Question about affording FSH medications

Hi all, I am new to the forums. I am a 33 year old male, married for two years to a wonderful 27 year old woman, who is a cancer survivor from birth. We knew that the cancer treatments she had growing up had affected her fertility, as she does not get a period and we have been trying to conceive for some time now. We went to a reproductive endocrinologist in Garden City, and after several tests, we got the good news that she has viable eggs. The only obstacle at this point is that she will need FSH medications (the doctor named Follistim and Gonal-F as the only acceptable options) in order to ovulate.

After going through all this over the course of a couple of months, we were told on Friday that the next step was to email the account administrator of the doctor's billing department, who would contact our insurance company (Blue Cross/Blue Shield Federal Employee Program) for prior authorization for the medications. We did, and she wrote back 7 minutes later saying only, "I regret to inform you that your plan does not cover these medication for infertility purposes. I do apologize."

I wrote back explaining that before we chose our plan, I had spoken to a plan representative who told me that the plan DOES cover fertility drugs, except when used in conjunction with "assisted reproductive technology" which the plan brochure ( http://www.fepblue.org/downloads/2013-service-benefit-plan-brochure_100512.pdf ) defines as "Fertility treatments in which both eggs and sperm are manipulated", citing scenarios where sperm and eggs are combined in a laboratory.

Since that is clearly not what we are seeking, I told her I couldn't understand why the drugs wouldn't be covered. She wrote back saying that she was sure federal employee plans don't cover them, but she would "verify the benefit again." Today she wrote again, saying "I called the below number and did the prior authorization as you requested. The authorization was denied. They said that they would send you a letter in the mail explaining the decision."

Needless to say, I was not pleased with this interaction, and I don't feel particularly confident that she even explained correctly to the plan what we are seeking, so I intend to follow-up with the plan myself tomorrow and get some clarification. But if it turns out that she is correct and these medications are not covered by our plan, I would like to figure out other options to look into, whether it is switching to a better plan, or going elsewhere for the medications, or some other option. We are not wealthy people (a combined income of about $70k before taxes), but I am willing to do whatever it takes, especially since we have come this far. Any advice would be greatly appreciated.

Question about affording FSH medications

Try asking your RE to see if they can donate meds to you

Re: Question about affording FSH medications

Did you check to see what other plans are available to you? My friend is a federal employee and with the plan she has now, she had no OF coverage. But she did research and found out there are other plans available with coverage. She just has to wait until December to change plans.

If not, as pp said, ask your dr. They usually have meds available to donate

Re: Question about affording FSH medications

Question about affording FSH medications

Hi all,

Thank you so much for your words of advice and support! I am happy to report that the doctor's billing person did indeed get it wrong (even after I told her we were not having any procedure in which sperm was manipulated, she proceeded to tell the insurance company that we were having IUI), and she has since been corrected by the doctor, and the medications will be delivered to us on Tuesday. I am really grateful to have a support community like this to keep me in a positive frame of mind, particularly when dealing with difficult people! :)

Re: Question about affording FSH medications

Question about affording FSH medications

Great news!! Good luck to you and your wife!!!