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babydreams21
LIF Adult
Member since 12/12 3656 total posts
Name:
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FYI NYC DOE Employees No More Injectable coverage for fertility ****Maybe it is!
So after getting charged over $2000 for Ganirelix without even authorizing them to ship it out to me I have called everyone. I called GHI, express scripts, Freedom. I spoke to MANY people. I gave the names of many injects that are needed for fertility reasons ex) Ganirelix, Menopur, and Gonal F. They all came back as not covered. When I asked, well what happened with the 3 fills lifetime, they acted like they had no idea what changed and basically said well it is what it is. I had only filled ganirelix 1 time. No notification about any changes. So basically as of 2014 it seems that if you are a NYC DOE employee there is no more injects coverage. Just wanted to let you all know before you order anything. Ironic that a profession/union which has a huge majority of women now doesn't cover fertility meds. Let me know if any of you had the same issue. IF sucks
*** The ladies on here are saying it is covered. I guess I'm just getting screwed....great.
Message edited 3/18/2014 8:37:50 PM.
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Posted 3/18/14 8:11 PM  |
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Long Island Weddings
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FYI NYC DOE Employees No More Injectable coverage for fertility
I don't know if this is true. At least I hope not. Wouldn't we have received paper work?
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| Posted 3/18/14 8:14 PM |
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FYI NYC DOE Employees No More Injectable coverage for fertility
It's your PICA card. It's a totally different benefits package. If you have filled it three times it's done :(
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| Posted 3/18/14 8:17 PM |
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NicoleF219
LIF Infant
Member since 5/12 232 total posts
Name:
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FYI NYC DOE Employees No More Injectable coverage for fertility
I don't think this is correct. I just got injectables less than 3 weeks ago and it was all covered. The nurses ordered it for me through freedom pharmacy and all I paid was co-pays. Gonal F, menapure, ganarelix etc.
Message edited 3/18/2014 8:19:33 PM.
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| Posted 3/18/14 8:18 PM |
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babydreams21
LIF Adult
Member since 12/12 3656 total posts
Name:
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Re: FYI NYC DOE Employees No More Injectable coverage for fertility
Posted by 2BirdsofaFeather
I don't know if this is true. At least I hope not. Wouldn't we have received paper work?
Michelle had posted about it a little while ago too.
I wish it wasn't true. I'm so upset. I spoke to so many people even the supervisors at GHI and Express scripts. They all tell me for whatever drug I tell them that its not covered. I asked if the phamacy changed and if its now accredo but they said its just saying plain out its not covered not even to use another pharmacy. I questioned why wouldn't I have received paperwork on something I have refills on and have been using. Again no answers. They said sometimes in a new year coverage changes. The supervisor was searching in the computer and says he can't find anything out about why it changed.
SO yeah over $2000 on my CC for Ganirelix and IDK if I'll even have enough Menopur to make it through the cycle. I'm hoping this is just a fluke and they change the coverage back.
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| Posted 3/18/14 8:20 PM |
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babydreams21
LIF Adult
Member since 12/12 3656 total posts
Name:
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Re: FYI NYC DOE Employees No More Injectable coverage for fertility
Posted by 2BirdsofaFeather
It's your PICA card. It's a totally different benefits package. If you have filled it three times it's done :(
Yup they checked PICA too. I spoke to everyone. I only filled Ganirelix once. When they looked up the other meds they came back as not covered.
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| Posted 3/18/14 8:22 PM |
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babydreams21
LIF Adult
Member since 12/12 3656 total posts
Name:
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Re: FYI NYC DOE Employees No More Injectable coverage for fertility
Posted by NicoleF219
I don't think this is correct. I just got injectables less than 3 weeks ago and it was all covered. The nurses ordered it for me through freedom pharmacy and all I paid was co-pays. Gonal F, menapure, ganarelix etc.
Are you DOE? Then why aren't they covering it for me? Now I'm even more confused.
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| Posted 3/18/14 8:23 PM |
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FYI NYC DOE Employees No More Injectable coverage for fertility
Yes. I think it has to do something about how doctors write the orders. I'm sure we would've known something had it changed that's a big change. Check out the PICA labor relations page.
