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classc1
LIF Adolescent
Member since 6/10 805 total posts
Name:
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NYC Employees- ? Re: PICA and Fert Med Coverage
Hi,
My husband is a NYC school teacher and I am under his GHI plan in addition to my own. I knew that PICA covered injectible meds and called today. At first I was told that all prescriptions would be filled by Freedom....and then a supervisor came on and said that Curascript would cover this instead. Has anyone been required to fill their prescription through Curascript under PICA? I thought that this was odd. Also...as best I can tell..the co-pay is $25 per cycle with a $100 deductible...is this correct? Thanks.
Message edited 8/10/2010 4:49:38 PM.
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Posted 8/10/10 4:49 PM  |
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Athee
I believe in miracles!
Member since 8/07 2462 total posts
Name:
A
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Re: NYC Employees- ? Re: PICA and Fert Med Coverage
I filled my meds with Freedom Fertility.... not sure if they changed their policy or what...
also i had 25% copay not $25...
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| Posted 8/10/10 5:15 PM |
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BabyLove08
Love her!
Member since 2/08 3673 total posts
Name:
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Re: NYC Employees- ? Re: PICA and Fert Med Coverage
Just went through my cycle and am a NYC Teacher. I used Krupners, no problems:) They just ask for my info (Express Scripts and GHI) and I got everything, no problem with minimal copays:)
Let me know if I could be of any other help to you. Good luck!
Keri
Message edited 8/10/2010 5:22:20 PM.
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| Posted 8/10/10 5:21 PM |
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Daisy21
My Little Loves
Member since 6/10 1133 total posts
Name:
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Re: NYC Employees- ? Re: PICA and Fert Med Coverage
I'm also a NYC teacher and I've been having a very difficult time with all of this. I find it very difficult to get questions answered correctly when I call. I'm terrified to fill injectible prescriptions because I was told we are only covered for three cycles. If that's the case, I want to save them in the event I need to do IVF. I find it hard to believe that we're not covered though. I was told I needed to use Freedom. I've only just started my IF journey and in terms of injectibles, I've only needed ovidrel so far. I paid out of pocket for that just in case. I know I need to get more information before my next cycle.
Can you please post any information you find out? It would be greatly appreciated. I'm sorry I'm not more help. If I get any other information, I'll post as well.
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| Posted 8/10/10 5:22 PM |
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Daisy21
My Little Loves
Member since 6/10 1133 total posts
Name:
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Re: NYC Employees- ? Re: PICA and Fert Med Coverage
Posted by BabyLove08
Just went through my cycle and am a NYC Teacher. I used Krupners, no problems:) They just ask for my info (Express Scripts and GHI) and I got everything, no problem with minimal copays:)
Let me know if I could be of any other help to you. Good luck!
Keri
Are we covered for whatever injectibles we need or are we on a three cycle limit?
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| Posted 8/10/10 5:23 PM |
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classc1
LIF Adolescent
Member since 6/10 805 total posts
Name:
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Re: NYC Employees- ? Re: PICA and Fert Med Coverage
Posted by Athee
I filled my meds with Freedom Fertility.... not sure if they changed their policy or what...
also i had 25% copay not $25...
Hmmn...I was told $25 plus a $100 deductible when I called Express Scripts and I just found the following link on-line which says the same:
http://www.nyc.gov/html/olr/html/health/pica_prog.shtml
Do you have other coverage? Maybe they went under that plan.
Message edited 8/10/2010 5:30:18 PM.
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| Posted 8/10/10 5:29 PM |
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classc1
LIF Adolescent
Member since 6/10 805 total posts
Name:
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Re: NYC Employees- ? Re: PICA and Fert Med Coverage
Posted by BabyLove08
Just went through my cycle and am a NYC Teacher. I used Krupners, no problems:) They just ask for my info (Express Scripts and GHI) and I got everything, no problem with minimal copays:)
Let me know if I could be of any other help to you. Good luck!
Keri
Okay...so now I am officially confused...I was told on the phone...Curascript...the literature says Freedom...and now you are saying Krupners? Did you go through PICA?
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| Posted 8/10/10 5:31 PM |
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classc1
LIF Adolescent
Member since 6/10 805 total posts
Name:
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Re: NYC Employees- ? Re: PICA and Fert Med Coverage
Posted by Daisy21
I'm also a NYC teacher and I've been having a very difficult time with all of this. I find it very difficult to get questions answered correctly when I call. I'm terrified to fill injectible prescriptions because I was told we are only covered for three cycles. If that's the case, I want to save them in the event I need to do IVF. I find it hard to believe that we're not covered though. I was told I needed to use Freedom. I've only just started my IF journey and in terms of injectibles, I've only needed ovidrel so far. I paid out of pocket for that just in case. I know I need to get more information before my next cycle.
