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jessnbrian
Only God knows His plan for us
Member since 4/13 7238 total posts
Name:
Jessica
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Re: NYC PICA - FERTILITY MEDS NOT COVERED
Posted by Lillies
DH is calling about thus tomorrow bc we we're never notified via mail or email about he chance. Maybe GHI NYPD is different?
They don't - unfortunately - need to notify you specifically. Typically you'll just get a letter telling you that there are changes and to "refer to the website for complete details".
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Posted 1/23/14 9:39 AM  |
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Long Island Weddings
Long Island's Largest Bridal Resource |
GoodThoughts
Dreams do come true
Member since 2/12 2259 total posts
Name:
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Re: NYC PICA - FERTILITY MEDS NOT COVERED
I realized that there were changes when I tried to refill my endometrin:
1) They required pre-authorization in order to process the refill.
2) I had a $100 copay ($50 after the manufacturer's coupon)
Edited for error due to my failing memory.
Message edited 1/23/2014 10:39:20 AM.
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| Posted 1/23/14 9:54 AM |
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NYCGirl80
I love my kiddies!
Member since 5/11 10413 total posts
Name:
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Re: NYC PICA - FERTILITY MEDS NOT COVERED
Have your RE's office call the insurance company. My guess is it requires pre-authorization to be covered.
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| Posted 1/23/14 10:01 AM |
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CindySN23
Stop, Think & Breathe...
Member since 8/11 3550 total posts
Name:
Cindy
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Re: NYC PICA - FERTILITY MEDS NOT COVERED
Posted by jessnbrian
Posted by Lillies
DH is calling about thus tomorrow bc we we're never notified via mail or email about he chance. Maybe GHI NYPD is different?
They don't - unfortunately - need to notify you specifically. Typically you'll just get a letter telling you that there are changes and to "refer to the website for complete details".
Based on the nyc.gov website for the PICA program nothing has changed with regards to covering injectable meds for infertility
http://www.nyc.gov/html/olr/html/health/pica_prog.shtml
Fertility Medication Maximum
Injectable 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
Unless your insurance now does not cover infertility treatments I dont see how PICA wont cover the meds.
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| Posted 1/23/14 11:28 AM |
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Michelle1110
My family is complete
Member since 1/12 2338 total posts
Name:
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Re: NYC PICA - FERTILITY MEDS NOT COVERED
Posted by mama2b
Posted by jessnbrian
Posted by Lillies
DH is calling about thus tomorrow bc we we're never notified via mail or email about he chance. Maybe GHI NYPD is different?
They don't - unfortunately - need to notify you specifically. Typically you'll just get a letter telling you that there are changes and to "refer to the website for complete details".
Based on the nyc.gov website for the PICA program nothing has changed with regards to covering injectable meds for infertility
http://www.nyc.gov/html/olr/html/health/pica_prog.shtml
Fertility Medication Maximum
Injectable 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
Unless your insurance now does not cover infertility treatments I dont see how PICA wont cover the meds.
That's from 2008. They are saying it no longer applies as of 2014.
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| Posted 1/23/14 1:25 PM |
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Re: NYC PICA - FERTILITY MEDS NOT COVERED
Posted by PhyllisNJoe
Posted by NYCGirl80
Posted by PhyllisNJoe
Im telling you. When I spoke to a rep at BCBS - an insurance company that had plans that covered everything, they said they will no longer be giving ANY IF coverage as of 2014. I was shocked.
The coverage for IF is going backwards!
FYI - it's not the insurance company that determines coverage benefits. It's the specific policy.
That's what I asked and the rep I spoke to said all policies. I am hoping he was wrong. I went though 5 people until I found someone who can answer me. We purchase our own insurance and are willing to buy a policy with the coverage and he said it did not matter as of 2014
I actually saw your post on this the other day and went into panic mode b/c I also have BCBS (Empire). IVF was never covered under my plan anyway; but IF treatments still were and and assured me that it all depends on each person's policy and that specific coverage didn't change for me for 2014.
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| Posted 1/23/14 1:31 PM |
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Michelle1110
My family is complete
Member since 1/12 2338 total posts
Name:
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Re: Update NYC PICA - FERTILITY MEDS NOT COVERED
Posted by HopelesslyDiscouraged
Posted by PhyllisNJoe
Posted by NYCGirl80
Posted by PhyllisNJoe
Im telling you. When I spoke to a rep at BCBS - an insurance company that had plans that covered everything, they said they will no longer be giving ANY IF coverage as of 2014. I was shocked.
The coverage for IF is going backwards!
FYI - it's not the insurance company that determines coverage benefits. It's the specific policy.
That's what I asked and the rep I spoke to said all policies. I am hoping he was wrong. I went though 5 people until I found someone who can answer me. We purchase our own insurance and are willing to buy a policy with the coverage and he said it did not matter as of 2014
I actually saw your post on this the other day and went into panic mode b/c I also have BCBS (Empire). IVF was never covered under my plan anyway; but IF treatments still were and and assured me that it all depends on each person's policy and that specific coverage didn't change for me for 2014.
It's so weird! I work for the city and as far as anyone knows our plan wasn't altered yet express scripts/pica is acting like it did.
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| Posted 1/23/14 1:36 PM |
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CindySN23
Stop, Think & Breathe...
Member since 8/11 3550 total posts
Name:
Cindy
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Update NYC PICA - FERTILITY MEDS NOT COVERED
But if there was a change it would be posted on the page. I got my fertility meds thru Freedom in 2012. Also it states effective 2008 and it was last updated in 2011. I would call the PICA program to see what is up with this because if its true it affects all NYC employess not only for fertility meds for all injectables.
Someone should call OLR to see if this is legit. I work for the city and if this was true there would have should be something in writing about it. To make a drastic change like this would need to be documented.
Message edited 1/23/2014 1:44:04 PM.
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| Posted 1/23/14 1:42 PM |
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Michelle1110
My family is complete
Member since 1/12 2338 total posts
Name:
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Update NYC PICA - FERTILITY MEDS NOT COVERED
I called them four times Cindy. I'm banging my head against a wall.
Message edited 1/23/2014 1:54:57 PM.
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| Posted 1/23/14 1:54 PM |
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CindySN23
Stop, Think & Breathe...
Member since 8/11 3550 total posts
Name:
Cindy
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Re: Update NYC PICA - FERTILITY MEDS NOT COVERED
Posted by Michelle1110
I called them four times Cindy. I'm banging my head against a wall.
You called office of labor relations? Keep at it with them cause they would know for sure if there was a citywide change to pica.
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| Posted 1/23/14 3:12 PM |
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Update NYC PICA - FERTILITY MEDS NOT COVERED
Please keep me updated!
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| Posted 1/23/14 5:10 PM |
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