I think insurance companies are put here to drive us all mad. Seriously! With their double speak and other confusing language it is no wonder that we all spend hours and days of our precious time WASTED! Today I had to ask myself, how much is my time worth? I spent a good 2 hrs on the phone just today with the insurance company and mail order pharmacy (which, I realize, is really nothing as these things CAN go) and much more when you consider how long I have dealt with this particular issue.
I mentioned before that I was told hcg wasn't covered 2 year ago or so. Somehow I got the impression it was just b/c of IF, can't recall why, and so a letter was sent by Dr. Hilgers that it wasn't IF. I was told, it wasn't about it being IF, it just wasn't covered. Thankfully I had some leftover from when it was covered so I used that.
Then when I called again, last week or so, they said it wasn't covered under pharmacy, but maybe medical if it wasn't for fertility. I said it was not for fertility and so she said my doctor would have to fill out medical necessity paperwork and it would probably be covered. That would have been helpful a year ago. I guess what the women should have told me back then was that the letter merely was processed by pharmacy and should have been processed by medical.
So today I call to check on it since Dr. Hilger's office had sent in the paperwork and I need to take it in about a week. The first person I talked to said, yes it was approved and she sent me to Tel Dr.ug (their mail order pharmacy) because to get it anywhere else would be costly. Here is why. Now that it is covered under medical, Target etc are only contracted through Ci.gna pharmacy, not medical, so they would be considered out of network. It is hard to find a medical provider that will give this kind of medication as if they were a pharmacy. She suggested another option may be something like Apr.ia. (I asked for this 2nd option because sometimes Tel Dr.ug is not the cheapest option). Then they connect me with Tel Dr.ug who proceeds to tell me this medication is not covered-under pharmacy or medical. This time, armed with the right information, I tell them it has been proven medically necessary and is covered by medical since it is not related to fertility. Okay, she says, since it isn't fertility it can be covered. (Man they train them well to be so anti IF!) What if I didn't know and just said okay?! Like I basically did last time!!!! I ask how much it will be next. Full price for this Novarel (hcg) is $102.38 per vial without insurance. Of course, she had to transfer me back to Cig.na Medical to determine the coverage. I want to know because now I have been informed that Fertility Friend is $59. And I also learned that Kubats, who compounds it themselves, (mail order that Dr. Hilgers uses in Omaha) is $51! So I wanted to make sure it wasn't higher than that with insurance. At first I am told it is covered 90% and subject to my copay. But then I push more-why then was my progesterone (similar situation) while I was pregnant covered 100% with no copay or deductible? He puts me on hold again and low and behold-it will be covered 100% Yippee!
Today I asked the question, how much is my time worth? And now I know, it is worth free hcg while ttc. That's actually pretty good for once!
I hope this post will help you know the right questions to ask to get something covered that perhaps wouldn't have been covered had you not had the exact same words. Ridiculous! Please share this post with everyone you know on hcg!
P.S.This was the simplified version-there was even more confusion and transfers and I had to talk to Dr. Hilgers office twice (not their fault) and I am waiting for a 3rd call back.
I am on the journey we are all called to-to accept God's will and perfect love. Whether I am white knuckling it with my eyes shut tight or standing up with my arms outstretched enjoying the ride, I try always to let God be the driver and not bail out the side when there are bumps (like IF!). On good days, I trust He won't run me into a tree. :)
5 comments:
It's so annoying how most insurance won't cover fertility-related stuff, but will cover birth control and e.recti.le dysfunction. I understand not covering IUI and IVF, which we won't do anyways, but I wish they would cover meds better without all the hassle.
I'm glad you were able to get them to cover the HCG, despite the drama that it took to get it sorted out.
I hear you. Dr. H was not under my insurance plan when I first started my journey. In the end with some help from my husbands employer we were able to have him added. So, if someone is with a big company, HR might have an advocate person who will speak on its employees behalf. Which saves time - bc how much is our time worth? :) I was going round and round until we figured out we had someone in HR that would talk direct for us. PS: I got my HCG via Kubats - I just trusted them and the price was right. Thanks for posting. While you might feel you wasted time - sharing helps others :)
What a headache! All this makes me realize how very little I know about insurance.
Working with ins. companies can be such a headache! Ugh. And there is a lot of confusion over IF meds. I had quite a run around over the follitis.m meds I took last summer. Thanks for sharing your story...one has to be determined and one has to know the language. My dh wanted me to get all my correspondence in email however the mail-order pharm we had to use wouldn't do that. It drove him crazy (he's big into budgeting and he wanted the prices quoted to us in writing). Praise God it all worked out in the end. :)
How frustrating. It's almost as if you have to be as tricky as they can be to get anything covered.
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