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| Posted 3/18/14 8:25 PM |
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NicoleF219
LIF Infant
Member since 5/12 232 total posts
Name:
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FYI NYC DOE Employees No More Injectable coverage for fertility
I'm NYC DOE. Have GHI with express scripts. Everything was covered no issues never spoke to a single person about it. Someone is giving you wrong info someplace. There's no way they changed it since February.
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| Posted 3/18/14 8:25 PM |
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FYI NYC DOE Employees No More Injectable coverage for fertility
I hear ACcredco is the place to order from too. Call them!
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| Posted 3/18/14 8:26 PM |
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babydreams21
LIF Adult
Member since 12/12 3656 total posts
Name:
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Re: FYI NYC DOE Employees No More Injectable coverage for fertility
Posted by 2BirdsofaFeather
Yes. I think it has to do something about how doctors write the orders. I'm sure we would've known something had it changed that's a big change. Check out the PICA labor relations page.
I guess I'll have to make some more calls. I seriously spent 2 days calling people and getting transferred around and everything came back as not covered. I even spoke to a supervisor.
I'm hoping more DOE ppl respond if they ordered recently. I just don't get what is happening. I don't know what to do next now.
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| Posted 3/18/14 8:28 PM |
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babydreams21
LIF Adult
Member since 12/12 3656 total posts
Name:
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Re: FYI NYC DOE Employees No More Injectable coverage for fertility
Posted by 2BirdsofaFeather
I hear ACcredco is the place to order from too. Call them!
I brought that up on the phone. PICA said that is now our specialty pharmacy but it doesn't matter if I order from them bc its not covered.
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| Posted 3/18/14 8:29 PM |
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NicoleF219
LIF Infant
Member since 5/12 232 total posts
Name:
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FYI NYC DOE Employees No More Injectable coverage for fertility
And I specifically remember getting a list of covered drugs in the mail from express scrips at the beginning of the year and injectable meds were on there I think for one med it said they used gonal f instead but it was covered for sure
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| Posted 3/18/14 8:33 PM |
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babydreams21
LIF Adult
Member since 12/12 3656 total posts
Name:
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Re: FYI NYC DOE Employees No More Injectable coverage for fertility
Posted by NicoleF219
I'm NYC DOE. Have GHI with express scripts. Everything was covered no issues never spoke to a single person about it. Someone is giving you wrong info someplace. There's no way they changed it since February.
Wow. Now I'm pissed that I'm getting all the wrong info. I ordered injects in 2013 no problem. Now this has been a nightmare. SO I guess I just call them all again??? Why can't this be easy?
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| Posted 3/18/14 8:34 PM |
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babydreams21
LIF Adult
Member since 12/12 3656 total posts
Name:
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Re: FYI NYC DOE Employees No More Injectable coverage for fertility ****Maybe it is!
Posted by 2BirdsofaFeather
Yes. I think it has to do something about how doctors write the orders. I'm sure we would've known something had it changed that's a big change. Check out the PICA labor relations page.
Just checked out the page you said and nothing had changed. It says 3 fills. WTF
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| Posted 3/18/14 8:45 PM |
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Lillies
Grateful for my babies!
Member since 2/12 4571 total posts
Name:
<3
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Re: FYI NYC DOE Employees No More Injectable coverage for fertility ****Maybe it is!
I'm city of NY but NYPD and have my same full coverage just two weeks ago, no changes.
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| Posted 3/18/14 8:56 PM |
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babydreams21
LIF Adult
Member since 12/12 3656 total posts
Name:
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Re: FYI NYC DOE Employees No More Injectable coverage for fertility ****Maybe it is!
Posted by Lillies
I'm city of NY but NYPD and have my same full coverage just two weeks ago, no changes.
You had told me that so I was thinking the issue was just with NYC DOE. Now it seems like it is not....
So I just called Freedom again and tried to plead my case. They said they will again reprocess the claim. They will call tomorrow. They also told me they would call me last week so I'm not holding my breathe. Please let this work out.
The thing that is getting me is when I called PICA/Express scripts every person I spoke to said all the meds I mentioned weren't covered.
