Today I Hit the Motherload

It started with a phone call I received Friday night, about 7pm.  It was the pharmacist from Ci.gna Teld.rug (their mail order pharmacy, which I basically have to go through to get my injectables covered-since they are covered through medical and not pharmacy benefits).  The pharmacist on the phone was calling because my order from PPVI didn't make sense to him.  He said they ordered needles and not syringes.  He wanted to know if I needed syringes.  I said yes, thanks for asking.  Then I thought to mention how last time the needles were on the syringes, but they were the needles to inject.  So I had to remove the needle and put a bigger one on to draw up the meds and then change it back to the smaller one to inject.  He said he had thought of that and it was corrected.  Then he asked about my dose and the concentration.  (It would be nice to have my meds concentrated at 100mg/mL so I could take half the dose, but compounded meds aren't covered on my plan so I just stick with the 50mg/mL to save money).  He said that it was ordered with refills available, but the way it was written up I was only get a one week dose (sidenote-I blame PPVI for none of this; they have always been fantastic and even have a nurse that deals only with insurance!).  He said they shoot for a 90 day supply!  I explained that the dose was based on a blood draw done every two weeks, but if my last pregnancy was any indication, I was on it for 36 weeks at mostly the same dose.  He said given that information, that he felt it would be fine to send me out more meds.  He also asked when I needed it by.  He said it wasn't included and he would have to talk to the doctor to confirm what I told him, and he couldn't until Monday, and he wanted to make sure he wasn't leaving my high and dry.  All I could say is "is this the same Cig.na that gave me such a hard time about the novarel?!" (seriously, they are still trying to get me to pay for the first months' supply which was filed wrong by their employees under the wrong diagnosis code; when I refilled it, they had the right code and it was covered completely!)  The nice man said, "ma'am, sustaining a pregnancy is a whole different ball of wax than getting pregnant in terms of coverage."  I thought "you aren't kidding!"  So today, Tuesday, I receive a box with 10, yes 10, vials of progesterone and needles and alcohol pads (I love the those!) and a sharps box.  Now that is service!  I only wish this was the service we get prior to getting pregnant-wouldn't that make (IF) life just a little bit easier!

Rough Day

Insurance companies are just evil.  I got a bill for my novarel.  $96.  I was hot!  And despite my blog venting, I really don't get hot that often.  It takes a lot, but once the train gets started, it takes awhile to put on the brakes.  (At least that was the analogy I used with dh this weekend.  Let's say Valentine's day was NOT like in the movies at our household). I called the insurance agency and they had the gall to tell me that Dr. H submitted the dx code that was IF.  I actually said BS to the lady.  I am not one to get mad at messengers, but she was starting to become part of the problem.  I was nice, but firm, after that and said the problem was on their end, NOT my the doctor's.  After looking into again she said the 2nd refill was under a different diagnosis code and was covered.  I told her it was merely a refill, nothing was actually resubmitted by the office, and she admitted it was a coding error then on their part.  I wonder if they get paid to make dx code errors.  Maybe that is too extreme, but I am really starting to wonder!

There is so much going on right now.  I am exhausted.  Charlie got the stomach bug right a few days before surgery to put in tubes.  He vomited for 4 hours, every 15 minutes, and not surprisingly he is being very difficult at meals-he has been traumatized!  The surgery was very minimal and he did great.  But there is still night waking (we were up 3 hrs last night!) and I am confused.  Has it turned behavioral?  Is he reflux not controlled by medication anymore?  The teeth are seeming to do a number on him too.  I wish it was just one thing at a time, but no, much more complicated than that.

Dh got stomach bug next and we had to cancel our Valentine's plans (we were celebrating early-Fri).  We had a nice day Saturday and took Charlie to his first basketball game at dh's alma mater.  It was a good time, but Charlie was exhausted the whole time and I felt bad for him, all that stimulation and all he wanted to do was sleep.  We planned it around his typical nap schedule, but he wasn't typical that day because of recouperating from the bug and surgery. (by the way, ped ENT told us it was fine to go and we used plugs to protect his hearing).

I dropped Charlie off at daycare today to work from home, only to have to pick him up a few hours later.  The sitter's daughter starting throwing up.  That is where we got the stomach bug in the first place, but I don't want to pass it back and forth.  He spent the day crying at my feet, and just having an overall rough day.  He is, at a minimum, exhausted like I am.  But kids have this crazy way of not wanting to sleep when they are over tired, so he wouldn't nap until later and napped shorter.  He pops up and shouts "all done" and you can't help but smile through the frustration.

Also I have MAJOR MAJOR family stuff going on right now with my sister and her kids and my parents and it is just ugly and sad.  I don't have the energy to go into detail now, but it has so many twists and turns it resembles a soap opera.  But it is my sister's life and even though she's nuts, it makes me sad.  And especially for her children.  It has also been a source of stress for dh and I lately, which just makes it worse.  He sees things black and white and forgets that it is my sister and his words are hurtful, even when I agree sometimes.

On a positive note, he did say I could hire someone to clean the house once to get the germs out and get us back on track.  And I got a call from my ob/gyn's office saying that my urine came back fine.  So strange.  They initially thought there was a UTI, but I guess when they cultured it out longer? it wasn't anything.  I don't know what the deal was, but I will take it.  The thought of something surviving those antibiotics...I shudder at the thought!

I hope everyone is having a better day than I am.  I need my child to eat and sleep so I can too and we can return to normal!

Seriously? Seriously?!

I called today to make sure that Cigna TelDr.ug had received the script. They had, but said it would be awhile.  Since I am showing peak type today, I don't necessarily have "awhile" so they were kind enough to put it on priority so it would go out today.  Then I get a call back, usually it is to set up delivery.  But this was to say that, fyi this isn't covered under your insurance.  I told them it was covered under medical if the dx isn't infertility and it is not.  It has to do with my cycle and hormones I am low on, PMS, etc.  She said the dx they were given was infertility.  That is absolutely BS b/c Dr. Hilgers never uses that term b/c he is smart enough to know that IF is a result (or symptom of the problem is maybe better way to describe), and not the cause.  He calls everything what it is. So I just left a message for the insurance nurse again, who is fabulous.  I am grateful for her to argue this on my behalf.  Grrr.

How Much is My Time Worth?

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.