So, I had a cerclage stitch put in last week and had a progesterone shot in the hospital (which sucked) and I am supposed to get them weekly till the baby comes. My husband picked up a Rx for me and the pharmacist said there was an Rx for 8,000.00. It was the shot. We assumed there was some kind of mistake because for one, I didn't think I would get it from the pharmacy and ins. didn't pick up any of the shot.
Long story short....I will be getting it from the pharmacy (mail order) and it is NOT covered under insurance. Yet, it's medically necessary. Has anyone had any problems getting this covered? I'm going to be so pissed if the insurance still says it's not medically necessary.
Re: Progesterone Shots-problems with insurance
thank you so much!!!
They may need it stated in a certain manner to be covered. I went through 4 weeks of getting all my ducks in a row and ended up starting my shots late over the craziness. I had to call every two days for 4 weeks and talk to a different person each time to find out what more was needed etc.
And even offered to pay for the vial out of pocket and wait to be reimbursed so yeah that $8,000 is right sadly.
BUT that should be covered under your insurance!
If it is not then you also said your hospital gave you the shot which means they are considered a "dispensary" for it. See if the office can arrange to bill your insurance for it and you have to endure going in weekly for it. BUT the first shot they gave you is obviously going to be billed to your insurance so that is one way around it if you cant get the RX itself covered...
I did that at my last hospital some shots I got there b/c they were graded as a "dispensary" of compounds but now that I go to the hospital where I work we are not so I had no choice but to go through insurance soley.
Baby #1 7/16/10
Baby #2 11/14/12
Baby #3 12/11/14
Baby #4 3/30/17
Baby #5 2/28/19
Baby #6 Miscarriage
Baby #7 7/3/22
Naturally with PCOS
If they are sent to your Dr's office ask the office or you NP or OB directly can you have the vial and a few syringes to administer at home (also have them so you how to do it- though there is a youtube video that most offices point you in the direction of to view that was done by fertility village I think). They may give it to you and save you the trip each time. I do mine at home at night so I can sleep through any side effects I might have lol.
Baby #1 7/16/10
Baby #2 11/14/12
Baby #3 12/11/14
Baby #4 3/30/17
Baby #5 2/28/19
Baby #6 Miscarriage
Baby #7 7/3/22
Naturally with PCOS
@AnonnAni
SIDE AFFECTS?!?!?!! OH NO!!!! I'm scared! LOL
I'm one of those...lets just get it over with so they are every Tuesday at 8:30 am! LOL....This baby better love the crap out of me for having to do all this! LOL (only kidding...he/she better love me for my awesome personality..lol)
I'll ask about doing it at home. Copay is $30 each time but I figured if the nurse did it then there is no copay but the insurance said yes it does. We originally thought we would have to pay upwards of $400 a month so $30 a week is much better!
Baby #1 7/16/10
Baby #2 11/14/12
Baby #3 12/11/14
Baby #4 3/30/17
Baby #5 2/28/19
Baby #6 Miscarriage
Baby #7 7/3/22
Naturally with PCOS
Yes there are side effects unfortunately. The shots hurt, sometimes alot! but sometimes not so bad. Only reaction i have had is a bump forms so always switch butt cheeks and different locations as to not have too much scar tissue build up in one spot. (the needle is thick hence the scar tissue) I reacted worse than most people and at first my "bumps" spanned 6" across and were horrible colors. The doc said it was normal, i was just more sensitive than most. That lasted the first 3 weeks or so, it has since gone away which is good.
I was told they will do it in my leg?? Is that not where most get it? I'm assuming you are talking about the 'back side'. lol
Baby #1 7/16/10
Baby #2 11/14/12
Baby #3 12/11/14
Baby #4 3/30/17
Baby #5 2/28/19
Baby #6 Miscarriage
Baby #7 7/3/22
Naturally with PCOS
I was told to go in the upper butt/lower back area. I get REALLY sore for several days after, but the actual shot doesn't hurt. The trick is to pull you skin while the dr/DH is administering the shot. I grab my fat at pull to the side, and DH sticks it in. He goes slow, releasing just a little bit at a time. It's oil, so it's thick and takes time to work into your body. He does a 1-2-3 count, and I release my grip on my skin as he pulls the needle out. It prevents the burning, I guess?
Married 12.9.06
DD born 1.6.11
TTC #2 since 7.12
I'm really nervous to get these done every week but I know it's worth it.