What About this? And this? And....

April 5, 2017

 

I never take the first answer as the real answer when it comes to medical anything.  Its one of the perks of coming from a medical family.  When I say that, let me be clear on what I mean. My mom is a R.N. in Occupational Health, one aunt was in Labor and Delivery as a nurse for at least 2 decades, one aunt is a RN NICU nurse, and one aunt is a RN in ER/Trauma.  So, I have all the bases covered in knowing what things are supposed to be, how coding works, and when people are being lazy in an office and not doing their job when it comes to my money and insurance.  That being said, I have to give props to the Fertility Clinic of LV for being very transparent and helpful while I try and get price quotes on the medications.

 

I wanted to write this post so others out there know what questions to ask and what to request when going through this process. 

 

Initially I was told that my insurance doesn't cover meds. This is not true.  They do cover most of them and the co-pays on them are quite low.

 

So, here is the process.  

After the procedure quote is sent to you, check your insurance to see if any of the actual procedure is covered.  More likely than not, it will not be covered.  Mine is not.  So that will cost X amount. 

The donor you choose also has different types of vials available.  Call the bank to find out if they have what you need (i.e. I am having IVF, does this donor have that type of vial available? How much is it?)  The different vials cost different amounts.  That will be X amount.

 

For the meds, have the IVF coordinator send you a copy of the FULL prescription so you have a point of reference when speaking with the different pharmacies.  I was not familiar with ANY of the meds so this was super helpful. That way, when the pharmacy staff start telling you what is and is not covered by your insurance, you can look at the page and see what the hell they are talking about :0 (My coordinator sent me an email of the pharmacies she sent the script to so I knew who would be calling.) 

 

I asked the pharmacies to please email me a price quote (this service should be free) by filing a "test claim" with my insurance.  Some pharmacies were completely out of network, so I would have to foot the full bill ($4950.00). Yikes!!  Others had some that were covered and others that were not.  I would have saved A LOT of time if I had just asked my insurance what the preferred pharmacy is for them.  Turns out, for my company, its Briova.  There are still some prior authorizations that have to happen, but all in all, I will spend less than $500 on meds compared to the $5k I was told.  It is worth it to wait and find out- for me anyway.

 

**Note: make sure on your insurance card, you have the correct ID number for your prescriptions. Mine was slightly different than my normal ID #.  There is NO way to know this unless you ask, I found out. (shaking head in annoyance.)  But everyone has been super friendly and helpful along the way!  

 

If you need to use ACARIA pharmacy- Aaron was the most helpful in this whole process!  I even wrote his boss about how awesome he is.  Ask for him if you need help at Acaria. :) 

 

Talk to your coordinator.  That is what they are there for- to help you through this process that you never thought you'd be in the middle of anyway.  Don't be afraid to say "I need a step by step of what I need done and what I need to do.  This is overwhelming- help me please."  :)  

 

So- you should have: 

1- the cost of the procedure

2- the cost of the donor vial(s)

3- the cost of the meds

 

Then you will have a more accurate number for your loan inquiries. 

 

I also went back over real time dates of when I start the meds to harvesting the eggs (sounds SO Halloweeny plus Eastery to me!), to putting the embryo back in, and all the details about recommended time off from work and how long I will need to be at the clinic for the harvesting part.  You should receive all of this information, but along with ALLLLLL of the other information, once I knew when my cycle would start, it was helpful to have real dates to put with it. :) 

 

I hope that this helps you get through this process a little easier and hopefully less expensively!  In my process, I am waiting for the final quote and then it all moves forward. ahhhh!  Here we go!

 

-M

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