Tuesday, April 22, 2008

Mother Runner

First of all, thank you to everyone who chimed in with advice on the insurance/billing issue. I'm waiting to hear back from my letter to the billing office, but in the meantime I am going to get all of the records from my insurance company from that cycle and look into getting a RN case manager to help me untangle the mystery so I am prepared when the hospital comes back to me with an answer.

I just got back from my first trip away from all three kids- and really my first extended trip away at all since I've had kids- to return to Boston to run the 2008 Boston Marathon. For those unfamiliar with the world of distance running, Boston is like the Super Bowl of running. The Stanley Cup. The Olympics. Runners must qualify to run with a certain time except for a few runners who run for charity causes. Boston is not just a marathon- it is an experience. Running Boston has always been the highlight of my entire year. This was my fifth time running Boston but only my first since having children, and I have to say that this particular time was one of the most memorable experiences for me for a number of reasons.

First, my finishing time (three hours and sixteen minutes) was almost a personal record for me- I have only run two of my eleven marathons faster than that, and one was Chicago (which is fast and flat anyway) and the other was an earlier Boston that I finished only seconds faster than my time yesterday. I felt better through the run and feel better today (I honestly feel like I could go out for a run) than I can ever remember feeling after any marathon with the exception of the one I ran "slowly" to help pace my husband so he could finish in his own goal time of under four hours. I don't know if I should attribute that to better training- I ran much more in my training than I used to, especially because I knew after giving birth almost six months ago I couldn't rest on shoddy training- or if my body is somehow stronger now that I am older.

Or maybe it's the inspiration my children gave me on this run. Every time I thought of slowing down, I'd see little kids on the side of the road, offering their hand for a "high five," and I'd think of our twins saying "Mommy run" (that's what they say every time they see a runner out on the roads). I'd think of the day they'll come up to Boston with DH to cheer me on. And I'd run just a little faster. I'd feel a little stronger.

I was reading an article in the Marathon program about last year's Boston Marathon women's wheelchair champion, Wakako Tsuchida from Japan. Tsuchida had a child seven months before her victory in 2007 and felt that

"giving birth has made her body stronger. 'Being a mother an an athlete means so much to me. To succeed in both roles, I need to seek a balance. I find that I train harder so I can spend more time with my son.' She is not the only elite athlete and mother to suggest that having a baby improved her athletic performance. Paula Radcliffe, the world record-holder in the marathon, won last year's ING New York City Marathon seven months after giving birth to a daughter, and stated afterward that giving birth made her a better runner."

While I don't know if the physical act of giving birth (especially because my children were all born by c-section, so I can't claim that the pain of a marathon is nothing compared to vaginal delivery!) has made me stronger, I do think that living my life for my children has given me such a sense of purpose and determination that I have become more focused and balanced.

The second reason this was such a memorable trip was that it reminded me what it's like to be on my own schedule again. I hadn't realized how much I had forgotten what that was like until I actually had a weekend with no one to answer to but myself. I went to bed when I wanted to (sadly, that was 7:30 p.m. the first night I was there, as I had been up since 3:30 a.m.!), decided what activities to do during the day, left the hotel within five minutes of deciding I wanted to leave, walked as fast as I wanted, ate what I wanted (in peace!) and when I wanted. I hadn't done that in over two years and it felt so foreign.

I won't lie- I loved the freedom of being on my own for a weekend. But I also can't deny that I missed my family terribly. Every little kid I saw reminded me of our own. I watched, teary-eyed, as I saw other runners walking around over the weekend and after the race, with their children. I got choked up when I saw little kids holding signs that said "Go Mommy" or "Go Daddy." I talked about my kids (and DH!) to as many of the other runners who would listen. I called home A LOT.

