Is my TTC days over? Totally crushed

kallygirlie · April 2014

So We've been TTC for 3 yrs but working with our RE since August. All has been great thus far. We have a $40,000 lifetime max on insurance coverage for fertility treatment and we have so far used $13,000 and have only had to pay $20 co-pays out of pocket. We have prescription coverage through another provider (all through DH work). No one ever told us we only have a $10,000 lifetime max on Fertility drugs. Last cycle my RE switched me to Gonal-F multi dose cause we were having such issues getting our meds in a timely manner (prescription company has there own specialty pharmacy and REQUIRE all fertility meds be mail ordered through them). Seems no one thought it would be a wise idea to tell us that my meds for 1 cycle would be eating $4,000 of that max. So as of today, We are totally out of prescription coverage. So irritated the prescription company wouldn't tell you 1 order would be eating almost half of your coverage so maybe we would have had the chance to talk to our docs about another med. UGH!!

So my question to you ladies. Do any of you have supplemental prescription insurance? Any Idea where I can look? DH is gonna speak with his employer.

Currently I have a 15mm follie and enough meds to get me to Sunday. Praying my body works with me so we can at least get to IUI this cycle.

cls78 · April 2014

Wow, that is some really great coverage. A lot of people have little to none for IF.

Saintelizabeth · April 2014

I had to pay my IVF costs OOP. My RE's practice was amazing and donated my Menopur. I definitely wouldn't been able to do this IVF cycle so quickly without that donation. Talk to your the nurses and they may know of some options you can try.

theholmanherd · April 2014

To answer your question in your title, I don't think your TTC days are over. You and YH can save for the costs. I never recommend going into debt (a personal belief), but there is the option of a loan. I don't think you're out of the game by any means. Was this news a set back? Absolutely. Will you find a way to have a child despite this set back? Where there's a will there's a way. I'm sorry you went through this. Good luck for the future.

[Deleted User] · April 2014

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kallygirlie · April 2014

NariaDreaming said:

You're very lucky to have the coverage you have had so far.

ETA: How much gonal-f did you use that it ended up costing 4k for an IUI cycle?????

I usually go through 6 boxes per cycle. They charge over $700 per box to the plan.

Aeml1985 · April 2014

$4K in meds for an IUI seems like a lot. We have 80% of all meds covered, but are on the hook for the remaining 20% which has the potential to be pricy still?I would look into ways to save for your medication costs.

KT416 · April 2014

I don't think your TTC days are over just because you are almost out of fertility drug coverage.

It does stink that you didn't know there was a max and how expensive one of your drugs were. I would talk to your RE and talk about options and your concerns about paying OOP. There may be a much cheaper drug or other treatment option that you can do. Good luck!

Pintobean39 · April 2014

Aeml1985 said:
$4K in meds for an IUI seems like a lot. We have 80% of all meds covered, but are on the hook for the remaining 20% which has the potential to be pricy still?I would look into ways to save for your medication costs.

My RX cost for this cycle was about $3200 for TI. It adds up when your injecting 275 iu of Gonal a day. That also included ganarelix, trigger and progesterone. Were completely OOP.

OP that does sound like awesome insurance. I'm sorry you are out of coverage. You can save up and shop around on rx's. If you need any tips just ask, I've done some serious shopping to help keep my cost down since I'm OOP.

Lillovebug79 · April 2014

I have some coverage for fertility drugs as well but mine is 30% with a lifetime max of $10,000. So my follistim IUI cycles cost me around $700 out of pocket (I used 75u/day). My insurance picked up $300 of the tab, it would have been $1000 for 600u out of pocket. Your must have 100% coverage for up to $10,000? That's awesome! It's crazy though that 1 cycle cost that much. What was your dose?

kallygirlie · April 2014

Lillovebug79 said:

I have some coverage for fertility drugs as well but mine is 30% with a lifetime max of $10,000. So my follistim IUI cycles cost me around $700 out of pocket (I used 75u/day). My insurance picked up $300 of the tab, it would have been $1000 for 600u out of pocket. Your must have 100% coverage for up to $10,000? That's awesome! It's crazy though that 1 cycle cost that much. What was your dose?

Now I am on 300u/day, started at 100u/day last cycle and have climbed up from there.

Mommalawyer · April 2014

I'm sorry. I have no advice. I don't think your TTC days are per se over, just may get more tricky financially. Good luck.

katib77 · April 2014

If you have coverage for everything but meds moving forward, and IVF cycle of just meds would cost you oop maybe 6k max. There are 401k loans or other options. We've spent about 20k so far in four years and will be spending another 15k for this last ivf. Count your blessings and regroup.

sherrimspires · April 2014

We are OOP for everything. I did apply for the First Step DesignRx program for medications and was able to get all mess half price. But if your husband has a swanky enough job to get insurance, you might not qualify, I would try just in case.

wishiwaspreggo · April 2014

Dang, your coverage is fabulous. I'm 100% OOP. I'm surprised you need such a high dose of Follistim for an IUI... I bought one 300 iu vial for my next cycle ($260) and my doctor expects I'll use 50-75 iu per day for 3 days. This is in combination with letrozole, but still.

