Rhogam NOT covered????

OMG I just called my prescription plan provider to see how I can order Rhogam (I need it next week), and they are telling me it is an auto-immunity, intra-muscular something or other & is NOT covered. ***? So I am supposed to put myself & my baby at risk. And hello, you covered it when I got it in the hospital.

FRIGGIN INSURANCE!

Re: Rhogam NOT covered????

I don't see how that could be possible, I'd have your doctor order it, maybe that is the problem.

Don't let it stress you out more, you will get it

Message edited 3/20/2007 12:34:29 PM.

Re: Rhogam NOT covered????

i can't believe it wouldn't be covered. how is rhogam not "medically necessary"????

that makes me so angry. guess i'll have to add that to my list of expenses since i'll need rhogam for sure.

Re: Rhogam NOT covered????

I know I am so aggravated right now. I called my regular health insurance person here & they said that is not accurate. They are going to call the provider & find out how to get it covered.

Sheesh are they kidding?

Re: Rhogam NOT covered????

I recently read that many ins co's will refuse to pay for something at first but that you should write a letter including a letter from your Dr of medical necessity. Or you can get it in the hospital..

Re: Rhogam NOT covered????

Yeah, you could always go to the hospital. I know when my insurance wouldn't refill my Zofran prescription my doctor offered to admit me so they'd give to me in an IV form.

The run around is out of control, isn't it?

Re: Rhogam NOT covered????

You should try having the doctor order it and give it to you in the office, it will probably be covered as a procedure that way.

Re: Rhogam NOT covered????

At our insurance, you have to get it through the pharmacy dept. at your insurer, not through the insurer themselves.

Re: Rhogam NOT covered????

Re: Rhogam NOT covered????

That is crazy! Would they rather pay for the possible risks if you don't get it?? STUPID INSURANCE!

Re: Rhogam NOT covered????

My dr. ordered it both times. The first time I didn't need to pay a copay for it. The second time I had a prescription deductable and a $40 copay on that shot. So if I completed my Rx deductable then I only had to $40 but if I didn't then I would have had to pay the difference of $100 and what every I reached with my Rx deductable.

Why didn't your dr. order it to begin with?

Re: Rhogam NOT covered????

mine werent covered either!!!! Just the one in the hospital after delivery. the other 2 I had to pay out of pocket. they are 150 a pop BUT at CVS they did a nassau county insurance thingy, not sure exactly and cost was 118 with tax.

Re: Rhogam NOT covered????

Re: Rhogam NOT covered????

what insurance do you have?

If you havent had any luck...FM me, I can walk you through what to say to the insurance company....to figure it out.

Re: Rhogam NOT covered????

Ah, the joys of trying to get Rhogam from the Insurance company. . . . . . I remember it well!!!!!

I have United Healthcare- and they only cover rhogam if it's delivered to your home (and it comes in a big box with practically a skull and cross bones on it - danger - hazardous materials, or something like that).

My obgyn told me that I'd have a lot of trouble getting this drug - he said that over the years he's seen more and more insurance companies balk at paying for it - as if it's not necessary, whatever.

When in doubt, have your doctor order it. Good luck!

Re: Rhogam NOT covered????

The first time I got it, the doctor called the RX into the pharmacy and it wasn't covered. I had to pay out of pocket, but was reimbursed the $125.00 since it's covered under the medical portion of the plan not the RX portion. I have Oxford. The second time, the doctor had it in on hand the office (I switched doctors), so that's where I received it.

Re: Rhogam NOT covered????

Re: Rhogam NOT covered????

ok then its covered. Empire does cover it. It has to be ordered through a par pharmacy or Medco and delivered to the Dr's office and they have to bill as an injection.

If you want it covered by Empire. Call them, ask for a supervisor and tell them you want instructions on how to do it and want someone to do it for you.

We have this issue ALL THE TIME with reps not knowing how to handle the rhogam calls and saying the wrong thing.

DO you have the name of the EMpire rep you spoke with?

Or actually I may have to go up to my job tommorow. Im making myself a note to ask them what you should do...

Re: Rhogam NOT covered????

I did not get the rep's name, but Pat got the same answer when she called the provider's assistant line.....

I mean as long as one of my insurances will cover it I am OK, but it is annoying to hear. Medco was NO help at all.

Re: Rhogam NOT covered????

What a pain. Why can't it be less complicated?

Re: Rhogam NOT covered????

Posted by MsMBV

I did not get the rep's name, but Pat got the same answer when she called the provider's assistant line.....

I mean as long as one of my insurances will cover it I am OK, but it is annoying to hear. Medco was NO help at all.

Re: Rhogam NOT covered????

Posted by dm24angel

Posted by MsMBV

I did not get the rep's name, but Pat got the same answer when she called the provider's assistant line.....

I mean as long as one of my insurances will cover it I am OK, but it is annoying to hear. Medco was NO help at all.

wait you have EMPIRE BCBS or the Empire plan?

Re: Rhogam NOT covered????

Posted by MsMBV

Posted by dm24angel

Posted by MsMBV

I did not get the rep's name, but Pat got the same answer when she called the provider's assistant line.....

I mean as long as one of my insurances will cover it I am OK, but it is annoying to hear. Medco was NO help at all.

wait you have EMPIRE BCBS or the Empire plan?

Empire BCBS EPO plan

Re: Rhogam NOT covered????

Donna thank you so much!

Re: Rhogam NOT covered????

Im confused..why do you need to order the Rhogam..in the past my doctor just gave me the shot at 28 weeks in his office and then I had one after the birth...this time around, if I choose to have an amnio at 16 weeks I will have a shot..my doctor has the Rhogam there...

Do you need it for a different reason..why do you need to order it?..Has this much changed in 8 years?