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.
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.