Wednesday, December 21, 2011

stupid insurance

Hi everyone. Thank you for all the comments and suggestions for making metformin a little easier on me. I eased my way into it and it's better on my stomach. Another side effect showed up. I have absolutely no appetite on it. I had to force myself to eat today and couldn't even finish half my dinner It is so weird.

I have been running around like a mad woman trying to get everything done on my mad dash list. I have been trying to read and comment here and there throughout the day, but I am still days behind on all the blogs I want to read! Kinda having withdrawal from you guys.

If you are visiting for the first time through IComLeavWe, Welcome! You have come just in time to read me vent. Well aren't you lucky. I promise you my posts aren't usually like this.

This morning I woke up in a good mood. I ate breakfast, read some blogs and got down to work cleaning and organizing. While cleaning out a drawer I found a pile of pregnancy magazines that I started collecting from a Dr. office I worked at when we first started TTC over 2 years ago. They made me smile. I remembered reading them when we first started trying and how excited I was that I was going to be pregnant soon. Well we all know how that ended up, yet I was still smiling. Soon I will be pregnant. I have hope. I decided not to read them now. I will wait, so I put them back and closed the drawer.

As soon as I knew my RE office was open I gave them a call to make sure they got my most recent pap and to check on the prior auth for my clomid and ovidrel. They got my pap and were expecting to hear about the auth soon. They would call me. About an hour later the pharmacy called and said both were denied! I asked why. I was told they don't get that information so I have to call my insurance.

Months ago when I called my insurance I asked about meds and the IUI. I was told they cover a percentage of both so I was happy. Today when I called I was told this. Make sure you read the bold part.

BRAVELLE (urofollitropin), CETROTIDE (cetrorelix), CLOMID / CLOMIPHENE POWDER /
(progesterone), FOLLISTIM AQ (follitropin beta), GONAL-F / GONAL-F RFF (follitropin alfa),
GANIRELIX (ganirelix), ELIGARD / LUPRON DEPOT (leuprolide), LUVERIS (lutropin alpha),
MENOPUR / REPRONEX (menotropins),
Pre - PA Allowance
This is a covered benefit for male members and for female members greater than 50 years of
Prior-Approval Requirements
ALL diagnosis covered EXCEPT use in conjunction with Assisted Reproductive Technology
(ART) procedures
, which include but are not limited to:
- Artificial insemination (AI)
- In vitro fertilization (IVF)
- Embryo transfer and gamete intrafallopian transfer (GIFT)
- Zygote intrafallopian transfer (ZIFT)
- Intravaginal insemination (IVI)
- Intracervical insemination (ICI)
- Intracytoplasmic sperm injection (ICSI)
- Intrauterine insemination (IUI)

Ovidrel is not in this list, but she said it is part of the meds.

So that basically says none of those medications are covered if you are using them with any form of ART! WTF! Aren't a lot of those meds used only with ART like when making sure there are lots of eggs for IVF? I started crying on the phone. The lady on the other end was so nice. She apologized and said she wished it wasn't that way. She told me I could send in a letter of reconsideration with info from the Dr. of why they think it should be covered. She said if I wanted to pay out of pocket it would work the same for reimbursement, but it is not a guarantee of coverage. She wished me Happy Holidays and wished me luck with the treatment. I was still upset, but having someone so nice in the other end was a very good thing and probably the only thing that kept me from totally breaking down.

I called the pharmacy back to see how much it would be without insurance. They told me they have a discount plan where you pay $10 to enroll and it is for the whole year for any meds. With the discount the 10 clomid pills will be around $35 and the ovidrel injection will be around $90. It is not as bad as I thought it would be. The Hubby said we are doing it no matter what, even if we don't get reimbursed. So tomorrow I call the pharmacy back and they will send me my meds. I am really happy we are still on track.


  1. Stupid Insurance is right :(  I'm glad you're still on track, though.

  2. Why are we paying for insurance when all they do is limit us, take our money and tell us no?  Good luck. 

  3. What jerks to tell you they were covered in the first place! When I had insurance they wouldn't cover anything, including diagnosis, but at least I knew up front! I got 10 50 mg clomid at Walmart for $18. You can often get more pills for less if they're lower dosage.

  4. Ugh, so sorry your insurance doesn't seem to cover many of the meds. But like you said, at least the lady on the phone was sweet. It can definitely make a sucky situation tolerable. I hope you get everything sorted out and good luck!
    Thanks for stopping by and commenting! Our drive to the in-laws was uneventful.

  5. Insurance is the absolute worst.  Mine wouldn't cover anything for infertility including any diagnostic testing.  We were pretty upset.  I'm so glad you found a plan you can work with at the pharmacy and hopefully the insurance company will give you something with a doctor's note.  Good luck!

  6. Hi from ICLW
    I hate insurance. Ours doesn't cover anything. Hope your IUI goes well, though!


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