Another reason this trip was special was that I had a chance to meet-- in person-- someone I consider one of my closest friends but who, amazingly, I had never met in person until this weekend. We met on an online infertility discussion board four years ago and she's been one of my biggest supporters and inspiration through everything we've gone through over the years. It was so special to be able to meet her (and her sweet and funny DH) in person. Giving her a hug was really a highlight of the weekend. I also got to meet up with another "online" friend (who I had met before when I went to run Boston in 2005) and a friend I used to work with while I was practicing law. Reconnecting with all of these friends reminded me how lucky I have been to have such amazingly strong, inspirational women in my life.

Over the weekend I thought a lot about the differences between the last Boston Marathon I ran in 2005 and this year's race. In 2005 we were in between our fourth and fifth round of IVF. The race was a way for me to recover a little bit of who I was before we started going through infertility hell. I was poorly trained (thanks to having gone through a cycle just a few weeks before the marathon and lots of extra pounds complements of the injectible meds) and in a very negative state of mind. It showed in my finishing time (the worst of all of my 11 marathons) and in my condition at the end of the race (barely in one piece). This time I was really at peace and in the "right place," both physically and mentally. It's amazing what a difference a few years can make.

Wednesday, April 16, 2008

Statute of Limitations?

We finished the last of our five unsuccessful rounds of IVF with our local clinic almost three years ago in May of 2005. That's not counting the two IUIs we did before my RE convinced me I was such a "high responder" that it made more sense to move to IVF and not waste time on IUI. Five. Unsuccessful. Two of those with PGD that showed horribly messed up embryos (we're talking five of one chromosome, none of another, etc.) After which my RE told me the chances of me having a biological child with my own eggs was like "finding a needle in a haystack." And then proceeded to tell me that the Big Clinic we planned to go to for a second opinion (just to put our minds at rest that we did everything possible) would never accept us because I was too much of a "risk factor" to their statistics, given my horrible track record (Five. Unsuccessful. Remember?)

After we had success at Big Clinic, I tried not to dwell on the fact that we "wasted" SO much money at the local clinic before we went to Big Clinic. I justified it by telling myself that without the benefit of the hindsight of those five cycles, my RE at Big Clinic might not have been able to come up with the exact right protocol on the first shot. But it still made me shudder when I added up, mentally (and on our tax returns for purposes of medical expense deductions) how much we had spent. We were lucky enough to have some insurance coverage- 50% for most cycles- but with PGD and ICSI (not covered by insurance) we were easily out upwards of $50,000.

Last week in the mail I received a bill for $2,000 for a cycle from MARCH 2005. It's now April 2008. Trying to decipher the transactions on the bill, all I could make out was that even though the original charges were incurred in 3/05, something didn't happen with our insurance (an "adjustment"-- I am guessing that is their deduction for the agreed-upon price the clinic can charge according to my insurance company?) until March of this year.

My first reaction was rage. How can they send us a bill for a cycle from THREE YEARS AGO when we had checked numerous times after we left the clinic to make sure we had paid everything that was due? Luckily, I am pretty anally organized and had the paperwork on hand from that cycle, including an itemized statement showing that we paid a 50% co-pay of $3250 in addition to $5000 for PGD and $2000 for ICSI. Just looking at that statement- and all of the other statements in that pile of paperwork- made me want to throw up. If we had just a fraction of that money back today, it would seem like a fortune. At the time, I was working in a well-paid job and we could afford it, but now that I'm at home with the kids, money like that seems like an outrageous amount.

So of course I then spent the next several days gathering information, trying to get answers from the billing office, my clinic, and the insurance company. Each pointed to the other one-- "we don't know why you owe that amount-- check with [your insurance company, the billing office, the IVF clinic]." And it didn't help that the billing manager at the clinic ignored my phone calls until I sent an email, which I copied myself on in case I had to go to the doctor, which was my next step. She must have felt a little more accountable for a request that was in writing vs. my voice mails (no documentation) because she got back to me PDQ after I sent the first email.

