The Wonderful World of Insurance

So, the very knowledgable nurse at my doctor’s office sent a list of 10 meds I will need to CVS Specialty Pharmacy. That wouldn’t be a problem since that’s where I asked her to send them but when they contacted my prescription insurance company (Caremark; also a CVS entity) the main drugs were not covered so they just conveniently deleted them from my list of mail order meds. It’s a good thing I noticed and questioned it (I mean, just because I didn’t have coverage didn’t mean I didn’t want them!) or I would be really pissed come November when they were supposed to be delivered. Anyhow, I ended up talking to a lady at Caremark who said that my Follistim, Menopur, Ganirelix, and Gonal-F weren’t covered. I asked her if she was positive about that list since I was never prescribed Gonal-F (it does the same thing as Follistim). She claimed she was sure so I called my doc who faxed me the list of my meds and, sure enough, it wasn’t on there. I called back, got a different lady, and made sure it was HCG on the list and NOT Gonal-F. Once that was straightened out, I got to call CVS Specialty Pharmacy who took my major medical insurance information since they cover some injectibles. She called back an hour later to say they weren’t covered. It’s a good thing she slipped in the “by your prescription coverage” and I noticed because then I had to question her about if it was my prescription insurance or medical. She admitted it was my prescription insurance that denied coverage. I asked her why the hell she thought I had given her my medical insurance information earlier if I didn’t want her to use it; afterall, it was she who had offered to do a benefits analysis. She never called me back by the way. I called the Specialty Pharmacy again the next day, got someone else and they did the benefits analysis for blue cross and blue shield which came back as covering part of the injectibles! Yay! So now I’ve got the meds scheduled and straightened out. I think.

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One thought on “The Wonderful World of Insurance

  1. Ria says:

    Wow. That sounds like a nightmare, but I’m glad you got it worked out! Best of luck!

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