The Price of HCG and Robin Hood

I often like to use my blog to post little lessons learned along the way as I navigate through fertility treatments and the process of being an out of town patient of Dr. Hilgers.  I mentioned in my last post that I have benefits for hcg, but not through pharmaceutical benefits.  Injectibles are only covered through medical on my plan (boy did I go round and round with them before getting someone to admit that!). That means I could go to the doctor every time I need a shot (hardly convenient considering my cycle doesn't conform to weekdays) or I can find a pharmacy that bills my drug as medical.  To date the only pharmacy I know that can do this is the mail order pharmacy assosicated with my insurance.  And I am grateful to have them-they never screw up the billing, they deliver to my door, and I get all the lovely extras like alcohol pad, a sharps container, etc.

Today C.igna Te.l Drug contacted me regarding the hcg order I placed the other day.  I think, originally, she was calling to get my credit card information for the balance.  I was wrestling AJ into a diaper and pjs when she called, and surprisingly I had my cell phone on me and chose to answer an unknown number.  Another thing I love about the mail order pharmacy?  She asked, so would you like to receive that tomorrow?  Um, heck yeah!  (I never pay anything for shipping and today is Peak plus 3!).  During the course of her verifying information, she gave me the amount of the hcg.  $152.63.  I was a little surprised-our insurance coverage is worse (and costs more!) this year, but that much?!  Then  probed more and found out that was only one month's worth, as opposed to the 90 days they typically fill and I became very nervous.  As Anthony interupted our conversation, yet again, the nice woman asked the question I can't stand from insurance companies.  Is this for fertility?  she asked.  Shocked at how easily it came out of my mouth, I didn't think twice before I cooly denied it.  She said, "I didn't think so, I can hear your little one, but that is how it is written down."  I told her hormones can mess up a lot more than infertility, and asked if it was written that way from the doctor because I was shocked and she said no, probably the woman who received the fax wrote it up that way because it didn't say either way from the doctor's office.  How annoying that they assumed something that would negatively effect my coverage!  What if she hadn't asked me again?  Well, turns out, I would have paid $152.63 for one month of medicine.  And now that it isn't for fertility?  I pay $0.  That's right.  Nothing.  Nothing for 90 days worth of hcg.  That is exactly what I've paid for it in the past.  And exactly why I stockpile it like a hoarder and then give it away when I don't need it again.  (Robin Hood reference).

What's the moral of this story?  Um, let's just say I am struggling with that a little bit.  I almost called this post, liar liar pants on fire.  I mean, I know that I have a deficiency of hormones.  I know that I am treating that problem and it results in my fertility to be better.  I know that Dr. Hilgers calls it what it truly is and that is why he sees better coverage with his more accurate diagnosis codes.  But tonight, what she asked and what I answered, it didn't like in the past.  I don't know if that was because the exact question was worded just differently enough...?.  Normally I feel like what I am saying is more accurate.  And tonight, tonight it felt like I was lying.  So I will have to think about that one.  Part of me wants to say that insurance companies are evil and that there should be coverage for this and they deserve it.  But then I see the parental eyebrow raise and I lower my eyes to the floor in order to avoid eye contact and I don't feel like its justifiable.  I am interested in your all's thoughts...


Second Chances said...

That's a tricky one, and something I bet every one of us treating our IF has encountered! I know we have, and like you we skirted the questions. I don't know. I mean there definitely are two purposes to the meds, one IF but the other for health. And if the health has to be treated first, then it makes sense that it should be covered. Treating the IF becomes secondary. Even though its primary in our hearts!

More Than Anything said...

My insurance company will not pay for my HCG. When my husband was on it for low testosterone they would cover it and our co-pay was like $5!! I called BCBS and they said that they covered it for men and not for women. It was that simple. I tried and tried but could not get them to change their mind.

As far as the cost...I pay HALF of what they quoted you. Mine only costs about $70 a month. I also get sharps container, alcohol, needles, etc and overnight shipping.

Sew said...

When I bought HCG through Kubat I think it was $60 for 2 months. Id just pay the money then deal with the headache of insurance. :)

Little JoAnn said...

Oh boy, this post is SOOOOO interesting.

Well...if what you said is "wrong" I have been "wrong" so many times that I would have to do 3 more laps in purgatory.

They aren't qualified to determine or diagnosis on the other hand.

And, it is really none of their business.

As the liberals like to say, "It's between the woman and her doctor!"

So, I am all about less is more and don't think you said anything wrong.

Little JoAnn said...

I once had a nice insurance gal tell me, "Oh, just have your doctor re-write this script for a 90day supply (these were for gonatrophin injectables talk about EXPESIVE) and you will only have a 40 co-pay for all three months versus the 40 dollar co-pay on how it was written then. Like the 40 dollar co-pay was so bad!!! These meds cost thousands!

Was SHE wrong?

Did she betray her employer the insurance company?

You darn right that I asked the doctor to re-write the script and I thank her to this day for the hot tip which I quickly added to my arsenal of IF surivival.

On the other hand, my insurance does cover the diagnosis and treatment of IF. It just does not cover any ART procedures which I am VERY HAPPY ABOUT!!!!

But, I have had some clinics try to turn me down because my insurance does not ACTUALLY cover ART procedures. IT DOES COVER THE DIAGNOIS AND TREATMENT OF IT THAT INCLUDED EVERTHING BUT artifical reproduction and I remind the office billers/insurance gals of this. It helps to already have success so they can't just roll their eyes at me.

Since I re-read the coverage manual every single January, and have it virtually memorized, of couse, I teach these office billers the correct thing and everytime get all my meds and appointments totally covered, even when I use an office that does IVF or ART procedures there (they hate having patients as part of their practice that don't use their unethical anti-life ART/Procedures and would love to be able to refuse treatment to Catholics, etc.

But, like I said, I know my policy like the back of my hand.

I even bring it IN with me when I go to new offices and have my first few appointments.

Simone said...

wow that is crazy. Medicine is medicine. What does it matter what you use it for? That should be private. If your Dr feels that you need it for your health then that should be the end of it. Glad to hear that it worked out. You have to be on your top game.

All in His Perfect Timing said...

I would have said the same thing. You are right ... it is not for infertility, it is for your health. If you just "happen" to get pregnant, they can't prove it was a result of the HCG directly. :-)