From what I can tell (and this whole thing is so complicated and convoluted I really don't know which way is up any longer), they are claiming that the 50% co-pay the clinic charged us at the outset was not enough to cover the costs not covered by insurance, and that they did not get the final word from our insurance as to what it would cover until last month due to a lot of back-and-forth getting billing codes correct, etc. This is despite the fact that the policy of the clinic was to collect the full co-payment up front (after verifying with insurance how much I would owe) before the cycle. And despite the fact that we paid $10,250 for the cycle anyway. (OK, that makes me want to gag again. That was for ONE of our SIX cycles).

If anyone out there knows anything about medical billing and insurance reimbursement, do you have any insight into this? My response in the end was to mail the billing office a copy of the statement from our cycle- which showed that we paid the $3250 co-pay which was supposed to cover, among other things, the two services they are now billing for (retrieval and culture/fertilization) and requested a full explanation of why that co-pay did not cover what they are billing us for now and why it has taken three years for this charge to come to light. I want to put the burden on their shoulders to unravel this complicated web of insurance and medical charges because despite the fact I am an intelligent person (I'm actually an attorney- go figure...) I have NO idea why we're being charged for this now, or even if they can bring this up three years after the service. I have a sick feeling we're going to end up having to pay this in the end- to a clinic that basically kicked us out to the curb- but I'll fight it tooth and nail before we do.

Monday, April 14, 2008


One thing I really wanted to know before Smiley arrived was what the addition of a new baby to our family would mean in terms of our day-to-day life and logistical reality. So in case anyone is reading this blog who is expecting a third very soon after their twins (or even expecting their second child soon after their first), here are the major adjustments we've had to adapt to and issues we've faced over the last several months:

Zone Defense vs. Man-to-Man: This is probably the single biggest adjustment. With two kids, I was easily able to transport and supervise them myself. When we went out as a family to gatherings, like neighborhood barbecues or birthday parties, generally DH or myself could keep an eye on the kids while the other one hung out with friends, grabbed something to eat and otherwise relaxed. Now outings look something like this: I take care of Smiley, holding her and/or feeding her if she is not sleeping in her carseat, which barely happens any longer now that she's almost six months old. DH keeps an eye on the twins, getting their food and drink, making sure they don't try to pull things down from a counter or eat something they shouldn't, changing poopy diapers, etc. So neither of us really gets a chance to just relax. I've seen DH step up a LOT more now because of this. Before, it was generally me doing all the work with the twins while he got involved in a conversation with a friend or grabbed a bite to eat. Now he's on full duty with either Smiley or the twins. However, it is getting easier as the twins get older and they're able to go off on their own and play. We actually let them go down in a basement playroom at a neighbors' house to play with the "big kids" on their own recently. I was going down every two seconds to check on them to make sure they were OK, but I think it's the start of them getting more independent, freeing us up to take turns with the baby. In fact, we left Smiley with her grandparents this weekend while we took the twins to a birthday party and as the twins played off on their own with their friends, I mentioned to DH that I was actually bored without Smiley to take care of!

Out and About: When I'm out and about on my own, it's a little trickier to transport three kids, especially when one is an infant. At first I was doing a lot of double stroller/baby bjorn combinations but that was waking Smiley up and let's just say Smiley wasn't so Smiley when it was time to put her back in the carseat. So we ended up buying this "freak show" of a stroller which allows me to put Smiley, in her carseat, into the stroller, while one twin sits in the other seat and the other stands on the back. You should see the looks we get when we use this stroller. I really like it despite the fact it's huge. I don't use it all that often because for short walks the twins can walk or I can take the double stroller, put Smiley in one side, a twin in the other, and have the second twin hold my hand while we walk; but for shopping trips when I just need to get everyone in and out quickly or for longer commutes, this stroller is worth it's weight in gold.

