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Insurance companies suck

J&D2007J&D2007 member
in Infertility Veterans
So, I got a new plan this year secondary to the new insurance laws. I've never had IF coverage and I was really excited to see my new plan list 'specialty/infertility drugs' as a 25% copay. Yay! So I have been debating whether to do one more OE ivf and use that meds coverage (there is no ivf coverage at all). I called today to verify and they say no IF meds are covered. Wth? It says so right here! Insurance lady says 'that is there in case you have coverage, but YOU don't'. 'And the meds aren't in the formulary'. Ummm..what about pg 77 where it lists them?? So apparently they can make up rules as they go?! I guess I will be forced to do DE because another OE won't be in the budget now. So pissed. I just don't understand why if there is something wrong with your uterus or ovaries nothing is covered, but if you drink your liver into cirrhosis, don't worry. We will cover that. No problem.
Me: 37, DH: 38: ttc 7 years, dx: unknown
10/11: after 2 years, saw a RE, FSH 5.4
11/11: BFP! (surprise after thyroid & normal hsg),
12/11: missed m/c after 7 week u/s, 1/12: D&C
6/12 IUI#1-IUI #3: clomid = BFP!, C/P
IVF #1(10/12) FSH 5.4, AFC: 16 long Lupron, 5R/5M/4F, all 4 made it to 5dt, 1 blast/1-8 cell transferred=BFN
IVF #2(12/12)AFC 21, MD lupron, 4R/4M/3F, 5dt of 1 blast and 2-8cell. BFN.
IVF#3(4/13) Natural start antagon protocol, 12R,11F. one PGS normal at day 6 transfer. BFN.
IVF#4 (11/13) C.CRM (ODW.U normal 8/13 Still no Diagnosis) EPP/antagonist. ER 13R/7M/6F. Only 1 made it to freeze. Abnormal. Looking into options of DE, Fresh vs frozen.
10/14 new local RE to look into what's next. CD3 FSH 4.7, AMH 0.9. Met with DE agencies and exploring options for feb/march 2015.
Surprise natural bfp (4 days before donor is signed). Beta #1 at 9dpo: 51.8, 2nd beta: 195 (25 hours doubling) @11dpo. 3rd beta (12/15): 516 (35 hrs doubling) 4th beta(12/17): 895 (58 hours doubling) 5th beta(12/19): 2120. U/S at 5w0d(12/22): one gestational sac with yolk sac. U/S #2 (6w0d)12/29. One little bean measuring 6w0d with HR 124. 3rd u/s(1/4)7w0d: baby measuring 7w2d. HR 134. 3/30: A/S at MFM went great except for low lying placenta. Verifi results are normal! Team Blue! Please send any positive thoughts our way! EDD:8/24/2015
Baby Will born 8/18. He's perfect.
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Re: Insurance companies suck

  • kflynn81kflynn81 member
    Urgh... I agree it doesn't make any sense how they decide what to cover and what not to cover. I'm sorry :(
    Me: 33, Endocrine issues & FVL       DH: 32, Nothing 
    NTNP 2009-2012         TTC since 2012:
    • Clomid, 2 IUI cycles, and 5 IVF cycles = BFN
    • FET #1   August 2013 = BFP!     EDD 5/11/14
    • Jack dx at 19w1d with Dandy Walker on 12/16/13
    • Severe Pre-e /HELLP set in Jack born sleeping at 20w1d on 12/23/13
    • FET #2 --July 2014  BFP!  ---  EDD  4/5/15

    Jack has handpicked his sibling up there :)

    My blog about IF and loss ... Kate's IF Blog

            Lilypie Angel and Memorial tickers 

                                                      

                                                                              Lilypie Pregnancy tickers


                  Anniversary





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  • LeggyJeggyLeggyJeggy member
    Oh, I'm so sorry. It's really terrible.  It's weird, I struggle each cycle with my new insurance to get my gonal-f covered.  This cycle, it approved fine, but apparently they don't want to approve lupron.  It really doesn't make any sense.  I also feel like it depends who you speak to at the insurance company.  I got more information about my coverage from my clinic and the woman who submits the approvals than when I called my insurance company about 50 million times.  
    ****************SIGGY WARNING****************

    image
    TTC since 2011
    DH: 29, Severe MFI; grade III varicocele; surgery postponed till KU
    Me: 30, POF/DOR, factor II hetero, MTHFR homo
    5 IVF's, LLP, EEP, MDLF all BFN
    IVF 6 using DEB USA frozen eggs
    developed bilateral PE's from BCP, cancelled/delayed 6 mths, taking lovenox
    Feb'15 SURPRISE 1st BFP ever! EDD: 10/10/15, FX
    Still have frozen donor eggs on ice
    All are welcome!
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  • hmz819hmz819 member
    I would see if your RE will call in the drugs to the speciality pharmacy you need to use just to see if they get covered. I was told by my insurance company none of my meds would be covered by insurance and for the past 2 years every single fertility med has been covered.

