Insurance

This has been the worst week.

Still no AF.. probably from stress.


SO here is the update from my insurance. Tuesday, I called Our third party prior authorization company (Hines & Associates) who tell me that my Prior authorization claim had been CANCELLED! They told me when they called my insurance company to verify my benefits they told them I did not have coverage for fertility medication, only coverage up until a diagnosis of infertility. Why would someone who doesn't have infertility be given a fertility medication....makes NO SENSE! They advised me to call my insurance company.

I immediately called Signature Scripts who takes care of our prescriptions and they tell me that my prescription "IS" covered and they are just waiting for the prior authorization code to enter into the system.

Then I called HealthScope who are in charge of benefit questions for our health insurance Medical Mutual and they tell me I "Don't" have coverage for fertility medications. I explain to the lady that I am employed by a government agency and we are self insured so we don't have the same guidelines as HMO's asked her if she could bring up my 80 something page benefit explanation. She says..yes. She finds the section that under my "PRESCRIPTION DRUG BENEFITS" that specifically says 10 fertility medications they will cover. One of them is Follitropin, which are sold under the brand names Gonal F and Follistim AQ
My RX is for Follistim AQ & HCG. HCG is not covered and I am ok with that, we are happy to pay for it. But the Follistim aka follitropin is under the approved drug list. So the customer service rep said she printed off what my plan stated and said she had to go to her manager for an override.

2 hours later she calls me back, says that after reviewing my policy further, the policy states after the diagnosis of infertility no further treatments will be covered. I kept telling her that I am not asking for medical treatment, I am asking for a prescription drug. I kept explaining MEdical benefits and prescription benefits are DIFFERENT! What a bunch of idiots!

Thank God my husband and I work together. I started to get these huge tears and I quickly dried them up and got pissed off. WE both marched our arse's upstairs the the human resources office. We did not want to tell work what we were doing, but we were kind of forced to. The HR Manager immediately got on the phone and called our coordinator, Chuck who negotiates our insurance plans and then they called our insurance. They had a meeting about our claim today along with our county commissioners (boy, I am starting to feel important) and I was told that they are confident this will be ruled in my favor...but there are no guarantees.

I am not ready to throw a party yet with joy because we haven't been approved yet. But we told our HR manager that if this isn't resolved we would get an attorney. Thank god I have a relative who is an attorney because we won't charge us but just a little. It's not our fault it isn't available in generic form. and all the meds they say they will cover for fertility are listed under the generic name and NONE OF THEM Are available like that. It should read that they will cover brand name if no generic is available...

I am really hoping that this is resolved by friday.