Fertility Future, Part 2

Did you get enough of a breather, lol?? Ok, here we go...Part 2!

So my insurance has no coverage limits for infertility diagnosis. It does, however, put a $1500 lifetime maximum on infertility treatments. That include medications. We have what is known as a Health Reimbursement Account, which means that our insurance gives us an allocated amount to use for "free" before we start paying anything (including copays!). We are given $650. Ironic, aye? (remember, the IUI procedure and the things included with it should come out to be about $650.) That DOES count toward the $1500 max though, so that means that if the IUI cost $650, we only have another $850 that the insurance will cover to any degree. That remaining $850 will only require us to make our copays, but once we've reached that limit, we're completely on our own.

Here's the problem...the FSH injections (Follistim) are not cheap. My doctor originally told me that I would be taking an injectable called Gonal-F (instead of Follistim). After speaking to my insurance this morning, I was told that I could expect 900 units of the Gonal-F to cost about $1500. Well, my doc told me that I would need to take roughly 260 units A DAY for 12 DAYS, which means I would need over 3000 units...which means it would cost more than $5000 JUST FOR THE MEDS! Um yeah, sooo not gonna happen.

After talking to a lot of you last night on Facebook, I decided this morning that I needed to call my fertility clinic and ask them about the meds. What I found out was fantastic! After I left my appointment last night, my doctor apparently reviewed my case and decided that she wanted me to take Follistim instead of the Gonal-F, and since it's stronger than the Gonal-F, I will only need 100 units of it a day. According to the nurse I spoke with at the clinic, usually the Follistim costs about $100 per 100 units. Which means that over the course of the 12 days I need to take it, it should be roughly $1200. Yeah, that's a HUGE difference!! Anyways, my insurance requires prior authorization before I can take/it will cover any injectable medication, so today the nurse I spoke with was going to get the process started so that I can stop worrying. Seriously, there are such incredible people working there!! She's ordering the Follistim through the specialty pharmacy (normal pharmacies don't generally carry FSH injectables), they will send her an authorization form for the insurance approval, she will submit that to my insurance, they will approve or deny it, and then she will call me to let me know what the EXACT cost will be. From what I am told the authorization usually only takes a couple of days, so I am hoping that I hear sooner rather than later. Approval from the insurance companies depends on whether or not they feel that the medicine is medically necessary for what I am doing...if they deny it, I'll be shocked. I really can't forsee that happening, especially since it says in my coverage (and I verified it more than once with insurance in the past 12 hours, lol) that medications for the treatment of infertility are covered to a certain amount.

Sooooo, now it's a waiting game. I swear Heavenly Father has a sense of humor...He knows I'm not a patient person, and let me tell you, this ENTIRE infertility issue has been the biggest test in patience for me EVER, lol! If it all works out like I'm hoping it will, we will end up paying, out of pocket, about $450 for EVERYTHING. Now that's affordable!! What sucks is that if this IUI cycle doesn't work, we won't be able to afford to do it again, since we will have maxed out our lifetime benefits...unless...I get a new job, with health insurance that has fertility benefits. Then we will switch to that insurance and maybe we will try again!

Anyways, I think I about covered everything...except I wanted to say to all of you, THANK YOU!!! Never before have I felt so much support and love from people all over the globe for what we are going through. I cannot even begin to express to you all how much it means to me to know that you are praying for us, thinking of us, giving us your advice, helping us in any way you can. It has been your support that has seriously gotten me through all of this, and I cannot thank you all enough!! I love you all!