Help w/Insurance vs. Doctor's Office

I have United Healthcare, and when I called a month ago, I was told that IVF will be covered 100%. I'm currently a patient of Dr. Goldschlag's at Cornell.

I'll start my shots on July 12 w/an expected retrieval/transfer on 7/27 or 7/29.

I'm going on vacation and wanted to make sure that all my meds are handled before leaving and when I called my nurse to confirm which pharmacy I would be picking up from or if it'll be my mail-order.

She advised me to call UH to confirm 1) if my medications are covered 2) if I require pre-authorization and 3) what's UH's preferred pharmacy. I call UH and speak to THREE different departments (everyone keeps transferring me around.)

I find out that:
1) yes, I need pre-authorization and the doctor's office has to call.
2) the preferred pharmacies are Rite-Aid and CVS but they don't carry IVF.
3) They want the doctor's office to call to discuss the medications.

I call my nurse back, and she tells me this is the most difficult "part" of the process and that I should speak to a supervisor at UH.

Am I nuts that I think the doctor's office should either 1) KNOW this 2) BE DOING this or 3) knowing that I'm meeting so many difficulties that they'd just handle it WITH me or for me?

Can anyone give me advice? I feel like I'm constantly being bounced around with the doctor's office AND the insurance company!!!!!!

I'm really upset with this nonsense.

Re: Help w/Insurance vs. Doctor's Office

Do you have united healthcare for pharmacy benefits as well? I would call the members service number on your pharmacy benefits and double check again. Find out if they will cover the meds from any pharmacy not only the chain stores. If they do get the number that the doctor needs to call for the prior approval. I would call your nurse back and give her the number she has to call and the pharmacy number that you want to work with. I would follow up with both to see if there were any issues. I never needed any prior authorizations but am a pharmacist and deal with this constantly.

Re: Help w/Insurance vs. Doctor's Office

i called ghi/express scrips myself to find out bc it was confusing

now that u know u need a pre authorization that should be handled by the office and well as ordering meds

but i would cal back and find out which fertility pharm they use bc they can order it to one and u will only be covered by a certain one

so when u get the paharm i would call back and say ok they need u to authorize,this is the pharm order the meds etc

Re: Help w/Insurance vs. Doctor's Office

I had UHC and we had to use Freedom Pharmacy. I'm pretty sure you talked to someone who had no idea about IVF.

Re: Help w/Insurance vs. Doctor's Office

Posted by NYCGirl80

I had UHC and we had to use Freedom Pharmacy. I'm pretty sure you talked to someone who had no idea about IVF.