    I've learned to run everything through insurance and let them deny. Found out 2 months ago my insurance picked up about 1/3 of my ivf cycle even though I don't have ivf coverage (ins paid for us, bw, surgery suite fee, and sperm wash)

    TTC#1 since April 2011
    IVF#1 July 2012 5R, 3 made it to blast, sET c/p
    FET#1 Aug 2012 2 blasts transferred BFN
    IVF#2 Oct 2012
    16R/6M/6F/2-8 cell grade 1 transfer
    Beta 1-237.9, Beta 2-566, Beta 3-8657
    US 6w3d shows one baby w/ HB 115
    US 7w1d no more heartbeat/ D&C 11/30/12 normal karyotype
    IVF#3 Mar 2013
    6R/4M/4F 1 compacting and 2-8 cell transfer
    ectopic pg MTX given 3 month break from TTC

    IVF#4 Sept 2013--BFN
    IVF#5-7 Apr 2014, Jun 2014 and Aug 2014 banking embryos for CCS testing. Praying for normals! Image and video hosting by TinyPic imageimage

    http://i61.tinypic.com/34zll06
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  • RunCC37RunCC37 member
    I'm so sorry!!
    **SIGGY WARNING**

    Me: 32 DH: 35  TTC#1 since March 2012
    Dx: Poor Embryo Quality, Arcuate Uterus, Poor Uterine Blood Flow, Mild Endo, 
           Protein S Deficiency, Sjorgen's Syndrome 

    IUI #1-5: BFN
    Laparoscopy & Hysteroscopy: minimal endo, partial septoplasty
    IVF #1: 10R/6M/6F ~ Day 3 ET = BFN
    IVF #2: 14R/9M/5F ~ transfer canceled ~ all embryos arrested at 1-2 cell stage
    IVF #3: 9R/5M/5F ~ 1 frosty!
    IVF #4 (FET #1): BFN

    IVF #5 (DE IVF #1 with Dr. KK protocol): Currently PREGNANT!!!!!!
    Synthroid + Prednisone + Metformin + Baby Aspirin + Supplements Galore = 15+ pills a day
    Lupron + Lovenox + Delestrogen + IVIG + B/W = 2-5 pokes a day
    19R, 17M, 17F - transferred two Grade A blasts 11/16, four frosties!!!
    Beta #1 11/24 (13dpo/8dp5dt) = 367 ~ Beta #2 11/26 (15dpo/10dp5dt) = 709
    Beta #3 11/29 (18dpo/13dp5dt) = 1,997 ~ Beta #4 12/1 (20dpo/15dp5dt) = 3,403

    imageimageimage

    My Blog: Running and Dreaming for Two ~ All are Welcome!
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  • luvbostonluvboston member
    I am so sorry I walked into the pharmacy to pick up drugs today and they charged full price and the stupid drug has been covered for a year with a pa. So when I called the insurance that acted like dumbasses and had to escalate it. What is the point of having insurance it's such a pia.
    6 m/c
    Anovulatory cycles, increased Synthroid Diagnosed Sep 2010
    Natural cycle Dec 2010 BFP M/C 6 1/2 Weeks, D&E Jan 2011
    1 Clomid/Ovidrel BFN May 2011
    Natural cycle Aug 2011 BFP M/C 4 Weeks
    1 IUI Sept 2011 BFP M/c 7 weeks
    Provera Dec 2011 BFP M/C 3 Weeks
    DQ ALPHA HLA MATCH, High NK Cells Diagnosed Dec 2011
    IVF March 2012 BFP m/c 4weeks 5 days (IL, Prednisone)
    IVF#2w/DS July 2012 MEGA FAILURE BFN (IL, Dexamethasone)
    Diagnosed No real HLA Match, DQ Beta Triad, High TNF, Low NK Cells
    Oct 2012 Natural Cycle m/c 4wks (Lovenox, Prednisone) 
    Went to Beer Center- high tnf, low lad, implantation failure
    Nov/Dec 2012 LIT Treatment
    Dec 12 Humira
    Jan 2013 BFP
    Humira,LIT,Prednisone, Lovenox, IVIG, Baby Aspirin
    Miracle Born August 2013 Premature

    Yours doesn't have to be a sad story


    image
    image


    Lilypie - (ugiy)


