The IVF meds game

So I am in the process of ordering meds for our upcoming IVF cycle.  This is one of those topics that brings the whole thing down to earth in terms of dollars and cents.

We have insurance. I have insurance through my company that covers infertiity and assisted reproductive technology (ART) including IVF up to a lifetime limit of $10K. I also have insurance through my husband's company that covers infertiity and assisted reproductive technology (ART) including IVF up to a lifetime limit of $10K.

In both of these insurance statements of benefits it says that this infertility coverage includes meds for ART procedures.

This is a lie, however.  They do not cover the drugs for IVF because those drugs are not on the list of covered drugs, at least for MY insurance company.  During our first IVF David's insurance covered some of the meds.

But here's the funny (funny weird, not funny ha ha) thing.  If you call the different specialty pharmacies, they will give you a price for each of these drugs if you are paying CASH with no insurance involvement. 

But if you are using insurance they will not give you a price.  The customer service people say it depends on which insurance you are using.  They have to actually process the prescription in order to get you a total price. You can only do this with one pharmacy at a time (because the charge is against your account once they run the prescription to find out the price.)  So it is virtually impossible to comparison shop for IVF drugs if you are using insurance.

I spoke with one of the well known IVF pharmacies over the past few days.  They say my primary insurance (through my company) is not covering any of the meds -- not even the progesterone, the Lupron or the steroids.  The secondary insurance will cover those meds -- the cheap ones.  But the insurance company told the pharmacy that I had to call a couple other specialty pharmacies to talk about the other drugs (the expensive ones, Follistim and Repronex) and whether they would be covered at all.  The customer service person at the well known IVF pharmacy said that this is no guarantee that they will cover the meds at all. 

So I need to call the insurance company tomorrow and find out what's going on.

One of the maddening things about dealing with health insurance is that you never seem to be able to talk to decision makers directly. Rather, you are in an endless queue of talking to people who only know how to say no. (Like David Spade in that commercial, except most of these phone center people are women.)

They don't have any answers on who sets policy. They can't refer you to anyone who may have a better understanding of the seeming contradictions in what they are telling you. You are not a person with a problem to solve. You are a problem that they want to put neatly into one of their piles, even if that doesn't help you at all.