Can you please post any information you find out? It would be greatly appreciated. I'm sorry I'm not more help. If I get any other information, I'll post as well.
Well...you are covered...but for only three cycles....take a look at the link below. I think you have to make sure that all of the meds you need are requested as being for one cycle. I was told that my co-pay would be the $25 whether my doctor requested say six 450 Gonal-F pens or 10.
This three cycle policy is kind of bad as GHI requires that you do 3 or more IUI's before they will approve IVF unless you have a waiver...yet if you do that, you will not have coverage for meds if you need to do IVF!! Still and all..it's very good coverage...I only have 50% coverage under my original policy and I had to pay $525 per 900 IUi pen!!
http://www.nyc.gov/html/olr/html/health/pica_prog.shtml
Message edited 8/10/2010 5:36:26 PM.
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| Posted 8/10/10 5:35 PM |
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Daisy21
My Little Loves
Member since 6/10 1133 total posts
Name:
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Re: NYC Employees- ? Re: PICA and Fert Med Coverage
Thanks so much!
I just think this is insane though - Realisticly speaking, this typically takes more than 3 cycles. Many women have been trying for over a year. How are we expected to pay so much each month for medicated IUI cycles and such? What about a second child?
I'm going to look into us adding my husband's insurance during open enrollment, so we have more coverage.
IF is emotionally draining on its own, and now we have to figure out how to pay for medication.
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| Posted 8/10/10 5:56 PM |
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BabyLove08
Love her!
Member since 2/08 3673 total posts
Name:
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Re: NYC Employees- ? Re: PICA and Fert Med Coverage
Posted by Daisy21
Posted by BabyLove08
Just went through my cycle and am a NYC Teacher. I used Krupners, no problems:) They just ask for my info (Express Scripts and GHI) and I got everything, no problem with minimal copays:)
Let me know if I could be of any other help to you. Good luck!
Keri
Are we covered for whatever injectibles we need or are we on a three cycle limit?
Well you get 3 IVF cycles a lifetime. As for injectibles/medicines just make sure the IVF nurse (and they SHOULD know gives you refiills). Mine always gives 3 refills on everything and this covers you for 1 cycle:) Understand?
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| Posted 8/10/10 7:11 PM |
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BabyLove08
Love her!
Member since 2/08 3673 total posts
Name:
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Re: NYC Employees- ? Re: PICA and Fert Med Coverage
Yes, through PICA...but PICA is only for the injectibles. Regular meds are through Express Scripts. Like I said, Kraupners took all my info and everything was fine. I did this two years ago with my first daughter and now did it again:)
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| Posted 8/10/10 7:13 PM |
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BabyLove08
Love her!
Member since 2/08 3673 total posts
Name:
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Re: NYC Employees- ? Re: PICA and Fert Med Coverage
Posted by classc1
Posted by Daisy21
I'm also a NYC teacher and I've been having a very difficult time with all of this. I find it very difficult to get questions answered correctly when I call. I'm terrified to fill injectible prescriptions because I was told we are only covered for three cycles. If that's the case, I want to save them in the event I need to do IVF. I find it hard to believe that we're not covered though. I was told I needed to use Freedom. I've only just started my IF journey and in terms of injectibles, I've only needed ovidrel so far. I paid out of pocket for that just in case. I know I need to get more information before my next cycle.
Can you please post any information you find out? It would be greatly appreciated. I'm sorry I'm not more help. If I get any other information, I'll post as well.
Well...you are covered...but for only three cycles....take a look at the link below. I think you have to make sure that all of the meds you need are requested as being for one cycle. I was told that my co-pay would be the $25 whether my doctor requested say six 450 Gonal-F pens or 10.
This three cycle policy is kind of bad as GHI requires that you do 3 or more IUI's before they will approve IVF unless you have a waiver...yet if you do that, you will not have coverage for meds if you need to do IVF!! Still and all..it's very good coverage...I only have 50% coverage under my original policy and I had to pay $525 per 900 IUi pen!!
http://www.nyc.gov/html/olr/html/health/pica_prog.shtml
It depends on your diagnosis. We never did IUI's, wasn't an option for us. We have severe male factor infertility. We went straight to IVF, my office submitted documtation and all got approved in seconds:)
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| Posted 8/10/10 7:15 PM |
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Daisy21
My Little Loves
Member since 6/10 1133 total posts
Name:
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Re: NYC Employees- ? Re: PICA and Fert Med Coverage
Thanks!
