Wow it's a good thing I have a job with flexible hours. I just spent over an hour with my prescription insurance company (Express Scripts) and several hours today dealing with this mysterious $400 charge for my endometrin. The official reason I was denied coverage for the endometrin is my failure to respond to ovarian deduction combined by my meeting my maximal allowable benefits for this diagnosis (infertility). As discussed earlier, there is no such thing as ovarian deduction (this was verified by my CCRM nurse). Also according to the express scripts rep, my lifetime max for fertility treatment is $5 million and I've thus far spent $28,000 (of Express Script's money. This doesn't include the $$ DH and I have paid out of pocket for meds that were denied coverage). So none of this adds up.
This is now making me wonder whether other times we've been denied for various parts of our coverage whether I should have called to follow up on that as well. The thought of doing that for sometimes weekly treatments over the past year makes me want to barf. Because we're talking thousands of dollars that DH and I have paid out of pocket for meds for IF treatment over the past 1-1.5 years.
So my options are:
1. appeal which I plan to do
2. get CCRM to write a new Rx with a different diagnosis.
Luckily I have a few weeks before I have to start taking the endometrin to try to sort this out.
I'm also going to activate my on-line Express Scripts account and try to review my prior claims. After taking some anti-nausea meds.