Posted by: birdsandsquirrels | January 17, 2009

insurance changes

On Wednesday, before I had the ultrasound of disappointment, I decided to refill my Follistim, so it would be here this week. I anticipated starting injections that day, and I had some Follistim left, but I wanted to get the refill delivered before the weekend. It didn’t even occur to me that I would have to sit this cycle out. I had a cyst at my screening ultrasound the prior two cycles and I had still been able to continue. I submitted my refill for four cartridges of Follistim before leaving for the RE’s office. I authorized a charge of $800 something dollars before my screening ultrasound. Arrogance maybe?

On the way there, I get a call from IVP Care. They wanted to confirm some things – is this cycle #2 or #3? Are we doing IUI? Any health information changes? I started getting nervous, because it’s January, and our health insurance may have changed what they cover. They cover nothing of the treatment or monitoring, but they had been covered the meds at 50%, which is great. I answered the questions, then hung up and continued driving.

A few minutes later, they call back. “Um, there’s been a change, but I think it’s something we can work around,” says the girl with the nice southern accent. As it turns out, Follistim is no longer covered by our lovely insurance. The girl (who probably has three kids and no problem getting pregnant) tells me that they will cover Gonal F, but it’s more expensive, so our cost goes up. If I want Follistim, I have to pay completely out of pocket. They do have a discount program without insurance, but we’d still have to pay an extra three hundred dollars. I’m sure Gonal F is fine, but I’ve heard that the Follistim pen is easier to use because if you misdial the dose, you can reset it and not lose any of the precious expensive medicine. Does anyone have any opinions about Follstim vs Gonal F?  I know they are essentially the same medicine, just by different manufacturers, but do people ever have different responses to them? Can you use both in one cycle? I have two cartridges of Follistim left, which isn’t enough for the next cycle, so could I use the Follistim up and then switch to Gonal F midway through the cycle?

I told the girl that I was just at my doctor’s office now and that I would check with them and if needed have them call or fax in the prescription for Gonal F. Of course, after the appointment, I had to call back, all embarrassed, and cancel my order completely. The lady I spoke with that time was very nice, and clearly knew what it meant to cancel a cycle. She actually told me that she was sorry, and she wished us luck and hoped that the next cycle works. I liked her.

So, how many of you have had insurance changes at the beginning of the year? Any of them good?

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Responses

  1. Our co-pay doubled and we have to pay ten percent more out of network and I think we have to get to like 300 dollars each or six? I forget.

    It is more, but it is still really good coverage so I am not complaining.

    That sucks that your coverage changed. I swear to God it is outrageous that infertility is not completely covered.

  2. My insurance changed 4 days before my miscarriage, yet my husbands employer failed to notify us for 3 weeks. Then they wanted to haggle, claiming the pregnancy was a pre-existing condition (I had only been pregnant officially for 8 days. I was 5 weeks LMP.)

    Yeah, I totally wanted to deal with that on top of my loss, and my last grandparents funeral (Cancer, yeah, I got hit hard that month.)

    Oh, and the shock that they only cover IF diagnositic until one cause is found. They cover nothing after that, so no HSG for me because I have PCOS already in the books.

    Or when I had exceeded the limit on getting b/w done, so I have to pay for all my liver b/w out of pocket now. I have fatty liver, I have to get it checked every few months while on Metformin… thanks insurance, another nice slap in the face.

    I am a bit jaded when it comes to the world of health insurance… does it show?

    Sorry. That sucks that they changed it on you two. I hope you can figure something out.

  3. i’ve always used gonal F, and never had a problem with the pens. i don’t have any insurance coverage.. ugh..
    good luck!

  4. I’m not sure if my insurance has changed or not yet. I haven’t had any appointments. I do know that it’s time to start over on those deductibles. Woo hoo!!!

  5. My medical ins didn’t really change this year (to my knowledge… the company said the benefits were staying the same) but I do worry about my prescription plan. They didn’t really cover much (no IF) to begin with but it could still get worse.

    I think there is a slight difference between Gonal-F (Follitropin Alpha) and Follistim (Follitropin Beta) but I have no idea what that means in real terms and I have asked Dr. Google and he hasn’t been very helpful. So I would be really curious to know if you could switch from follistim to gonal F in the same cycle.

    Sorry your coverage changed on you. Hey, maybe you’ll have a stroke of good luck if the clinic has some free/donated follistim sitting around they will let you have it so that you don’t have to switch mid cycle… of course you might be better off playing the lottery than waiting for that one to happen.


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