Battling Bureaucracy

It is a fact of life and unavoidable; at one point or another we all encounter bureaucracy. If the DMV is the worst of it, consider yourself lucky! Israel thrives on bureaucracy and Israelis spend significant amounts of time and energy negotiating their way through oceans of paperwork and endless lines at numerous offices – welcome to Israel. Over the years, I have developed a few strategies for dealing with this reality. It all begins with acceptance, don’t fight the  bureaucracy, instead focus on your goal of getting whatever you need. With a little persistence, you can almost always get what you want or need from the system.  Second, the fax machine is your friend and can spare you hours on hold or waiting at an office. Finally, be sure to bring something along  to keep you busy as you wait. When I arrived in this country ten years ago, I had only the newspaper and some mediocre games on my phone to keep me entertained in a long line; today my smart phone offers me infinite opportunities to mindlessly pass the time.

Strategies aside, I never expected to encounter bureaucracy while trying to conceive. I had always just assumed that it would involve a bit of fun and the need to pee on a stick (POAS).  Eventually,  I learned that it might not be quite that simple for us,  but instead of bureaucracy, my associations with fertility treatments included tests, injections, examinations and stirrups.  Therefore, allow me to set the record straight, there are many forms and documents that must be submitted, signed and approved. The bureaucratic elements of fertility treatments are particularly difficult to maneuver because often both emotions and hormones are running high. I have dealt with lost folders and numerous tests that have simply disappeared or were not recorded; all of this can be resolved, but is nonetheless frustrating.

Tommy and I were introduced to the web of  medical bureaucracy well before we began fertility treatments. About two years ago,  I had been told that my cysts could become cancerous and needed to be removed as soon as possible. The doctor wrote an order that I be hospitalized and informed me that I could simply call a hospital and schedule the surgery (he was not a surgeon).  He was correct and though Tommy insisted on vetting the doctor who would perform the surgery, the process was easy. Probably too easy.

The final step was to obtain a form from my insurance company confirming that they would pay for the procedure. It is a standard form and, in most cases, easily obtained. I faxed a copy of the doctor’s order to the insurance company’s administrative office – it  seemed to be a redundancy as the order was already in my electronic file and had been ordered by the company’s employee. The insurance company informed me that they could not provide me with their commitment to pay without a written order from the hospital. That seemed reasonable so I contacted the hospital. Only they told me  that they could not provide the information because they did not order the surgery!

A game of ping-pong began only I was not having much fun. After endless phone calls that led nowhere, I decided to show up at the hospital and find someone to resolve the problem. I spoke with the same nurse who already insisted over the phone that it was impossible to provide the information. She assured me that the insurance company was mistaken and had an animated phone conversation with them regarding the situation. She begrudgingly signed the form and the insurance company committed to pay.

My persistence had paid off and proved that I was unstoppable, but the twist would come two days before the scheduled surgery. I went to the hospital for a series of tests and to meet with the surgeon. I had a new set of blood tests and another ultrasound and handed it over to the surgeon.  He reviewed the file and made it clear that he disagreed with the diagnosis. The cysts were most definitely not cancerous, they were endometrioma and they were not especially big. Since we had yet to try and conceive, there was no reason to remove the cysts. The surgeon told me that he would not have approved this surgery and it is unfortunate that he was not asked to approve the surgery – touche!  He wrote a very direct letter to my physician explaining that there was no reason to suspect cancer (my doctor conceded that he was right). Last but not least, he told Tommy and I to get busy; that prescription was easily approved.

3 thoughts on “Battling Bureaucracy

  1. I think a good rule of thumb, bureaucratic achievement of yours aside, is to get a second opinion before agreeing to surgery. Leaving aside broken bones, erupted appendices, and other medical emergencies, scheduled surgeries should only be planned after two doctors, surgeon included, agree that it is necessary.

    • Agreed. This was actually the second Dr. to recommend that the cysts be removed (albeit for totally different reasons). The first one was in Haifa and he was a surgeon. He believed that it was emergent and wrote an order that I be hospitalized, I could have just as easily gone to the emergency room and been admitted that way (but then there would have been no way for me to pick my surgeon). He probably should have just given me a referral to the surgeon (who sees patients once a week at Macabi) but actually getting an appointment with him and then scheduling the surgery could have taken months (it took 2 months to get a surgery scheduled anyway). I agree that the process was backwards, but in the end I did meet with the surgeon before the surgery and he told me that it wasn’t necessary – it was not cancer.

  2. Pingback: A Minor Nuisance | Futile or Fertile

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