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  • chucktgirlchucktgirl member
    Oh no! That would infuriate me! We've had similar issues this year. We switched insurance companies (because CC.r m takes United instead of Cigna, which we loved, and you know how that turned out!) this year and United has been a clusterfck every since the switch! Their "customer service" reps are completely useless. They have NO knowledge whatsoever. We've been incorrectly billed multiple times, etc. Insurance companies are enough to make a person postal, for sure. I'm sorry you have to deal with this. It sucks! I know you really want to try with OE. If having discounted meds is what's making the choice between OE and DE, as it seems from your post, then move forward with OE. You can possibly get a lot of help from the OOP program here, and from us, your fellow bumpies! Even I have some random stuff leftover I am happy to donate. It's important. Don't get discouraged.

    ...and if you do find yourself discouraged, open that bottle of wine and start taking advantage of your cirrhosis coverage. ;)

    imageimageimageimageimageimageimageimage
    My BLOG: www.ivfbabyquest.wordpress.com -Update - old blog.

    PAIF/SAIF Welcome!
    Me: 42, Hubby: 35, TTC since Jan 2010. Dx: DOR due to advanced maternal age. Also: Hypothyroidism (100mcg Levothyroxin). Positive for MTHFR (hetero-C677T), Factor V Leiden, and Fragile X (on DH side). Taking pre-natal vitamins    .
    First natural PG 9/27/11; mc: 1/20/12
    First RE visit: 8/8/12, Saline Sonogram: 8/28/12, IVF injection class: 10/11/12, add FaBB Tab for FVL, +Vitamin D.
    IVF #1: 10/17/12 Baseline: FSH- 9.4, E2- 24, LH- 3.7, Prog- 0.3 The u/s showed 6 follicles in my right  & 9 in my left. Rx: 150 Bravelle & 150 Menopur SQ nightly. 10/21/12: Add Ganirelix SQ every morning.
    ER 10/28/12: 13 Retreived. 7 Mature. 6 Fertilized. 5 Made it to PGS. ET 11/2/12: CANCELED. All 5 came back from PGS as having "severe abnormalities."
    IVF #2: 1/7/13 Baseline: FSH- 8.8, 4 follicles in my right & 6 in my left. Rx: 150 Bravelle & 150 Menopur SQ nightly. 1/11/13: Add Ganirelix SQ every morning. hCG Trigger 1/16/13
    ER 1/18/13: 9 Retrieved. 5 Mature. 5 Fertilized. 2 Made it to PGS. ET 1/23/13: CANCELED. All embryos (he even sent the ones not growing) came back from PGS as having "multiple severe abnormalities."
    IVF #3:     NEW RE! 3/1/13 Baseline: FSH- 9.6, E2- 61, Prog- 0.94, 3 follicles in my right & 4 in my left. Rx: 150 Bravelle& 150 Menopur SQ in PM. 3/7/13: Add Ganirelix SQ in AM. hCG Trigger 3/9/13 SQ.
    ER 3/11/13: 6R, 2M, 2F. Day 3: one 8 cell, grade 0.  Five day ET 3/16/13: one early blast, grade Fair. 3/24/13 AF came a day before beta. BFN
    IVF #4:     (Added acupuncture to this cycle.) 3/25/13 WTF & Baseline: FSH-11.8, E2- 56, Prog- 0.84 3/26/13 Start stims. 3/30/13 u/s: 5 follicles in my right & 4 in my left. Rx: 225 Bravelle& 225 Menopur SQ in PM. 3/31/13 Add Ganirelix SQ in AM.hCG Trigger 4/3/13 SQ.
    ER 4/5/13: 5R, 3M, 3F naturally. Day 3: two 8 cell, grade 0, one 8 cell, grade 2 (Scale 0-best to 3-worst). Five day ET 4/10/13: two blastocysts (the 3rd stopped growing.) Beta 4/18/13: 2.5 BFFN. RE recommends we stop trying and focus on living childless, due to the extremely poor quality of my eggs.
    ***Decided to stop trying and live CFNBC. I couldn't adjust. So, six months later...
    IVF #5: Changed RE. Going to one of the big name clinics now. OWDU: 10/29/13. Update: HORRIBLE experience. Disgusted and distraught at their complete unprofessionalism and how much money and precious time they cost us. Sickening. Have now changed RE again. New Patient appt. 1/30/14.
    BFP! Out of nowhere, I got KU the old fashioned way! POAS 1/26/14 - Positive! FDLM 12/30/13. Beta #1 16dpo= 373. Beta #2 18dpo= 801. EDD 10/6/14
    2/4/14 1st U/S revealed a 5wk2day sac but no fetal pole. Started 200mgs of progesterone suppositories daily
    2/11/14 2nd U/S revealed a perfect 6wk1day "diamond ring" embryo with a beating heart! 138bpm! Add 1mg folic acid and 40mg Lovenox
    2/25/14 3rd U/S: perfect 8w1d embryo, 178bpm. 3/6 start spotting. 3/11 10w1d U/S shows no heartbeat. Scheduling D&C. The Stork has forsaken me again.
    IVF #5.2: New in-state RE. Supplement priming for 1.5 cycles prior to start of cycle, including DHEA 50mg (stopped 5/15), CoQ10 200mg 2x/day, L-Arginine- 1000mg 2x/day (stopped 6/5 due to cold sore!), myo-inositol- 2g 2x/day, melatonin- 3mg, and Neevo (prenatal for MTHFR).
    5/16/14 Day 2 bw cycle prior: FSH- 12.22, E2- 38.37, Prog- 1.35, LH- 9.46. 6/2/14 Day 19 bw: Prog- 23
    6/12/14 Baseline: E2- 122.7, Prog- 0.4. 5 follicles in left, 4 follicles in right. Start stims: 375IU Follistim & 150IU Menopur. 6/19 Increase Follistim to 425IU, Menopur still 150IU. 6/18 add Ganirelix. 6/23 Ovidrel trigger SQ. 6/25 ER: 8R, 8M, 5F naturally. Start Medrol & Doxy. 6/26 Start Endometrin. 7/2 Start Lovenox.
    7/8/14 Beta= 137.4 BFP!!! (My first from IVF!) E2- 1109, Prog- >60. Stop CoQ10, myo-inositol, and melatonin. 7/9 2nd Beta= 281.4. TSH- 2.70. Increasing Synthroid to 100mcg daily. 7/24 6w3d u/s measured 6w3d, hb: 121bmp! 8/5 8w1d u/s measured 8w3d, hb: 164bpm! Graduated from RE to OB. Now I just need to find an OB!
    EDD 3/18/15!

