After looking at the possible costs for injectables, calling my mom and crying to her about it, crying to my sister in law Liz, crying to my internet friends - all literally, as yesterday was the day of tears from morning till night, I started calling our various insurance providers to see what the deal was.
I never questioned Clomid not being covered, because I knew from others that had been on it that it's rare that it's covered. I figured who could it hurt to call and ask about Follistim. First I called our health insurance, because we have some kind of additional rider on our policy that is supposed to cover some drugs that aren't covered under our prescription insurance. No dice there. They were so rude, but that's par for the course.
Next I called our prescription drug insurance company. The first girl I spoke to was very helpful, and said she couldn't help me, but transfered me to the specialty pharmacy division. I spoke for a bit with the girl there, giving her all of my information and the doctor's information, and she said they'd get back to me.
It sort of slipped my mind today that I needed to follow-up with them if I didn't get a call, but they called me back as we were eating dinner. (Gotta love caller ID on the TV screen - I nearly flew off the sofa when I saw who was calling.) The bad news she had for me was that I was not covered by them for this drug. The good news was that she knew by JB's employer that we did have coverage for this on yet a different insurance plan. She was even nice enough to give me the phone number and the web site for this coverage.
I remember we used to have member cards for this insurance, but then we got other drug plan insurance cards, and I think we assumed that they replaced this other thing, so we threw them out. Typical me.
I went to the website and clicked on the member button. It asked for member ID number to set up an account, so I tried the obvious, and it worked! I was in! I plugged in the information to price out the Follistim, but it came back that I would have to call for a price. Off to the phone! I navigated several menus, plugged in the same info over and over again, and finally just pressed 0 in hopes that there was a human somewhere on the other end. After holding a bit an angel came on the line. I gave her the basic information that she asked for and she said YES! OMG OMG OMG!
We have a $100 deductible, and once that is met, the Follistim will be $25! OMG! I'd even be happy to pay $100 for it!
JB's told me before that his coworkers bitch about copays - doctor visits are $15, and covered drugs (which are 99% of what most people ever need) are $5. Cost to employees? ZERO. How many people in the US get FREE health insurance? We pay ZERO for IUI's. My fertility treatments so far have been about $15,000 and it's cost us maybe $400 out of pocket, not including Clomid and HCG. (Speaking of which, if I need that again next month, I'll have to see if that's covered too. Fortunately the cost of that is a lot easier to swallow that the Follistim if it isn't.) If JB ever tells me again that one of his coworkers bitched about copays, I will personally go punch them in the face.