Insurance - Schminsurance

I made some phone calls today, trying to chase down some insurance coverage for the damn near $400 worth of meds that I bought on Sunday.

After the usual press 1, say 'member,' stand up, touch your toes, turn around three times, spit over your shoulder routine, I finally got to talk to a human.

He told me that the coverage for those medications is as follows:

Clomid - Not on the formulary. He gave me a list of alternatives. Nurse E tells me that Dr. E will only prescribe Clomid. It was only $22.50 for five days, though, so I can live with that.

Ovidrel - Not covered at all; no alternatives. So, they are happy to pay for me to do as many IUIs as I want, but they won't pay to make sure that the damn egg is dropping the same day I'm inseminating. That's asinine.

Bravelle - $50 copay (as opposed to the $300 that I paid) - if you have preauthorization. Here's where it gets fun. . .

I called Nurse E to check on why it wasn't preauthorized. She called the pharmacy and they told her that when they submitted the prescription, the insurance company just told them it was not covered, but never mentioned needing preauthorization.

So, I called back and talked to a different insurance stooge.

First, I figured out that the preauthorization for the cycle itself - monitoring, IUI, etc - does not include preauthorization for the meds. That has to be done separately.

Then, when I asked why they'd not told the pharmacy to get it preauthorized first, he told me (oh, you're going to love this one) that "Our computer sends four lines of information, but the pharmacy's computer can only see three of them."

What the fuck does that even mean?

"So," I said, "you're telling me that you did tell them about the preauthorization, but it was in like invisible language, and now I'm stuck paying an extra $250 because they didn't know they needed it?"

He did give me a phone number for the preauthorization people, and I've asked Nurse E to call them and ask for the authorization, and ask them to backdate it because no one told the pharmacy that it was needed.

I'm really hoping that she can sweet-talk them into it, because at this point, $250 is huge.