Okay, rant about my employer/insurance

danieleandwayne

So, of course, mere minutes before I start cramping and bleeding yesterday, I picked up and payed OOP for my progesterone suppositories-- you know that med that was going to help me avoid a miscarriage (because I'm old)? Yeah, that one.

I paid $140 when I'm supposed to be paying the remaining $1100 of my garage roof's bill. 

Then I called the OB's office to have them call the insurance company to clarify that I was prescribed the supps to help stay pregnant, not because I'm infertile. The OB's office calls me back to say that I still got rejected. I call the insurance company and they explain to me that it was my employer's choice not to cover the supps no matter what. 

I work for a freaking hospital. My employer's workers are overwhelmingly predominantly women. My progesterone supps that were supposed to help me keep this baby were not covered. WTF is wrong with this picture?!?

I am so going to wait until I'm slightly less hormonal and then I am going to ask to speak to whoever it is who makes the decision on what plan we have. I want to have that person say (preferably to my face) that s/he has no problem with the fact that I spent 5 days without this drug because I had to chase down the insurance company and the OB office and then spend $140 OOP on it-- a drug that *may* have prevented this miscarriage. 

I should probably point out at this time, too, that apparently, if I pay up front in full, I can get a 10% discount on any elective plastic surgery I may want to get from the plastic surgery department.

Whiskey Tango Foxtrot. What is effed up about my hospital's priorities for women's health care?!?

MarylandWed

That's really lame of them - I am sorry.

MrsNukem

That's just so wrong, especially for being a hospital!  That's messed up!  I don't have suppositories but I would have given you my PIO I still have if I had known.

danieleandwayne

Aww, thanks, Nukem!

I actually still have the supps and they won't expire for a year. So I'll use them this next time. I'm just pissed off that I'm out the money and that I couldn't have them 5 days earlier when they might have done some good because the pharmacy and I were too busy trying to coordinate with the insurance company.

 

ShellBear+

Yep it sucks.  Mine were $320 for a month and that was with a coupon from the re.  My ins. just doesn't cover this medication at all.  Next time I'll just ask for the prometrium which is like $30.  IF costs are really annoying.

mrsjami

I'm sorry, insurance is so tough, I argue constantly. Not sure if this helps...but I've always been told by my doc, prog won't prevent a m/c, just helps support a healthy one. I took it with all of my pregnancies and and can attest that's held true for me. Hugs to you during this time.

danieleandwayne

mrsjami:

I'm sorry, insurance is so tough, I argue constantly. Not sure if this helps...but I've always been told by my doc, prog won't prevent a m/c, just helps support a healthy one. I took it with all of my pregnancies and and can attest that's held true for me. Hugs to you during this time.

That's the thing, though-- we have no idea if the egg was bad or my uterine lining... 

I'll be running tests next cycle to check all these things, now that I'm no longer pregnant and will have a next cycle.

 

dhreczuck

The insurance thing sucks beyond belief and trust me, even though I work in HR, I don't actually have a say in what is covered under our particular plan, and I know I'm being a bit of an objective ass'***%^% but the insurance companies typically outsource prescription services, so its a toss up about what will be covered. I could push for a fully loaded benefit plan, but then many of my co-workers might not be able to afford the employee contributions to remain in the plan. My progesterone costs the most out of all my meds, I guess I'm just saying don't go all guns loaded on your HR person because ultimately they might not be the final decison maker on those types of things...it just sucks plain and simple

danieleandwayne

dhreczuck:

The insurance thing sucks beyond belief and trust me, even though I work in HR, I don't actually have a say in what is covered under our particular plan, and I know I'm being a bit of an objective ass'***%^% but the insurance companies typically outsource prescription services, so its a toss up about what will be covered. I could push for a fully loaded benefit plan, but then many of my co-workers might not be able to afford the employee contributions to remain in the plan. My progesterone costs the most out of all my meds, I guess I'm just saying don't go all guns loaded on your HR person because ultimately they might not be the final decison maker on those types of things...it just sucks plain and simple

Oh no-- I'm planning on asking who it is (what committee, whatever) who chooses our plan. My insurance company has 2 options for the prescription plans-- one that covers the progesterone and one that doesn't. I want to know why, when we have a majority of female employees, something like progesterone supps (as prenatal care, not as IF treatment) isn't part of the plan they chose to take for us. And keep in mind, our hospital owns the freaking pharmacy that supplies the meds to its staff.

I just want an explanation. I think I'm entitled, since I get paid less than the state-- let alone federal-- standard for a nurse.

jchow009

Insurance sucks big time!  I also found out my insurance covers infertility drug not testing or treatment......so what's wrong with the picture?  If you don't have $ to pay for testing and treatment, how's the coverage of the drug help.  Well on the other note, the radiology place called me and said they will give me 30% discount on my HSG test.  As much as I am appreciative of the discount, it is still $700. 

danieleandwayne

jchow009:

Insurance sucks big time!  I also found out my insurance covers infertility drug not testing or treatment......so what's wrong with the picture?  If you don't have $ to pay for testing and treatment, how's the coverage of the drug help.  Well on the other note, the radiology place called me and said they will give me 30% discount on my HSG test.  As much as I am appreciative of the discount, it is still $700. 

Can you go to a place outside of NYC?? I mean, if you're paying OOP anyhow, maybe you can go to a place that will give you a discount on a much smaller fee to begin with??

jchow009

I am meeting my RE next week, I guess then I'll ask what kind of tests I need.  I think some of the basic blood work I can use my family doctor and that probably cover.  I already took the HSG test, so I have to pay that bill nomatter what.  But going forward, I'll definitely check around.

randi0606

thats horrible ... i have never understood why they do and dont cover things

Mayzie15

I hope you get some answers - my insurance covers nothing for anything if they pay anything I'm amazed.  We have a flex plan at work but it's limited to what you can put in a year and doesn't come close to what this is costing us OOP.  I completely sympathize with you insurance sucks!!