Wednesday, June 29, 2016

Is There a Code for That?

So I'm expecting to start Follistim and Estrace next week. To give you an idea of the cost, according to Walgreen's specialty pharmacy, they'll bill my insurance $1,800 for 6 days of Follistim.

Anyhow, my insurance will cover Follistim if it's not being used for procedures related to IVF. So, IUI & related procedures = covered. IVF = self pay.

I am not doing IUI or IVF. I am taking drugs and having sex.  (As a relatively prudish straight-arrow, those are words I never expected I would type!)

The insurance company, because of the IVF limitation, will not authorize Follistim unless I can provide a procedure code. Because the procedure code tells them if it's for IVF or not. There's one big problem here: there is no procedure code for "have sex!"

I am stuck in this infinite loop. First, insurance assures me it will be covered, since I'm not doing IVF, so my doctor should submit an authorization request. As soon as my doctor submits the authorization request, insurance requires a procedure code. Then, insurance tells me there's no procedure code for sex, and I remind them that sex is not IVF, at which point they agree it should be covered.

GAH!

I've now wasted spent more than two hours on the phone with the various parties to this BS.

"Just relax and it will happen" - a phrase that is applicable to neither getting pregnant, nor getting insurance preauthorization.

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