Friday, November 8, 2013

Insurance headaches

So, they lied to me in February. Or rather, misinformed me. The 8% Crinone is not covered with prior-authorization, the 4% is... and it does us no good. My clinic is currently trying to get Endometrin pushed through with prior-authorization. There are a few reasons I am not a happy camper about this. I don't really feel comfortable switching to this, I've never used it, I don't know how my body will process it. Furthermore, it's twice a day instead of once a day... which means it's not the same strength as the Crinone. I had told them that if we can't get Crinone, I'd rather switch to PIO injections... but they seem really against letting me do this. Why? I don't flippin know! but you better believe I'm bringing it to my doctor on Monday... assuming everything looks good on the ultrasound.

Depending on the tier of coverage (which I can not see on the website, because Endometrin just says "not covered") it would be way more expensive than PIO injections anyway. I don't know how strong Endometrin is, but I'd rather switch to something I know will work good than risk downgrading my progesterone and risking spotting, bleeding, or a miscarriage. Not to mention, what if I pay for this vaginal supp then start bleeding from a SCH- I'd then have to turn around and pay out the ass for PIO OOP and risk not having the money.

We're still waiting to see if I'll need prior-authorization for my Lovenox (generic) because I've talked to two reps now and they've given me conflicting stories. It looks like they might have quantities limited to 28 days for a month, then require prior-authorization for more. I don't know, and I just want to throw something because I am so frustrated and just so DONE with this insurance company.

My husband's work changed because this new insurance was "cheaper" well, I tell you what, it SHOWS.

I guess we'll know Monday what's going on. With, well, everything.


Celia said...

I would tell them you are recording the conversation and ask if they are trying to get you to miscarry since that would be cheaper for them. I hate insurance. My problems are TEENY compared to yours but I still hate them. said...


my re had me use endometrium stuff, it was pretty potent if i remember correctly.

yep as far as the love.nox. When i was pregnant with C they'd give me a 30 day supply 2010-2011). With M it was a 28 day supply. Weak sauce.

AnotherDreamer said...

Celia, I flat out told the rep that without these meds I would miscarry. Useless. I should record it next time, so nuts.

Melissa, and the 28 days thing makes no sense! The nurse I talked to at the clinic even said, "What, is every month February?"

Anonymous said...

UGH I am so sorry that you are dealing with all this!! I don't know a single person, NOT ONE, who is having a good time dealing with their insurance... and it only gets worse from here, unfortunately. I hope you get the answers you need. It does sound like you need to record every single conversation that you have with those people.