She Says… Ugh, Insurance

I have to admit, I do not think much about insurance. I am very fortunate to work for a company that offers good benefits. My payment for health insurance comes out of my paycheck before I receive it, so I barely even think about it. Aetna, a large insurance company, is my insurer, so almost any doctor I want to see is “in network”. Before going to the doctor, I don’t really worry about payment at all — I just wait for the bill to come for my little portion of the total amount, and I pay it.

So when I started going to Boston IVF to see Dr. P, my reproductive endocrinologist, I did just that. I showed them my insurance card and didn’t think about it again. Luckily, the first two bills (initial appointment and bloodwork/ultrasound) were paid mostly by the insurance company with no problems. But then at my last appointment (where I was prescribed Clomid), I was told that I had to enroll in Aetna’s Infertility Program before they would cover the medicine, since it is technically a “fertility treatment”. They consider Clomid a fertility treatment just like an intra-uterine insemination (IUI) or in-vitro fertilization (IVF)! And as I have a limited number of IUI’s covered, they have to enroll me in a special infertility program and make sure I qualify. Usually a couple has to be trying to conceive for a year before they “qualify”, but the lovely nurse on the phone said that since I clearly have ovulation issues, that should “help”. Yes, it certainly should, shouldn’t it?

Here I am on the edge of my seat waiting for my miracle drug to come in the mail, and it can’t even be ordered until Aetna confirms that I really am “infertile” enough to need it! Slightly frustrating. Nevertheless, I think I got everything squared away with Aetna yesterday, so as soon as I’m officially enrolled in the infertility program, my Clomid can be ordered. Chop chop, ladies! I’m ready to get going!

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7 responses to “She Says… Ugh, Insurance

  1. Hi! Thank you for the comment on my blog. I really hope the Clomid is all that you need. From reading your diagnosis, it sounds like you have a good chance to react favorably to it. Although we were very, very lucky, it was on ly Clomid and IUI that did the trick for us, I hope you have a similar experience. I also know alot of people that just needed Clomid to get their ovaries to behave. Best of luck making your sweet baby! 🙂

  2. How frustrating! It sucks when making a baby (a product of your love with your husband) turns into red tape!

  3. Ugh, everyday can feel like so long when all you want is to know you can have a baby.

  4. wow, i didn’t have that experience at all! it was n problem to get clomid (no additional insurance fees or other problems). i’m sorry, that’s incredibly annoying! i hope you get it all sorted out soon!

  5. How expensive is Clomid???

  6. Shannon, Thank you! You are very lucky, but I’m sure you already know that 🙂 Hopefully my story ends up the same way.

    Kara, I know. Red tape doesn’t usually bother me, as I know it’s just part of the process, but in this case I’m very impatient!

    MyHormonesMadeMeDoIt, Seriously. Why does it have to involve so much waiting?!

    Sarah, I didn’t think I would either! Seems like it should be just another prescription, right? You know, call it in to the drug store and pay your copay and be on your way. Apparently not (at least with Aetna)?

    thebakerbee, I think once my insurance goes through, it won’t cost me any more than a normal prescription. For me, that is usually a $10 copay. So I’m not really worried about the costs at this point (although if I have to keep going in for blood and ultrasound, it could get very expensive very quickly!).

  7. oh man. that is so frustrating! although our healthcare in canada is riddled with it’s own problems, i definitely appreciate not having to deal with so much red tape anytime i need some medical assistance. so far, my work insurance (that covers things not covered by general health care like drugs, dental, etc) has been pretty painless to use.

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