Well Friday was to be the first day of my follicle stimulating hormone injection, but at this point we aren’t really sure what is going to happen.
Here’s the background….3 weeks ago, when we decided to go down the IVF road, I called my insurance, Cigna PPO, I spoke with the benefits people and they informed me that not only was the procedure covered, so was the medication. Oh how happy I was!!
My nurse proceeded to call my medication into the pharmacy listed on my insurance card (Caremark/ CVS). I promptly received a phone call saying that this medication was going to cost me upwards of $9500. She also told me that this was normal, and since it was injectables that I needed to call my insurance company to make sure it was covered from the medical side (not the pharmacy side, which was who I was speaking with). A bit annoyed, I mean they were working together why didn’t they go ahead and do that? Whatever….I called. They again reassured me it was covered under the medical side and informed me that the nurse or the doctor had to call CIgna to speak with them directly. I immediately instructed my nurse to do so….knowing that at this point it was 10 days until I started my meds.
She called the insurance company, as they had instructed her to do. They then told her (after 45 min on the phone with them) that she needed to fill out a form. She did so, and sent it along. This was Friday the 7th of March. I had been told that the decision on the authorization for my meds would take 24-48 hours. Monday, the 10th I called the insurance company AGAIN to check on the status. They then informed me that it would be 7-10 business days for them to reach a decision. Um, what?!? I started to panic, but there wasn’t anything I could do…so I called back Monday the 17th to follow up. They had reached a decision, I was DENIED.
Devastation shot through my body, and I held back tears until I finished the phone conversation. Well why was I denied? The lady on the other end of the phone told me that she couldn’t see in the system why, but that I would receive a letter with the details in a few days. She also said that I should appeal the decision and that the first decision isn’t necessarily final. Um…a FEW DAYS?!?! At this point I just broke down and cried nearly the whole day.
Monday after getting finding out that insurance had denied my authorization, I called MDR Pharmacy hoping for an alternate solution. They said that I might be eligible for financial aid and that I had to submit some documents and a decision would be made in 24 hours. I sent those documents exactly 23 hours ago….so now I’m just waiting to hear the decision.
At this point here are my options:
1. Appeal the decision made by insurance and wait a month (potentially longer, if this drags out). And the possibility that they STILL deny coverage.
2. Go ahead & order the meds from MDR Pharmacy (this will obviously depend on whether I qualify for some financial aid).
3. Give up completely…Clearly I’m not meant to be a mother in the first place.
Right now, #3 is sounding like the way to go. I hate to be a quitter, but one person can only take so much. Feeling defeated…..