Different Ages, Different Stages: I honestly think that it is probably easier to have triplets than to have twins and a newborn, just because of the different needs of the two different age groups. Whereas the twins want me to sit down with them and read a book, wait while they sit on the potty (but of course not actually "go") or play with them outside, Smiley needs to have a bottle, take a nap, etc. If all three needed the same type of attention, it wouldn't be as difficult as giving the two age groups (toddler and infant) different types of attention. There is a sort of economies of scale with multiples. So often I find myself feeling bad that Smiley is sitting in the Exersaucer while I read the twins a story or serve them their lunch, or when the twins are left to play by themselves while I give Smiley a bottle (speaking of which, I ended up nursing for one month and then pumping and bottle feeding-- mostly because of time and efficiency issues-- until she was 4.5 months old). It's times like this that I am actually thankful I have TWO older kids, though, as at least they have a friend to play with while I am busy with the baby. I also realize I'd have these issues no matter if I had just one older child or two...it's simply an issue of different needs for different types of attention.

Scheduling: With a newborn/infant, scheduling is always tricky. Try synching that with the schedules of older twins. Luckily, for now at least, I think I've done a good job of coordinating Smiley's second nap of the day with the twins' one big nap of the day, typically (but not always) giving me one long stretch of time in the afternoon when all three kids are sleeping and I can get things done. But occasionally Smiley will wake up from her morning nap just in time for the twins to go down for their long nap. And you guessed it-- they are waking up from their nap just about the time she's going down for her second nap. I've figured out that if I keep Smiley awake by keeping her out and about in the mornings (which generally isn't difficult since we're always running around with the twins to their activities) I can usually sync their naps in the afternoon. Plus, I try to tweak her feeding schedule to fit into the twins' schedules. Usually it works, but it definitely takes some thought and coordination.

In general, though, now that we've gotten into a routine, things go pretty smoothly and it's fun having a baby around and watching the twins dote on their sister. I can tell already that the three of them are going to be VERY close, and it makes all of the work well worthwhile.

Sunday, April 13, 2008


OK, OK...I know it's been a very long time since my last post. And no, I really can't use the excuse of having three little ones for my utter lack of posting. First of all, ironically I no longer technically have "three under two," as our twins turned two years old at the end of March (!!!) Second of all, we've settled into a nice routine now that LS is 5 1/2 months old. Since she was about 4 months old, I've had my evenings back and can count on a pretty good night's sleep, as she goes down right before the twins around 7:00 and generally doesn't get up until somewhere between 5 and 7 a.m. I can't complain. I've had plenty of time to get back to my volunteer activities, train for my upcoming marathon and lurk on everyones' blogs...so I have been keeping up with everyone else and always feel guilty for neglecting my own blog! It's just that I had let so much time slip by it seemed kind of silly to pop back in and start posting again.

But today I met up with the Order of the Plastic Uterus, an AMAZING group of women. Even though I only knew one of the members in attendance in real life (the utterly inspirational and tireless Mel), I really felt like I had known everyone else for a lifetime. Maybe it's our shared experiences or maybe it's the fact that I've been following their blogs through Mel's blogroll (and LJ's blogroll of the members of the Order) but I left feeling like I had just caught up with a bunch of old friends. I also left feeling like it was unfair that all of these ladies had allowed me an intimate look into their lives through their blogs, but I didn't reciprocate by keeping up a blog of my own. Not that everyone (or anyone for that matter) should necessarily find my life captivatingly interesting, but it only seems fair that if I get to look into their lives, they should have the opportunity to look into mine. Same goes for all of the other bloggers with blogs I read all the time.

So I am making a resolution to start posting more regularly again now that we've settled into a nice groove as a family of five. Don't get me wrong- there was plenty of adjustment going on the first few months (which I'll be sure to blog about in the future). But now it feels like we always had three kids and I'm really enjoying watching LS (who, by the way, I think I'll start calling Smiley because that is much more fitting than LS, since this baby smiles almost ALL of the time) go through the stages that are sort of a blur for the twins.

Before I sign off today, I just have to add that I'm feeling extremely self-conscious after I got home from our gathering today and our older daughter, now just barely two years old, points at my (admittedly bloated from too many brownies and cheesecake) tummy and says "Baby?!!" DH did his best to hold back his laughter as I didn't know whether to laugh or cry. No, sweetie-- no baby, just what Mommy's tummy looks like after having three babies in the course of 19 months. You can thank me later.