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  • J&D2007J&D2007 member
    @chuckt- lol at the wine comment! I've contacted the 2 ivf clinics in the area that take this new insurance and neither of them will release financial info to me regarding how much it costs to cycle there until I have a consult. So frustrated! I don't want a consult if I can't afford it there! I don't want to waste my time or theirs and I am getting nowhere!
    Me: 37, DH: 38: ttc 7 years, dx: unknown
    10/11: after 2 years, saw a RE, FSH 5.4
    11/11: BFP! (surprise after thyroid & normal hsg),
    12/11: missed m/c after 7 week u/s, 1/12: D&C
    6/12 IUI#1-IUI #3: clomid = BFP!, C/P
    IVF #1(10/12) FSH 5.4, AFC: 16 long Lupron, 5R/5M/4F, all 4 made it to 5dt, 1 blast/1-8 cell transferred=BFN
    IVF #2(12/12)AFC 21, MD lupron, 4R/4M/3F, 5dt of 1 blast and 2-8cell. BFN.
    IVF#3(4/13) Natural start antagon protocol, 12R,11F. one PGS normal at day 6 transfer. BFN.
    IVF#4 (11/13) C.CRM (ODW.U normal 8/13 Still no Diagnosis) EPP/antagonist. ER 13R/7M/6F. Only 1 made it to freeze. Abnormal. Looking into options of DE, Fresh vs frozen.
    10/14 new local RE to look into what's next. CD3 FSH 4.7, AMH 0.9. Met with DE agencies and exploring options for feb/march 2015.
    Surprise natural bfp (4 days before donor is signed). Beta #1 at 9dpo: 51.8, 2nd beta: 195 (25 hours doubling) @11dpo. 3rd beta (12/15): 516 (35 hrs doubling) 4th beta(12/17): 895 (58 hours doubling) 5th beta(12/19): 2120. U/S at 5w0d(12/22): one gestational sac with yolk sac. U/S #2 (6w0d)12/29. One little bean measuring 6w0d with HR 124. 3rd u/s(1/4)7w0d: baby measuring 7w2d. HR 134. 3/30: A/S at MFM went great except for low lying placenta. Verifi results are normal! Team Blue! Please send any positive thoughts our way! EDD:8/24/2015
    Baby Will born 8/18. He's perfect.
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  • summererobinsonsummererobinson member
    Im sorry. If there any way you could find a plan that covers IVF ( like a personal plan not a company plan) and get it just long enough to get the IVF done if it would be cheaper than pay for the IVF?
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