I just found this on Pica's website so if they still say its not covered I'm gonna appeal it and copy and paste this: Fertility Medication MaximumInjectable medication used to treat infertility is only available to PICA members whose health plan covers the treatment that require this medication. This medication is limited to a lifetime maximum of three (3) cycles of therapy. A cycle is approximately 28 to 30 days. Administration of the medication(s) is usually given daily for 7-10 days early in the cycle. Even though fertility medication(s) is physically administered for about 7-10 days, clinically, it is used as a treatment for 1 FULL cycle; 3 cycles is 90 days. If you have already received 3 cycles of therapy of fertility drugs, you will not be covered for any additional fertility medications.
Effective June 1, 2008 the fertility medication benefit program is available exclusively from Freedom Fertility Pharmacy. The Freedom Advantage®, offered to PICA members features personalized care, drug coverage and outstanding service. Key components of this benefit include a dedicated team of fertility only care coordinators, free shipping, free patient education materials and emergency same-day services. Questions? Call Freedom Fertility Pharmacy at 800.660.4283 or visit www.freedomfertility.com
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| Posted 3/18/14 9:03 PM |
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FYI NYC DOE Employees No More Injectable coverage for fertility ****Maybe it is!
Prayed to you! Please let us know.
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| Posted 3/18/14 9:08 PM |
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babydreams21
LIF Adult
Member since 12/12 3656 total posts
Name:
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Re: FYI NYC DOE Employees No More Injectable coverage for fertility ****Maybe it is!
Posted by 2BirdsofaFeather
Prayed to you! Please let us know.
Thank you! You have been so helpful and I found that info on the PICA site you told me about. If you and Nicole didn't respond I would have given up so now I'm back on it. Its really sad that people can't give you a straight answer and leave you feeling hopeless. Hopefully Freedom calls bck with good news tomorrow. I have been dealing with this issue for almost 2 weeks....crazy.
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| Posted 3/18/14 9:11 PM |
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Lillies
Grateful for my babies!
Member since 2/12 4571 total posts
Name:
<3
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Re: FYI NYC DOE Employees No More Injectable coverage for fertility ****Maybe it is!
I am so confused by everything you are going through! This is not fair at all. I hope Freedom can figure this out for you!
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| Posted 3/18/14 10:53 PM |
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Michelle1110
My family is complete
Member since 1/12 2338 total posts
Name:
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Re: FYI NYC DOE Employees No More Injectable coverage for fertility ****Maybe it is!
You know my story. I was told everything is no longer covered too!! I called express scripts, GHI, even UFT. I hope you get answers!
The only thing they cover for me now is lovenox
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| Posted 3/19/14 5:39 AM |
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ggt08
;)
Member since 5/05 5208 total posts
Name:
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FYI NYC DOE Employees No More Injectable coverage for fertility ****Maybe it is!
Ugh I have a headache for you. It's annoying but be persistent. Call even fax your case over until someone takes the time to look for,you. If you need any meds that I have extra of I'll be happy to give to you.
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| Posted 3/19/14 8:22 PM |
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JDubs
different, not less
Member since 7/09 13160 total posts
Name:
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Re: FYI NYC DOE Employees No More Injectable coverage for fertility ****Maybe it is!
Ugh, that is really unfair! Why are some people covered but others are not? It doesn't make sense.
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| Posted 3/20/14 10:37 AM |
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Lillies
Grateful for my babies!
Member since 2/12 4571 total posts
Name:
<3
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Re: FYI NYC DOE Employees No More Injectable coverage for fertility ****Maybe it is!
Any update from Freedom?
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| Posted 3/22/14 7:18 PM |
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babydreams21
LIF Adult
Member since 12/12 3656 total posts
Name:
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Re: FYI NYC DOE Employees No More Injectable coverage for fertility ****Maybe it is!
Posted by Lillies
Any update from Freedom?
YUP. I was gonna post today. SO I called everyone. GHI and Express scripts say I have no coverage according to the computer they are looking in. They can't tell me why. I called back Freedom and asked them why a manager hasn't called me back after almost 2 weeks when I left several messages. On Friday I got a voicemail from a manager at Freedom and she said she ran my insurance again and she was crediting my CC $2,500 and it should post next week! WOO HOO.
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| Posted 3/22/14 7:43 PM |
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