- Pregnancy
- Baby & Toddler
- Parents
- Getting Pregnant
- Baby Names
- Product Reviews
-
Registry
- Community
-
More
Want a personalized experience?
Download the free app
Preemies
ShannonSky
member
I have Makena coverage!
ShannonSky
member
in Preemies
I really can't believe it...I honestly thought there was no hope since A) I had pPROM, not PTL and 
DD was born at 33w6d. But I just got the email back from my insurance provider and it's all in writing, my copay will be $45 per month. So there is hope!
Now I need to figure out if I'm even taking it...I just wish I could trust my midwives on this, but it really was not reassuring at all that the one I saw last didn't know what I was talking about 
I'm losing sleep over this whole ordeal, so I think I'm actually going to call on Monday. I'd rather just have it settled before my 16 week appt, since I'll really have to scramble to get in with a new doc/start the shots prior to 20 weeks. I'm thinking I might just ask for a consult with a peri.
This discussion has been closed.
Re: I have Makena coverage!
Excellent news! I'm still trying to figure out what I'm going to do. I don't know if my insurance covers it, but even if they do I still will have to pay out of pocket b/c I don't have copays with my insurance. I put in a call to my OB today to see if they had any advice.
I have decided that even if my OB thinks I don't need it, I'm still going to take it (if I can afford it). It's not up to them, it's up to you. So if you want it then I'd just tell them you're getting it and leave it at that. I can't imagine why they'd argue, there is no risk involved.
Wait, I don't get it - insurance covers it but won't pay for it??? What kind of BS is that?! Anyway, I know we have similar stuff going on, so I'm sure you understand exactly where I'm at with the whole do I need it/should I take it question. I think I'm honestly more concerned about DD's issues at birth (for heaven's sake, I have yet to meet an u/s tech who's seen a BPP lower than 4/8 and she was 0/8) and the fact that the midwife I saw didn't know what I was talking about with the 17P stuff. She was trying to tell me it was just to prevent m/c. I just called up the OB who does my annuals (they are closer to my house, which is why I see them for annuals) and they are going to take me in for a 2nd opinion consult. Depending on that, I'll either stick with the midwives or switch over to them for the duration. I just need to get my records faxed over, so they should see me some time next week.
I hate feeling like I'm cheating on my midwives with this second opinion, but my gut is really telling me that I'm looking for things that they just aren't equipped to provide. Granted, I'm NOT high-risk, but since they don't take any high risk patients, I just feel like they don't have the experience in these borderline issues. Because yeah, you and I aren't high risk, but we DO have a past history of pPROM and preemies. I don't want to do that again, and I want to feel like I'm doing everything I can to prevent another preemie.
/end rant.
I don't have copays, but I have insurance that gets me negotiated rates. And I do have a deductible and out of pocket max. So I if it's covered, I should be able to get it cheaper than $1500 (but Lord knows what) and it will go towards my ded. and oop max. So I won't be $30K in debt over it. But will still end up paying alot more than I would have at $20 a vial.
Also, I read that now the injection can only be given at the Dr's office, so people will have to pay for that on top of the price for the meds. I was going to have to do that anyway, but it makes things complicated for others who were self-administering at home. You might want to look into that too, or ask the OB about it when you go.
I think it's a good thing that you're getting a 2nd opinion. I'm sure the midwives are great for run of the mill pgs, but even though you're not high risk you do have special circumstances that obviously they're not comfortable with. I know it's hard to do though, I'd feel guilty too. But you gotta do what's best for that baby!
Gotcha! I wonder if they'll charge that weekly trip as a regular prenatal visit or not? Because right now I pay my one co-pay and as long as my visits are part of my routine care (ie. no UTI's, stuff like that), it's all part of that one co-pay. I will definitely ask about that if they recommend the 17P for me. I think it'll be a good thing to get the 2nd opinion, too. It's not that I don't trust my midwives, and I will 100% recommend them for routine pregnancies, but all of this stuff taken together is just worrisome.
You have awesome insurance. Mine used to be like that, before I actually had kids. Now I have to pay for EVERYTHING. It sucks.
I *think* that if you just have to go in to get a shot, you don't have to pay for the visit. Kinda like if you go in to just draw blood, you only have to pay the lab fee. So you should be ok.
I just talked to my OB, and they are going to go ahead and order my 17p for me today, at least 1 vial, hopefully 2. I just have to pay out of pocket for it, and then submit it to my insurance later (since we don't have time to do it the other way around). But still, the out of pocket price is about $90 for 10 injections. So even if my insurance doesn't cover a dime, I'm still getting a good deal! Yay for awesome OB's!
I know - our insurance is amazing. And actually, I think my copay was only $10 when I was pregnant with DD...went up to $15 last year and $20 this year. We have great IF coverage, too, unlimted IUI/TI cycles and I think up to 4 IVF cycles. Thank goodness, we really wouldn't have either of these babies without it.
I'm glad your OB is helping you get the 17P! I really hope all the pressure being put on KV makes them change their minds about the price.
Hi Ladies -
That's great that your insurance covers Makena. Mine does too, however at a 20% co-pay, and they said I'd have to co-pay over $1,700 for a 4-wk supply! However, PLEASE remember that just because your insurance pays for it, doesn't make KV's price-gouging acceptable. Your insurance company still has to pay $1,500+ per shot. That just means that we will all likely have premium increases next year. I work at a mid-size company that is self-insured...so all of my co-workers will be paying for the $1,500/shot. It's just not right, in my opinion. Plus, we all we be paying (as taxpayers) the shots that will be covered on Medicaid & Medicare.
For lots more links, and information, feel free to join the FB Page called "Shame on you, KV Pharmaceutical and CEO Greg Divis"
https://www.facebook.com/pages/Shame-on-you-KV-Pharmaceutical-and-CEO-Greg-Divis/205462536133171