Anthem (novel inside)

surfergirlkona · September 2010

I spent all evening on the phone with Anthemcankissmyass last night. After several conversations with very unhelpful people, who just love to create misery, I finally got through to a very sympathetic woman. At that point I was in fits of tears and she listened to everything I had to say. Who knows, maybe she has been where we are. Anyways... I pleaded my case and told her that I have paperwork from Anthem stating that my Gonal-F was approved from April 1010 through April 2011. This paperwork does state that it doesn't guarantee coverage and depends upon my plan. In May and June Anthem did honor this and I have proof of my copays. She asked that I send over all of the documents including my RE's authorization letters from Anthem (which I still need to obtain). I sent all of the paperwork, including this letter. Not the best letter, but I was then on a xanax and two glasses of wine (self medicated therapy - don't judge). Cross your fingers that this will work.

We have decided to try to fight the insurance about coverage for IUI and IVF to see if we can recoup some of our expenses. My good friend knows people in the business and she is trying to get us some help. If anyone has fought their insurance that doesn't cover these treatments, I would love to hear your input.

Dear...,

Thank you for taking the time to listen to my concerns during our time of need. I am sure you can understand the pain and grief infertility causes a couple who dearly wants a child.

Attached are the prior Anthem authorizations for Gonal-F and Progesterone. The authorization for Gonal-F is effective April 24, 2010 through April 24, 2011. Progesterone shouldn't even be an issue as this a a standard medication for pregnancy and other medical conditions. I hope that these Anthem authorizations letters and Freedom Fertility copay receipts are proof enough of prior agreed coverage on behalf of Anthem. I am also requesting coverage for the following medications which are required for my treatment....

I understand that Anthem is not required to cover my infertility treatments, but to deny the coverage of medications is just not fair. Please do not deny my husband and myself the chance for a long desired baby. These drugs costs may ruin our plans and hope of a future family as we are already financing over $30,000 for IVF treatment and have recently spent over $7,000 for two failed IUI attempts. I find if very disheartening that the medical companies do not find infertility to be a necessary coverage for deserving couples that are unable to conceive a child naturally.

Respectfully,

Konathebitchthatsgoingtoburnyourbuildingdown

jen629 · September 2010

I think that letter sounds great..Hugs honey I hope they reverse their decision

Aubs13 · September 2010

Go get 'em, girl!

I'm glad to hear that you finally got ahold of someone who was willing to listen and not be a douchebag. Hopefully, between your letter, documentation, and this cs agent, things can be resolved.

Good luck!

butterfly843 · September 2010

Your letter sounds great and I am hoping they change their mind and cover the meds.

Olive44 · September 2010

That letter sounds great! I'm glad you got through to somebody who actually may have half a heart around there. I really really really hope this works for you!!

EntropicEpona · September 2010

Good luck to you, Kona. I hope that letter is just the thing needed to kick them in the azz.

My heart bleeds for you. You deserve this so fvcking much. {{{HUGS}}}

suntoto · September 2010

I am hoping they listen to you! I want to see a pic of a beautiful Kona baby soon!

AppleRidge · September 2010

First, I'm hoping like crazy that they'll get this figured out for you.

My only concern is that your insurance apparently excludes coverage for IF, but your letter says in a few places that these drugs are needed to treat your IF. I think it would be better if you could go through your medical records and use some of the buzzwords that might be the true and more specific dx, like "ovulatory disfunction." I just worry that the second they hear that IF word, they're going to say "right, so we have to deny it." Maybe your doctor is willing to talk to you a little bit to give you an angle on this?

ColindaP · September 2010

I really hope the appeal works, kona.

Dear Anthem,

Kona's not the only one who's gonna kick your ass.

Sincerely,

Kona's bitter, jaded, angry _bitch brigade

johannaknip · September 2010

That sounds great. I'm glad you finally found someone who will listen. I hope this letter is the ticket!

surfergirlkona · September 2010

BBHME:
First, I'm hoping like crazy that they'll get this figured out for you.
My only concern is that your insurance apparently excludes coverage for IF, but your letter says in a few places that these drugs are needed to treat your IF. I think it would be better if you could go through your medical records and use some of the buzzwords that might be the true and more specific dx, like "ovulatory disfunction." I just worry that the second they hear that IF word, they're going to say "right, so we have to deny it." Maybe your doctor is willing to talk to you a little bit to give you an angle on this?

I can ask them for assistance. Yesterday they were "oh well that is a bummer." Once I hear back today I will start a whole new debate on the issue with the exact reasonings I need the medications. Obviously this is how the RE got the prior authorization. Good point lawyer gal. Don't be shocked with emails for help FWIW, I have been diagnosed with low ovarian reserve. I forgot to mention that the pharmacy department of Anthem did tell me on the sly ("we are not supposed to say this") but Anthem can override any coverage exclusions if they want, it is just finding the right person to do it.

damabo80 · September 2010

::lurking::

It sounds great. I hope the letter works.

On a side note, you may also want to send a copy not only to the insurance company but also make a copy to send to the insurance company's president as well. I've found it to be quite entertaining how quickly a "no" turns to a "yes" when you go straight to the top. Smile

bbhalphen · September 2010

I think the letter sounds great! I hope they cover your meds!

ERICA21779 · September 2010

Good for you Kona! I think your letter is great and am so happy that you found someone who will listen!

DoingItRight · September 2010

I so hope that this works for you.

JuJuBe3 · September 2010

I think it's a great letter and I hope they get it together and you get good news soon. T&P to you, hon.

OCIrishBruin · September 2010

Big (((Hugs))) to you. That letter was perfection. I'm going to keep hoping and praying that this will work for you. It just has to.

maceymay1816 · September 2010

I love the determination. Your children will be lucky to have you a mother because you have fought for them to be born, you have fought to bring them into a loving family. You are setting such a great example for your children and for other women who in the same boat. I think your letter sounds great and I wish you the best of luck.

babes12 · September 2010

so glad you got a hold of someone who would listen. I hope you hear positive news in the near future!! GL!

Amanda78 · September 2010

I think it sounds great Kona. I'm so glad you found someone to listen to you.

Sunflower730 · September 2010

Very good letter and as Dambo suggested send it to the president of the company also.

kew243 · September 2010

Very good letter. Hope it works! Too bad you can't really sign your name that way.

triple_sevens · September 2010

Big hugs, Kona. I'm praying someone can come through for you.

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