Thursday, February 18, 2010

Another Day, Another Insurance Issue

I posted yesterday about the joys of dealing with insurance companies though all these IF treatments, but I feel the need to elaborate further on my vent with today's developments.  We already know how stupid I think the insurance company is for needing a prior authorization (PA's for short) for all of these meds, but now I see that the company as a whole is just ignorant.

So I called my pharmacy today to check on the status of the Follistim approval, as I need to pick it up by tomorrow to be on schedule.  They said everything was submitted, but that they were still waiting on my insurance company to authorize.  I asked if I should give them a call and she said "No", but me being me, I did anyway... and lucky I did.

Once on the phone, after being on hold forever and transferred several times, I was told they had never received the authorization request... the only PA's they had was for the Gonal-F (which was denied) and the Ovidrel (which was accepted), but nothing for Follistim.  I explained how my doctor had called them and was told Gonal-F was not covered, but that Follistim was, and so she decided to make the change.  She called in the new Rx for me and also called back my insurance company to let them know.  The PA went out for authorization and was sent back to the insurance company, but now all of a sudden, its missing... or rather, just plain non-existent.

You would think a company who is supposed to have a person's welfare in mind would be a little more "on top" of things.  I feel like I am taking crazy pills.  Now, my doctor had to call back and place another STAT (which the operator felt the need to explain means "urgent order", thanks genius) PA order with them and was told "we will make a decision in the next 24 hours".  Well, that's all well and good, but why the crap do you need a whole day?  You've already told us you cover this medication, so give me a break.  It takes, like, 5 minutes to update your computer system and select "Yes".

Soo back in the holding pattern.  I'm supposed to call the pharmacy back around noon tomorrow to have them re-run the insurance, and hopefully by then, it will go through.  If not, it looks like I'll be paying out of pocket... yay...

And just for a short status update, today is CD5 for me, and I have 2 days left of the Clomid... and only 2 days left until starting the injections, so YAY!  I'm very excited.


  1. Breathe!! If you pay for it out of pocket you should be able to submit a reimbursement request to the insurance company and get your money back. xoxoxo

  2. I'm trying! They just make it so frustrating sometimes. I have to admit I'm a very controlled, obsessive person, so this adventure into IF treatments as really tested my already limited patience. :) But they did say they would reimburse me like you said.