If you have separate coverage for insurance and pharm...

BBN2012

Just a quick note that I hope will help someone else out there who is struggling to move forward with IF treatment based on cost. I was told from the start by my insurance carrier that I had IUI coverage but nothing for IVF or for injectibles. It seemed crazy to me that they would say they were covering IUI, when all they were really covering was the procedure, but not injections necessary for the procedure. I did one IUI and paid OOP for trigger, which cost me $120. I know some people are completely OOP and those who have moved onto IVF have spent tens of thousands so this may not sound like a lot, but we know it all adds up month after month. When my RE told me I'd need several thousand dollars worth of Follitism and HcG, I didn't know how I could pay for it and there seemed like no alternative if we were going to move forward with treatment. Long story short, I called the insurance company again and finally someone there said "You don't have coverage for injectibles with us, but we're NOT your pharmacy. Your employer uses a separate pharmacy so it's up to them to decide if they will cover the injections." I wasn't super hopeful but given this new information I had to try. After weeks of phone calls back and forth with the pharmacy company and my RE, I got a call approving the HcG and Follitism. Total bill? $40. I don't know if this will be the combination that works for us (fx!) but if anyone has separate coverage for procedures and for drugs, please double check with your drug coverage program! It's horrible that a lot of us are making decisions based on what we think we have coverage for and/ or can afford when that may not be the whole story. Good luck!

violetmarie61516

This is good information for some people and I think it's great that you got this out here just in case.  I know this already about my insurance from other things I've had done but you never know what someone might not have learned yet!  Thanks.