>Before I get into this, I’ll say right away that I know I am lucky to live in a state that mandates fertility coverage. In my previous marriage, I dealt with infertility in one state that did not mandate coverage and one that did, and the difference was incredible. I now live in a different state that mandates coverage, and in writing, the coverage should be better than it was in the other two states I have lived.

I have a health insurance plan, but my prescription plan is separate. The prescription plan allows me to use a local pharmacy, but they also have a mail-order option. If you can get medications through their mail-order service, it’s a lot cheaper. Obviously, that doesn’t work if you need to start taking a medication right away. You have to go to one of their preferred pharmacies, which covers most of the pharmacies in the area.

I logged into the prescription plan’s website to see what is covered for my upcoming medications, but I got a series of confusing messages. The letrozole wasn’t even listed in their database, which seems bad, but I did find Follistim. The messages, though, were confusing. It says it’s not covered, but then at the bottom of the screen, it says to call the specialty branch of the pharmacy, in case it is covered (that, in itself, is confusing). I called the company (the main prescription plan group – not the specialty branch), because I thought maybe they would be able to give me some information. I swear the person on the phone knew as much about it as I did, and in the end, she really wasn’t sure. She said it seems like the prescription plan doesn’t cover infertility, and asked if I knew if my health care plan did. I told her they do, but I thought my prescription plan was separate. She said it said “not covered under plan,” but then she said it also said “contact medical insurance; pre-authorization required.” She said I could try a local pharmacy, but she said to give them my medical card, instead of the prescription card. At the time, I thought that seemed reasonable, but then I remembered my experiences at my local pharmacies, and decided that may not make the most sense. I think I need to know what’s covered, rather than going there and just hoping they’ll work it out. The other issue is that I’ll order it elsewhere if it isn’t going to be covered, because it will be cheaper (as much as $200 cheaper, my dr. said).

So, now I need to decide who to call next…my health care plan, the specialty pharmacy that’s listed on my prescription plan’s website, or a pharmacy that specializes in online orders of fertility medications. I’m thankful that I have insurance – and especially insurance that’s supposed to cover infertility – but this is rediculous!

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