Monday, March 28, 2011

The IVF story continues: Direct Debit or Bust

After my first round of blood tests and ultrasound on the third day of my menstrual cycle, and after being told by the hospital that I owed money to my health fund, I called the clinic at 1pm to find out the results. They told me to come in five days time for another blood test and ultrasound. Meanwhile I had to deal with the money I owed Maccabi or the hospital would not treat me.

Apparently my visit to a GP and my initial meeting at the IVF clinic, my only two visits to a doctor in ten years, had woken a sleeping monster. As the visits occurred in two different quarters of the year, I owed six shekels per visit. Add to that a few hidden administrative costs and I owed them all of 24 shekels (about $8 at the time). The woman behind the desk at the Maccabi offices (the wonderful Mika) suggested I open a horat kevah. This is merely 'direct debit' in English, but in Hebrew it conjures up horror stories of money disappearing from your bank account at the whim of the recipient, never to be returned or explained.

This is probably left over from the days when they didn't read every water, gas or electric meter every month. Rather they would estimate the bill and make compensations at the end of the year. The result of this was either a massive bill that was very hard to afford in one month, or else you found that you'd overpaid by hundreds  of shekels. The house would be credited - sometimes just before you were moving apartments or leaving the country. In effect, you had given a free loan to the electric/gas/water company which may have sent you into overdraft for which you paid interest for months. Many people in those days would do anything to avoid the dreaded horat kevah.

In 2005 there was a sense that things were better. At least there was a network of telephones and computers so you didn't have to personally visit every office and literally accompany your paperwork through the system. I signed all the relevent documents and Mika told me she would send it to my bank and the whole thing would be set up. I asked if I could pay the 24 shekels meanwhile, as I was sitting there and as I had the money. No, Mika assured me that it would be included in the horat kevah.

I went back to the IVF clinic five days later. This time I knew to sign my name on the ultrasound list before doing anything else. It was 7.30am and I didn't want to be there all morning, again. I got my notes from the nurse and rushed down to get them stamped at the reception before heading up to haematology for my blood test. I remembered to swipe my Maccabi card through the machine and get my printout. It was full of little notices in Hebrew which I didn't bother to read.

"It says here that you owe some money," said the receptionist.
"No, I dealt with it. I went to Maccabi and set up a horat kevah."
"I'm sorry, it says here that you owe 24 shekels. This is your second notice so we can't allow the treatment without authorization from Maccabi."

I called Maccabi. it was 8am and the recorded message said that the office opens at 8.30. I called the emergency 24-hour number in Tel Aviv. They told me to call the Jerusalem office at 8.30. So I waited - for a change, and then called Mika at 8.30. She got on her computer and confirmed that there had been a problem with the horat kevah. The bank hadn't accepted it. I called the bank. "What do you mean the problem was with us? Maccabi didn't send the right forms."

I called Mika back and promised to come in and sort it out, but could she please fax an authorization through to Hadassah Hospital as I needed my treatment today and they only did the blood tests until 9.30am. I really tried not to cry and I sort of managed it. Whether it was the tremble in my voice I don't know, but Mika faxed the OK and I was through to the next level.

Up two floors, take a nunmber, give blood - only two tries this time before striking gold, put the vile of blood in the heart-shaped plastic basket in the lab, back to IVF. They were way past my name for the ultrasounds but I was first on the list so I went straight in. "Call at 1pm for instructions." And I was back at the bus stop at 9am. I'd halved my time. This was getting easier.

Back at Maccabi Mika discovered that although a new horat keva can be set up via a request from the health fund, a previously cancelled arrangement required me to go to the bank and reactivate it. I was puzzled. Had I ever had a horat kevah for Maccabi? Then I remembered. We had all had one about 15 years previously, before health care became a pay-as-you-earn tax. When that came into effect we all rushed to the bank to cancel our horat kevah so that we didn't end up paying twice.

One trip to the bank and it was sorted. And my phone call at 1pm told me that I had to do the whole morning routine at the clinic again in two days time.


  1. Blimey I am so glad we have the NHS here (and believe me I don't say that very often) and I don't have to worry about paying for health care. I am enjoying reading your blog. Hope it all goes well.

  2. Thank you. In the end I got my DD so it was all worth it. Glad you are enjoying the blog.