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Rhogam not covered by insurance?

SittinUnderAPalmTreeSittinUnderAPalmTree
in 3rd Trimester

My blood type is A negative and my husband is O positive, so I need to have Rhogam.  I had a shot after my miscarriage and another after Amnio and both were covered by insurance.  I have to have another at 28 weeks and I just got a call from the pharmacy that this one is going to cost me $172!  Yes, it's a small price to pay to make sure my baby is healthy, but it's still a lot of money for one shot, especially when the others were covered.  

Has this happened to any of you?  Of course, I'm going to call my insurance company in the morning to try to get a reason, but I was just wondering if any of you have experienced this same thing.  Thanks!!

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Re: Rhogam not covered by insurance?

  • mama2bnov2010mama2bnov2010
    My insurance didn't cover it either! I think it's crazy... It should be covered.
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  • trizzietrizzie member
    That's nuts!  Why did it cover the first two and not this one? I had to have one in January after my m/c and I got the other one last month and my insurance covered both.  Sorry - that stinks!
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  • SonadoraSonadora member
    This happened to me when I made a trip to the ER at 16 weeks for spotting. The shot cost me $240!!! The one with my m/c was covered, the one I bought for the 3rd tri shot was just a $16 co-pay, but the emergency one was not covered.
    BFP #1 9/23/09. Missed MC 10w3d D&C 11/3/09.

    BFP #2 4/13/10. Bridget born 12/28/10

    BFP #3 Finn born 8/11/15


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  • SittinUnderAPalmTreeSittinUnderAPalmTree
    The only difference that I can see is that this time my doctor wrote me a prescription and I had to take it to the pharmacy.  After my miscarriage, the hospital just game me the shot and before I had amnio, the high-risk doctor ordered the shot for me.  Maybe because the shot was part of a bigger procedure it was covered?  
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  • TiggerLuv80TiggerLuv80

    Your physicians office should be able to fight to get that injection paid. It is medically necessary therefore your insurance might just require documentation proving so.

    I used to work for a company that provided those injections and I was in charge of obtaining the authorizations for the medication. Something doesn't sound right that it wouldn't be covered. I would call your insurance and possibly your physicians office to determine what you need to do to get it covered by your insurance.

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  • TiggerLuv80TiggerLuv80

    imageSittinUnderAPalmTree:
    The only difference that I can see is that this time my doctor wrote me a prescription and I had to take it to the pharmacy.  After my miscarriage, the hospital just game me the shot and before I had amnio, the high-risk doctor ordered the shot for me.  Maybe because the shot was part of a bigger procedure it was covered?  

    Typically medication is billed separately and not in conjunction with a specific procedure. Maybe you took it to a non-contracted pharmacy? That definitely doesn't sound right to me and I have worked in a home pharmacy as well as medical billing for over 8 years.

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  • mamaweebiemamaweebie

    I had two shots with my last pregnancy (at 28 weeks and then after delivery, as DS has the same blood type as DH.  They are both B+ and I'm O-).  I have had the 28 week shot this time around, too, and all have been covered.  I'm sure this little guy will have the same blood type as daddy and his older brother, so I'm just planning on having to take it again after this delivery.  Maybe it's because you have had several in closer succession?  Doesn't make sense to me that they wouldn't be covered, though, as they are considered medically necessary for women who have a negative blood type.  Why is your pharmacy billing you, anyway?  Do you have to give the shot to yourself?  I have always received mine either at the doc's office or in the hospital.  Definitely talk to your insurance company about it.

    Lori

    Wife to Morgan, Mom to Sebastian (almost 4)

    Little BOY #2 on the way!  Due 11.02.2010

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  • meant2bemommeant2bemom
    I am in the same situation - my OB gave me an Rx to get the shot - and then bring to her office for her to administer it.  The pharmacy told me it wasn't covered (would cost me $130) ... my Rx coverage is actually carried by a different company than my medical insurance (which I hadn't realized).  Since this is medically necessary, I found out that although I still must lay out the money, I can then submit the claim for reimbursement to my main medical insurance.  Maybe this is the case for you too??
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  • MeesheMeeshe member
    When I went to pick mine up from the pharma they said it was something similar to that.  I was thrown and asked if my insurance didn't cover any of it.  So they checked and said "they had used the wrong insurance???"  I have no idea what that meant.  My co-pay still ended up being $60 but it saved me over $100.  Do you have a separate pharmacy plan from your regular insurance plan?  I'd ask them to double-check all of it.  I was annoyed that it cost me $60 since it's completely necessary.
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