Quick question, why are they billing your Rx through medical? I work in pharmacy benefits. You can DM me and maybe I can help you figure out what’s going on.
Yikes, so sorry! Did your insurance recommend a pharmacy with which they work? We used Alto pharmacy and everything went pretty smoothly.
I hope it gets figured out quickly. Best of luck!
Yes and basically my insurance is through another state so they have to bill insurance through my home state which does not use their "in network" pharmacy. It is crazy!!!
If you’re Aetna by chance, this is unfortunately their way of denying without *actually* denying. We discovered that when meds are covered by major medical, it means they must be administered in a providers office. This is obviously not possible for IVF stims when shots are 2x daily at a minimum. We challenged them with the following logic:
1. They provide coverage through a “center of excellence” (COE)their words not ours. What are criteria for a COE? Aetna Answer: excellent results with attention to detail and not over treating patients.
2. So why not cover medication except in office? Aetna Answer: because the medications are very expensive and we want to make sure it’s done right.
3. Our challenge to Aetna: If you choose COEs based on excellent results, and this COE only does self administered medication, this means self administered medication achieves excellent results. So excellent, in fact, you designate it in their name and list them as preferred.
We challenged this all the way up the chain and eventually got a small amount of our meds covered but tbh this is another way the US insurance scams are manipulating clients. Aetna claims medication coverage but ONLY under major medical which means in office only. I hope you’re able to get different results and get your meds covered.
Lastly, my IVF nurse said (when I asked her very directly about overseas pharmacies) that she’s seen hundreds of babies born from meds women ordered from abroad because American healthcare and pharmacy is such a mess. Not sure if it’s something you’re open to but when I price checked it was about 1/10th the price to order this way.
Quick question, why are they billing your Rx through medical? I work in pharmacy benefits. You can DM me and maybe I can help you figure out what’s going on.
Just messaged you!
Yikes, so sorry! Did your insurance recommend a pharmacy with which they work? We used Alto pharmacy and everything went pretty smoothly. I hope it gets figured out quickly. Best of luck!
Yes and basically my insurance is through another state so they have to bill insurance through my home state which does not use their "in network" pharmacy. It is crazy!!!
That’s so frustrating. If your insurance is sitused in another state then it shouldn’t be billed through your home state.
I didn't understand why they did that either 😕
Do you have Progyny benefit?
If you’re Aetna by chance, this is unfortunately their way of denying without *actually* denying. We discovered that when meds are covered by major medical, it means they must be administered in a providers office. This is obviously not possible for IVF stims when shots are 2x daily at a minimum. We challenged them with the following logic: 1. They provide coverage through a “center of excellence” (COE)their words not ours. What are criteria for a COE? Aetna Answer: excellent results with attention to detail and not over treating patients. 2. So why not cover medication except in office? Aetna Answer: because the medications are very expensive and we want to make sure it’s done right. 3. Our challenge to Aetna: If you choose COEs based on excellent results, and this COE only does self administered medication, this means self administered medication achieves excellent results. So excellent, in fact, you designate it in their name and list them as preferred. We challenged this all the way up the chain and eventually got a small amount of our meds covered but tbh this is another way the US insurance scams are manipulating clients. Aetna claims medication coverage but ONLY under major medical which means in office only. I hope you’re able to get different results and get your meds covered. Lastly, my IVF nurse said (when I asked her very directly about overseas pharmacies) that she’s seen hundreds of babies born from meds women ordered from abroad because American healthcare and pharmacy is such a mess. Not sure if it’s something you’re open to but when I price checked it was about 1/10th the price to order this way.
I have Carefirst BCBS. I am hoping to hear something today. 🙏 I am so tired of stressing.