Doing Battle with … Insurance


As I had mentioned before, my insurance is covering my IVF (up to $50,000).  I am unbelievably lucky on this front, I know.  There are numerous women and couples who fork over their life savings for treatment which, as we all know, isn’t a guarantee that you will one day have a baby.  This doesn’t mean I don’t have to battle my insurance company for coverage of medicine …

As you all know, I’m currently in the middle of my first IVF cycle.  I was given a laundry list of prescriptions for the stimulating hormones which had to be fulfilled through a specialty pharmacy.  Four of the medicines required prior approval: the follistim (contains follicle-stimulating hormone (FSH) to help produce follicles/eggs), menopur (contains FSH and luteinizing hormone (LH) to help produce follicles/eggs), cetrotide (prevents premature ovulation by blocking the hormone that causes eggs to be released from the ovaries), and leuprolide (used as the trigger before IVF).  After much time spent on the phone with both the Fertility Clinic and Specialty Pharmacy through my insurance carrier, I was given the prior approval for three out of the four. Mind you, I was given approval after I had started the cycle – my Fertility Clinic was kind enough to “front” me the medicine that I needed with the understanding that, when my prescriptions came in, I would turn them over.   Leuprolide, however, was deemed “unnecessary” by my insurance carrier and denied.

Denied!  Even though it was a script written by my doctor for their IVF protocol.  Even though it was reviewed twice. Even though I am in the middle of my hormone therapy regimen and I need the medicine as soon as possible.  The specialty pharmacy said that my doctor could fax in a “letter of medical necessity”; the prior approval department at the doctor’s said they would be happy to do this but it could take up to two weeks to review.  TWO WEEKS?  Not the two week wait I am comfortable with … Instead, I am looking at paying out of pocket for the medicine, which is incredibly frustrating.

One more hurdle to clear. Deep breath in.

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