I hate insurance

lkfdp

So I was put on a progesterone supplement at 6 weeks (Crinone 8%, once a day).  It was not covered under our prescription plan, so I had to pay over $300 out of pocket.  The Dr. said they would send a letter to my insurance company saying that it was medically necessary for me to take it.  We have a provision in our medical plan saying that it could be covered under "other services" for RX not covered by the prescription plan.

 So I called today to see what I need to do next since the Dr. had faxed the letter.  The lady on the phone tells me it is not covered because it is an infertility drug.  I just wanted to scream at the lady.  I know it isn't her fault, she is just the messenger.  She said I could try to appeal if the Dr. could write a letter stating that it wasn't used as an infertility drug.  I told the woman on the phone I was pregnant at the time, so why would it be considered an infertility drug?

To top it off, my insurance also won't pay for the first ultrasound we had done.  I am going to try to appeal that too.  They paid for a $7,000 CT scan last year, but won't pay for a $150 ultrasound.  Nice.

I just want to scream,

mkwt

I totally feel your pain.  I am just waiting to get my "actual bill" for the D&C I had three weeks ago. 

lotus88

I'm sorry for your loss and then to have to deal with this red tape isn't fair at all.  I'd definitely call your doctor and insist on the letter, and you can write a letter of appeal too. I had an issure with my insurance about a year ago and they overturned their decision, got me about 350 back. Good luck.

sweetky_06

Insurances are ridiculous, and believe me, I've had my share of dealing with them.

Interestingly enough, my insurance doesn't consider progesterone (or prometrium/endometrium or their equivilants) to be infertility drugs because they are used to maintain pregnancy - they don't get you pregnant.

My tips are: ask for each call with the insurance company to be recorded, for them to give you the call ID #, for each person to give you their name and their employee ID (sometimes they can't) and escalate up to a supervisor/manager as quickly as you can. Insist in everything in writing, and enlist your HR benefits dept. to assist you - it's part of what they are there for.

Good luck! 

eli_and_jeff

That's just crazy. My insurance company didn't cover any of the blood tests to confirm either of my miscarriages.  At $80 a pop, it's cost me almost $600 out of pocket to have two complete miscarriages.  Ironically, if I'd have had to have a DNC they would have covered it. It doesn't make any sense.

Keep trying though. At least your doctor is willing to go to bat for you.

kamelendez

I had issues with my insurance as well. When I went in for my first u/s we found out we lost the baby at almost 9 weeks. Everything, including the blood tests and u/s were included. Then the dr sent me to another hospital with a radiology department to make sure I lost the baby. When we got there, because I wasn't pregnant anymore I had to pay for 2 ultrasounds. Then had to pay for my week after check up. Insurance SUCKS!!!