Dealing with expensive IVF medications is awful. My first two cycles, I had to deal with a clinic that stressed me out almost as much as the actual IVF outcomes. Now I like my clinic, but the medication-ordering process has been a comedy of errors. Except not really a comedy. More like an expensive and stressful disaster.
Basically, my insurance covers very little. They do cover monitoring appointments, at the specialist co-pay of $70 a pop, but they do not cover the IVF procedures or the medications taken in conjunction with IVF. So when it came time to order meds for this cycle, the nurse called them into a mail-order pharmacy for me. But then a woman in my support group with my same insurance told me that our insurance was covering her meds! Since I had already tried my insurance's pharmacy (Medco) a year ago for my IVF meds and been denied for everything except the antibiotic Doxycycline, I hadn't been planning to bother trying again. But when my friend's order will filled for just a few hundred dollars instead of a few thousand, I asked my clinic to call it again- just in case.
Well, as I fully expected, I was denied. I talked to someone at Accredo, which is Medco's specialty pharmacy. Confusing? Yes. I did not fully understand this then, but this is how it works: Medco is my insurance's pharmacy. You can get things cheaper through them than through going to CVS. The catch is that they mail it to you, so it takes longer. However, if it's a specialty (read: super expensive) drug, then they send it to Accredo. But for the consumer, it's seamless. They transfer the call, and you don't really realize you've been sent to a whole new organization.
So when I was told by Accredo that all my drugs were denied coverage, I took that to mean all of them. I mean, I did say "all of them" and she said "yes." So I ordered everything through Alexander's and paid $2000 out of pocket. I got another $600 of drugs from a friend who had leftovers. And that, I thought, was that.
But IVF life is never that simple. This past Friday, Medco called to tell me they were about to ship my meds. Um, what? Yeah, it turns out that Accredo had rejected my order for specialty meds but Medco was willing to fill my order for the non-specialty meds: the Doxycycline, another antibiotic known as the Z-pack, and the estrogen patches I'll take after transfer. They were willing to give me this for $46, rather than the $230 I'd already spent.
I was pissed, needless to say.
The explanation: they told me I'm denied, but I wasn't really. I was only denied the specialty drugs, but she did not clarify that on the phone with me and I thought she meant all of them. And then they wait a week- more than a week- to call me and say they will cover the non-specialty. So now I'm in negotiations with the fertility drugs manager to try to get reimbursed. Of course he's a total jerk and while he's admitted they weren't clear in what they told me during that first phone call, he also spent a long time arguing about how I should appeal every decision. This is stressful enough- I don't need to waste my time and energy fighting over this. And what cause would I have for an appeal? None. They don't cover IVF drugs. It's very clear, in writing, and I accept that. Somehow my friend's were covered, but even my nurse thinks it was just a mistake somehow. Lucky her, but it has no bearing on me at this time, and i have no logical reason for an appeal.
Meanwhile, the same day, I also received the FIVE denial letters in the mail, for the specialty drugs that they won't cover. That is what is in the photo above. FIVE letters, all several pages long, with the appeal process and a bunch of other mumbo jumbo. Really, Medco/Accredo? One letter with a list would surely have been enough. Talk about healthcare inefficiency!
Anyway, I can't waste any more time on this crap. I got my drugs, I paid too much but that's the way it goes. In all likelihood this is my last IVF cycle, and I need to focus on relaxing and staying calm during this one. And so far, I'm doing that.
No comments:
Post a Comment