#*@%&# insurance…

Yup…my insurance, which is normally fantabulous (seriously, I think they just paid out close to $2000 for me last month…and I didn’t have to pay anything but co-pay) really pissed me off today.

When I had my beta tests, they also checked my progesterone levels.  They were low both times (10.3 and 11.4).  When I went in to see the MFM doctor for my ultrasounds I asked him about this and told him I had some left over prog from my last IUI.  He suggested I take it and when I run out to get a new RX from my ob/gyn.  Okey dokey!  I thought I had about 2 weeks worth, enough to get me to my appointment (which is next Monday, fingers crossed) and then get the new RX then.

Did you know that if you have 21 pills and take 2/day, that’s only 10 days worth, not 14??  Yeah, I didn’t either!  However, maybe you don’t suck at math as much as I do – I mean really, I suck at math.

So, once I realized my error, it was this past Friday.  I didn’t get time to call during the day, so I left an after hours message, hoping they would get back to me at least by Monday, as I would run out on Tuesday.  Monday came and went, no phone call.  I think, “well, maybe they were closed Monday due to the holiday.  I’ll give them Tuesday.”  So, yesterday came and went – no phone call.  Getting pretty frustrated, as they always call me back!  So, I took my last pill last night and hoped it would all work out today.  Left a VM for the nurse at 9 am (knowing my doctor would not be working today, but hoping someone could give me the RX anyway…).

I get a call back relatively quickly.  Give them the name, amount and the location of my Target pharmacy.  Done!  No problem!  Figure I’ll run to Target over lunch and pick it up!  Great!

Well, about 2 hrs later, Target calls.  They tell me that they just got my prescription, but that my insurance does not cover any of the cost and it’s going to be $437 – WHAT THE &#)(&)%(@!!!!  Not only that, but they didn’t even have that medicine in stock and would have to order it.  I was livid to say the least.  Call the nurse back right away and she actually answered the phone instead of VM.  I told her the situation, asked if there was a generic?  She had put in a RX for 30 day supply.  We decide she will call Target and see if they can get a generic.

I call my wonderful, loving husband.  I think he had a small heart attack  when I told him how much money they wanted.  I remembered that when we got this last batch of progesterone, it was at a smaller pharmacy that had it in stock.  He agreed to track down the name of it, and we decided to just get a 10 day supply to get me through until my appointment and then go from there.   I decide to also call my insurance company and see what the heck is up.

I call them.  Here is the conversation:

Me: I’m trying to get a RX that I very much need and I’ve been told there is no coverage for it and I’d like to know why.

Insurance Guy: Let me look that up.

***on hold***

Insurance Guy: Yes, it looks like there is 0% coverage on that particular RX

Me: I know, I want to know why.  I’ve had it before and it wasn’t covered then as it was part of IF treatments, which are not covered – but this is for a pregnancy and prescribed by my ob/gyn.

Insurance Guy: It doesn’t give a reason why, just that it’s not covered.

Me: *deep breath*  Okay, this is very frustrating.  I need this medication.  If I don’t get it, my baby will die – I’ve already lost one pregnancy when I stopped taking this due to cost.  I don’t have the money for it.

Insurance Guy:  Well, in that case, would you like to file an appeal?  I can send you the forms and you fill out your reason and can even get your doctor to sign it.  It’ll take about 2 weeks.

Me: That will be too late.  Thank you. *click*

I know it wasn’t this guys fault, but I just get really flustered and angry when stuff like this happens – when I have no control over something this important.  It’s easier to just hang up on them rather than releasing the fury.

So, plan 2.  Justin does manage to find the name and address of the other pharmacy.  I call my doctors office back, and leave a message with the name and address, tell them just to order 10 days worth and we’ll figure the rest out later.

About 20 minutes later the new wonderful pharmacy calls me back and says they have my RX and when can I come pick it up?

Me: Well, I have a question first.  How much will it cost?

Lovely Pharmacy Man: Well, let me ask you a question, do you have any insurance I should know about?

