schedule for the same procedure. I replied to her saying that I will give up my slot for hysteroscopy and she can give it to her other patient as Medicard won't approve our request due to the pre-existing limitations for the first year of HMO membership. So now I'm stuck and trying to figure out other options. I was thinking of consulting another OB for second opinion or what will be their take on my situation.

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