You can find ways to come up with the money. I certainly don't think your TTC days are over. Hang in there, and good luck!

kallygirlie · April 2014

sherrimspires said:

We are OOP for everything. I did apply for the First Step DesignRx program for medications and was able to get all mess half price. But if your husband has a swanky enough job to get insurance, you might not qualify, I would try just in case.

Highly doubt a Maintenance Mechanic in a Pretzel factory would be considered "swanky" LOL! His income is about average for the area. I have no Idea why they offer coverage.

We do count ourselves very lucky. However, we don't exactly get the coverage for free. We pay a very large price to have this coverage. More than your average insurance plan premium.

wishiwaspreggo said:

Dang, your coverage is fabulous. I'm 100% OOP. I'm surprised you need such a high dose of Follistim for an IUI... I bought one 300 iu vial for my next cycle ($260) and my doctor expects I'll use 50-75 iu per day for 3 days. This is in combination with letrozole, but still.

You can find ways to come up with the money. I certainly don't think your TTC days are over. Hang in there, and good luck!

I tend to be pretty resistant to a lot of meds. 75-100iu did absolutely nothing for me. 225iu got me going but it was super slow and 300iu has made a huge difference. Been doing 225-300iu for 14 days and just now getting close to trigger (maybe this weekend).

kallygirlie · April 2014

I'm sorry if my asking for help caused some of you to be upset. I honestly had no idea so many of you are paying OOP completely. Losing coverage has come as a complete shock to us and I was hoping some of you had some insight on ways to save or if it really did mean I'd have to stop trying. I will first talk to my nurse to see if there are other options for meds that don't run so high since I tend to need larger doses.

In the mean time, have you ladies looked into family building Grants? My RE had a flyer out today about the Tinina Q Cade Foundation's Family Building Grant. If you all would like to look into it, visit www.cadefoundation.org. Just wanted to share that with you so hopefully some of you could find a little help.

BunnyBerry · April 2014

Not upset here. although it is a surprise to hear of someone who is lucky enough to have such complete IF coverage, I am thrilled for you and that you've been able to get so far in your treatments without running out of cash!!

I hope that from our experiences paying most or all OOP, you can feel encouragement that it can be done and that other women are here to help each other find ways to save on meds, make smart choices regarding IUI/IVF, etc.

I know everyone has a different threshold for the expenses of IF, and probably many of us can't even predict when we will reach our "limit"! For me, it took a while to convince DH that IF was worth spending money on. One of the worst feelings is a shock or surprise that we didn't see coming - it can make us feel really bad, as if we had been foolish.

I hope a blessing comes out of this for you. Perhaps with different coverage, you may choose IVF earlier and have better chances of a take-home baby even earlier? Of course...it completely sucks to have these unexpected expenses, and I'm so sorry and hope you get your BFP really soon.

jszy10 · April 2014

Freedom Fertility has more affordable options for OOP meds. You definitely haven't reached the end, you've just got to adjust to what the new "norm" will be for you financially. It is easy to get caught up in everything being covered, and then not want to pay OOP, but you'll get there. You could also look into applying for "First Steps" or "Compassionate Care" discount programs. I was approved for 50% injects through both of those companies.

sherrimspires · April 2014

kallygirlie said:

sherrimspires said:

We are OOP for everything. I did apply for the First Step DesignRx program for medications and was able to get all mess half price. But if your husband has a swanky enough job to get insurance, you might not qualify, I would try just in case.

Highly doubt a Maintenance Mechanic in a Pretzel factory would be considered "swanky" LOL! His income is about average for the area. I have no Idea why they offer coverage.
We do count ourselves very lucky. However, we don't exactly get the coverage for free. We pay a very large price to have this coverage. More than your average insurance plan premium.

Gotcha. Yeh, my individual premium is at a reasonable rate- family coverage will be ridiculous. In your case, I would apply for the designRx program. Every dollar counts. Also- find out if individual specialty stores have discounts. I, too, took a lot of follis time and went through 2 vials for 1 cycle.
we are pinching pennies and put off a trip to Hawaii to do this. We also have scaled back in going out to eat and treating ourselves to things we don't need. Having children means more to me than anything so if I have to be a little behind on fashion and eat peanut butter and jelly everyday, I will. But don't fret. I'm a firm believer that what is meant to happen, will happen. Good luck!

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