Me: I do, but they’re not covering any of it, bastards (I didn’t say the last part, just thought it.)

Lovely Pharmacy Man: Okay then, when I’ve already enrolled you in our discount insurance program.  It dosen’t cost you anything, just saves you money.  So, it would normally be $150 but with the discount it’ll be $124.

Me: Thank you!  I’ll be there during my lunch hour!

So, still kinda spendy, but no where NEAR the Target price, even for the 10 day supply!  I remember liking this pharmacy a lot last time we went there.  It’s just a small little building, and all they do is RX’s and over the counter stuff – nothing else.  They are always very helpful and friendly as well.  I may have to go there more often.

So – that was a very long tale.  Basically it boils down to my insurance screwed me over and I love this new pharmacy.  I’m also very happy again with my switch to the new ob/gyn.  It’s hard to get an appointment with her, but she and her staff are always helpful and willing to work with me.  Thank you!  Oh, and if you’re in Chicago and want a new pharmacy, let me know and I’ll give you the hook up.

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4 Comments (+add yours?)

  1. Holly @Ready2Bmom
    Jul 07, 2010 @ 15:57:36

    So sorry that your insurance screwed you over like that! That is so frustrating! But I am glad that you’re happy with the new pharmacy and OB/GYN

    Reply

  2. Susie
    Jul 07, 2010 @ 20:09:08

    I don’t know how you keep it together so well…wow. Kudos to you for that my friend. I just spazzed out at our phone/internet company last night on hold forever and that’s no where near important as you getting your meds!
    Thanks for visiting the other day, it was good to see you guys…see you in MN soon 🙂

    Reply

  3. Corinna
    Jul 07, 2010 @ 22:01:29

    Ugh. Suckage. @#$*%$ Insurance companies!!! I did a lot of calling around for prescriptions when I knew they wouldn’t be covered, and the lowest cost was actually a little local place, which I was much happier to do business with anyway than Corporate Monstrosity Pharmacy. Can you go ahead and file an appeal anyway, and see if they would reimburse you later? $124 isn’t spare change, and it sounds like you’ll need more of it later. Or, maybe you could get a copy of your insurance company’s formulary and have the doctor pick something from it that is comparable?

    Also, a very belated congratulations on this pregnancy – we’ve been out of town and are just catching up. We’ll be praying all goes well!

    Reply

  4. katery
    Jul 10, 2010 @ 16:39:58

    the thing about chain pharmacies (like target or walgreens) is, they have set prices, there’s one price that they charge the insurance company and one that they charge cash paying patients and that’s it. at the pharmacy where i work, which is a smaller one, when a patient doesn’t have insurance or a medication isn’t covered we look at how much the medication cost us and then decide how much we will charge, that’s why when you go to a small pharmacy you might get a better price, it’s not always true because they don’t all do it, but a lot of them do.

    and here’s another thing, those people that answer the phone when you call your insurance company, they don’t know ANYTHING about ANYTHING, they have no medical training, they just have a script and a computer that tells them what is covered and what is not, and what is covered and what isn’t is not always so black and white. some insurance companies cover certain drugs, but if you walk into a pharmacy with a prescription and try to fill it they will deny it, they want you to use a SPECIALTY pharmacy, lie freedom fertility pharmacy for example, so you might want to check with your insurance company, the only problem is those people that answer the phone, they’re not equipped to handle a question like this. i was lucky because my husband insurance company has an insurance broker which is kind of a middle man between you and your insurance company, and the broker helped me A LOT when i was trying to get things that i needed covered, things that they said were not covered but actually were according to my certificate of coverage, make sure you have a copy of your certificate of coverage because they might tell you things aren’t covered that are.

    lastly, i’m not sure what progesterone your doctor has you on, but there’s more than one form, i took prometrium and it definitely didn’t cost $437, when i’m at work on monday i will check some prices if you tell me what it is, and your doctor might be able to prescribe something else that doesn’t cost as much.

    Reply

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