MDIPA & IVF meds URGENT HELP!!!

[Anonymous]

I have been authorized to do my second IVF cycle with my MDIPA coverage (federal employee).

The drug order was sent to Freedom Fertility Pharmacy (the one that filled it for my cycle in September). Same drugs, and now I am being told that the drugs aren't covered (Freedom said they were told the plan changed as of Oct 1, and the claim was rejected. MDIPA said to call Medco. Medco said these are not covered. Huh????) They were covered in September. When I asked Medco for specifics they said, there was an authorization for the drugs to be covered under the Rx plan in the last order, but nobody seems to be able to tell me how to get this authorization for this go-round.


HELP!!!

[Anonymous]

Call your RE's office. I was having a hard time with BCBS and they couldn't give me a straight answer about what was covered, so I called my RE (CFA) and they helped me sort the whole thing out.

[Anonymous]

The drugs are not covered under the prescription benefit, they are covered under the medical benefit and should be authorized with your approval for an IVF cycle. My guess is that because they have a bunch of new people they aren't familiar with the ins and out this insurance coverage.

I would bug them to get this straightened out.

[Anonymous]

Have your RE call in the order.

[Anonymous]

definitely have your re call in the order. also, i had mdipa and the pharmacy on the first floor of the shady grove rockville office - ambulatory care pharmacy - not affiliated with shady grove- was able to fill the order. i found mdipa to cover much, but to be impossible to talk to on the phone. i stopped trying and had my re do all the communication.

[Anonymous]

Thanks to all who took the time to respond. Here's a quick update and more information that may be of use down the road to someone else in my situation:

First, the order was phoned in by my RE's office. They did everything correctly. MDIPA's secret infertility office (you know the one that none of us can seem to actually get on the phone, yet these are the only people who know how to do any of this) had authorized the IVF and associated medications. Now, here is where the snag occurred (and this may be a step none of us ever realized was happening): The injectibles, when approved for IVF, are covered under the medical benefit, as PPs have stated (and which was something I knew going into this debacle). HOWEVER, there is an internal mechanism at MDIPA where the infertility team has to upload the authorization into the system that handles the prescription drug benefits. So, while it is a medical benefit, at some point the approval gets registered in the Rx system so that when a pharmacy goes to run your info through to find out your total cost, you will come up as having Rx coverage. From the pharmacy's perspective, it doesn't matter if it is a "medical" or "Rx" benefit because by the time the pharmacy is processing your order, it seems like any other Rx benefit to them.

So, because someone at MDIPA's office "forgot" to upload my info, I was being completely rejected.

I have to say, I am at CFA and Kim, the insurance specialist, did the digging to find all this out. Without her, none of this would have been resolved because MDIPA's frontline customer service has little to no knowledge of the infertility benefits, and how our meds are covered.

All is well that ends well, but I feel like the frustration and anxiety of dealing with MDIPA have taken a few years off my life.

[Anonymous]

I am about to switch to MDIPA -- this sounds a little sketchy. You still think the benefits outweigh the problems in comparison to AETNA?

[Anonymous]

did three rounds ivf with aetna open access hmo and 2 rounds with mdipa. I think if you can put up with the hassle of mdipa (referals no one to talk to at mdipa) it is worth it in the long run because of the drugs. aetna was around 4000 for the ivf and around 3500 for me for the drugs at sg. mdipa was around 3900 for the procedures and 150 for the drugs. i almost cried when i received the huge bag of drugs for 150 dollars. aetna was wonderfully nice on the phone, etc. but my re dealt with mdipa instead of me. i also liked that i could use a local pharmacy for mdipa and had to have the drugs mailed to me for aetna. that gave me heart attacks staying home from work to wait for my 3000+ dollars worth of drugs and having them left at the front door, etc.

[Anonymous]

Anonymous wrote:I am about to switch to MDIPA -- this sounds a little sketchy. You still think the benefits outweigh the problems in comparison to AETNA?

I was on AETNA for a year and switched last year to MDIPA because the meds cost 150.00 with MDIPA compared to 3-4K with Aetna. I've have no problems with MDIPA. I've done 2 cycles of IVF and had my meds completely covered each time (no hitches) so I would say it is definitely worth it. You save so much more money with them.