Infertility, Our Infertility story

Insurance Nightmare

June 11, 2010

As if dealing with infertility were not enough, I now have the added stress of fighting with my insurance company for medicine that I will need one day if I ever get pregnant.

After finding out that I have Factor V Leiden disorder and low antithrombin III and protein S levels, my team of highly specialized doctors told me that this could certainly be a reason for my recurrent pregnancy loss and that there is any easy fix.  I should take Lovenox, a daily prophylactic injection, which is a safe anti-coagulant drug.   Great news – we found a problem and it has a solution.  Right?  Not yet.

My hematologist’s office submitted the paperwork months ago for pre-authorization from my insurance company.   On 4/8/10, they sent me a lovely letter saying that they denied my request because they determined the drug to be “not medically necessary” for me. WHAT?!?!?!  So, let me get this straight.  I have blood disorders that put me at a slightly increased chance of clotting problems like deep vein thrombosis (DVT).  However, when pregnant, there is a drastically larger chance of these problems, plus miscarriage.  So, they think that once I’m pregnant, a medication to prevent a risk of DVT, pulmonary embolism and miscarriage is not medically necessary?

Just thinking about this and writing it makes my clot-potential blood boil.  So, some schmuck sitting behind a desk at my insurance company knows better than my reproductive endocrinologist and my hematologist?  I think not!

So, what’s the big deal here?  Why don’t I just forget about them and buy the medicine myself?  Well, I almost passed out when I found out yesterday that this medicine costs $1100 for a one month’s supply.  So, if they don’t approve it, I won’t be able to afford it.

I’m pretty sure my insurance company will cover Viagra for men, but not cover this drug for me?  I just can’t get over the injustice of this.

So, I submitted an appeal on May 19, and called several times since to inquire as to the status.  Yesterday, I was told that it might take months.  So, I had my doctor’s office call and they agreed to expedite the appeal.

I should find out today.  Commence the nail-biting.

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Update: 6/11/10 6:00 p.m.

I just heard from the appeals department and I am APPROVED!  I am so relieved.  They sent it to a 3rd party board certified physician today for review.  Thank you to whoever that doctor is.

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