Friday, November 16, 2007

Why I hate insurance companies.

So this infertility thing is stressful enough without having to deal with insurance companies. Today was a perfect example.

I happen to have pretty darn good coverage for infertility through my husband's employer. But when one of my many doctors prescribes infertility-related medication, United Healthcare makes us go through a mail-order outfit called Pharmacare. Usually, this works pretty well. At least it did this summer. My IVF clinic faxed in my prescription, and Pharmacare shipped me a huge box of meds. Once they even shipped them overnight mail to the Tahoe area (long story). This coverage isn't trivial: the meds for an IVF cycle can total thousands of dollars, and I have the credit card balance to prove it.

But when the process goes wrong, it goes very, very wrong. Take what happened today.

It all started Monday, as we headed into what I think is going to be our last ride on the infertility merry-go-round. (I was hoping for a miracle "natural" pregnancy after last month's miscarriage, but that was not to be.) I saw Dr. R, and he prescribed letrozole to start Tuesday, and Menopur to start Friday, with a possible Ganirelex chaser.

I knew that there was no way Pharmacare could get me the letrozole by Tuesday, so I went to my local pharmacy. But I had Dr. R's office fax the Rx for the Menopur to Pharmacare.

Tuesday, I got a call from Pharmacare saying that they couldn't fill my order because I still had a balance from this summer that United Healthcare had denied. You heard that right: the insurance company makes me use Pharmacare, and then won't pay them. Only in this case, Pharmacare had it wrong: I logged onto the UHC Web site, and sure enough, United Healthcare had paid Pharmacare. They'd paid late, but they'd paid. I called Pharmacare, talked to two different people, and got everything straightened out, with assurances that I'd receive the Menopur on Friday.

On Thursday, I called Pharmacare to confirm that my meds were on their way. Yes, they'd shipped, the kind gentleman on the phone told me. That day, I did receive a delivery of needles and syringes (to work no less), but I just assumed that the actual meds would follow the next day, because the Kind Gentlemen had confirmed that they had shipped.

Well, Friday (today) arrives, and there was no shipment for me. I called Pharmacare, and after being on hold for an eternity, the representative tells me that my prescription hadn't shipped because of a miscommunication between the billing department and the orders department.

"But I have to take this medication starting today," I pointed out, somewhat sternly.

"I'm so sorry," said the woman, and told me that they could ship it so I could get it on Saturday.

"But my doctor wants me to take it starting today," I repeated. (Those of you familiar with the joys of infertility will understand the importance of timing. My husband and I have had to excuse ourselves from dinner parties to administer shots.)

What could she do? In the end, she arranged to ship it overnight, and I had Dr. R's office call the Menopur prescription into my local pharmacy for pickup today, even though it meant I was going to have to pay more than $1,200 for the meds out of my own pocket. I mean, I did extract a promise from the Pharmacare rep that Pharmacare would reimburse me, but I'm not holding my breath.

At least I get some 1,200 frequent flyer miles. Yeah. That helps.

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