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| Posted 8/10/10 8:12 PM |
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classc1
LIF Adolescent
Member since 6/10 805 total posts
Name:
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Re: NYC Employees- ? Re: PICA and Fert Med Coverage
Posted by BabyLove08
Posted by classc1
Posted by Daisy21
I'm also a NYC teacher and I've been having a very difficult time with all of this. I find it very difficult to get questions answered correctly when I call. I'm terrified to fill injectible prescriptions because I was told we are only covered for three cycles. If that's the case, I want to save them in the event I need to do IVF. I find it hard to believe that we're not covered though. I was told I needed to use Freedom. I've only just started my IF journey and in terms of injectibles, I've only needed ovidrel so far. I paid out of pocket for that just in case. I know I need to get more information before my next cycle.
Can you please post any information you find out? It would be greatly appreciated. I'm sorry I'm not more help. If I get any other information, I'll post as well.
Well...you are covered...but for only three cycles....take a look at the link below. I think you have to make sure that all of the meds you need are requested as being for one cycle. I was told that my co-pay would be the $25 whether my doctor requested say six 450 Gonal-F pens or 10.
This three cycle policy is kind of bad as GHI requires that you do 3 or more IUI's before they will approve IVF unless you have a waiver...yet if you do that, you will not have coverage for meds if you need to do IVF!! Still and all..it's very good coverage...I only have 50% coverage under my original policy and I had to pay $525 per 900 IUi pen!!
http://www.nyc.gov/html/olr/html/health/pica_prog.shtml
It depends on your diagnosis. We never did IUI's, wasn't an option for us. We have severe male factor infertility. We went straight to IVF, my office submitted documtation and all got approved in seconds:)
Yes...that's why I said unless you get a waiver..I'm looking to get a waiver myself due to age and having already had 2 chemicals. We shall see.
BTW..GREAT info on making sure that the nurse puts refills on the prescription...THANKS!!
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| Posted 8/10/10 8:26 PM |
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Athee
I believe in miracles!
Member since 8/07 2462 total posts
Name:
A
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Re: NYC Employees- ? Re: PICA and Fert Med Coverage
Posted by classc1
Posted by Athee
I filled my meds with Freedom Fertility.... not sure if they changed their policy or what...
also i had 25% copay not $25...
Hmmn...I was told $25 plus a $100 deductible when I called Express Scripts and I just found the following link on-line which says the same:
http://www.nyc.gov/html/olr/html/health/pica_prog.shtml
Do you have other coverage? Maybe they went under that plan.
ohh i thought u meant the copay for the actual procedure not the meds...
as bad as this sounds i really dont know what the copays are for meds- freedom always calculated the cost for me... one thing i do know though is that estrace is not covered by insurance because its considered a medication for menopause... sorry im no help!!
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| Posted 8/11/10 12:22 AM |
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classc1
LIF Adolescent
Member since 6/10 805 total posts
Name:
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Re: NYC Employees- ? Re: PICA and Fert Med Coverage
Just wanted to follow-up....I got my first round of meds under the PICa program...it went smoothly. I was in fact allowed to get them from Freedom so I have no idea what the orginal rep I spoke to was speaking about.
BTW...GREAT advice above...have the nurse request refills on each order as you only get three rounds lifetime under PICA. The cost was indeed $100 deductible plus a $25 copay. I can't believe it...i spent a ton of money on my first IUI when I only had 50% coverage under my old plan.
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| Posted 9/25/10 6:25 PM |
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dianadrw
LIF Adult
Member since 5/06 2092 total posts
Name:
Me
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Re: NYC Employees- ? Re: PICA and Fert Med Coverage
Can someone explain the benefit of having the nurse add refills to your prescription? For some reason I'm not "getting it".
My husband is a NYC employee and we are using the IVF benefits through his insurance. I just started my first IVF cycle and have all my meds for this cycle. I want to make sure that (god forbid) this cycle doesn't work that they are going to cover my meds for my next cycle.
Thanks.
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| Posted 9/28/10 12:42 PM |
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classc1
LIF Adolescent
Member since 6/10 805 total posts
Name:
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Re: NYC Employees- ? Re: PICA and Fert Med Coverage
Posted by dianadrw
Can someone explain the benefit of having the nurse add refills to your prescription? For some reason I'm not "getting it".
My husband is a NYC employee and we are using the IVF benefits through his insurance. I just started my first IVF cycle and have all my meds for this cycle. I want to make sure that (god forbid) this cycle doesn't work that they are going to cover my meds for my next cycle.
Thanks.
You only get three rounds lifetime of these meds under PICA from what I understand. If you do not get refills...that is literally what you will get...enough for three rounds. I think this is ridiculous since they normally require anywhere from 6 to 4 IUI's before IVF. If you do three cycles of meds with IUI...you will be out by the time it comes for IVF. However, ask for refills....you can use a refill instead of requesting another cycle of meds thereby using up your lowly three cycles.
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| Posted 9/28/10 1:11 PM |
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