Anonymous wrote:OP here. Can someone tell me more about the authorization? I didn't know there was such a thing. Mine just got sent in and shouldn't be ready until really close to when I start drugs. My Kaiser pharmacy already has my drugs on record and say they are ready to fill the prescriptions with a couple days' notice (and I can pick up locally) but I am nervous about this authorization. Will SG do bloodwork and US to start the cycle if authorization is delayed for some reason?

18:40 here. SG wouldn't let me start my cycle until they received approval from Aetna. I was just on BCP indefinitely until it came back. Once that was all set, I got my calendar and had a new beast to tackle getting everything taken care of with the pharmacy.

Anonymous wrote:OP here. Can someone tell me more about the authorization? I didn't know there was such a thing. Mine just got sent in and shouldn't be ready until really close to when I start drugs. My Kaiser pharmacy already has my drugs on record and say they are ready to fill the prescriptions with a couple days' notice (and I can pick up locally) but I am nervous about this authorization. Will SG do bloodwork and US to start the cycle if authorization is delayed for some reason?

They can but it's useless. No authorization=you can't start the cycle.

OP here. Can someone tell me more about the authorization? I didn't know there was such a thing. Mine just got sent in and shouldn't be ready until really close to when I start drugs. My Kaiser pharmacy already has my drugs on record and say they are ready to fill the prescriptions with a couple days' notice (and I can pick up locally) but I am nervous about this authorization. Will SG do bloodwork and US to start the cycle if authorization is delayed for some reason?

Another NP here. I was at SG and paying via insurance (UHC). I didn't have any billing problems or timing problems from a SG perspective, but a few insurance things:

1. My insurance provider requested I use Follistim instead of Gonal F (Shady Grove's recommendation). I ran through my med benefit in 3 IUI cycles and 1 cancelled IVF cycle. Second IVF worked, so I wasn't hugely out of pocket - but at least when I was paying myself, Gonal F was a lot cheaper. I wish I had called my insurance company and tried to understand what of my benefit I would use via each drug because I'm not sure I got the best deal. That's on me and not SG (they wanted me to use the cheaper product).

2. Similar to the above, a colleague of mine was told by our insurance she had to use a particular pharmacy. That wasn't true because I used Freedom Pharmacy and she/I are on the exact same insurance plan with the same employer. She ran through our benefit in one IVF cycle. So I would really push back on those costs with your insurance provider and try to understand.

The only time we had issues is when we were near the 1 year mark. So we signed forms, let's say, Aug 1 2011. Several IUI later, a few resting months, etc. Now it's Jun 2012. All the forms are good, so we get ready to do a cycle. But it takes a few months because of cysts. So I show up mid-Aug with his sample, all ready to do the IUI and BAM, forms are all expired. So there is lots of running around and thank God his work still has a fax machine. Stress that I just didn't need!

Make sure your thyroid levels are being monitored. SG does not routinely do this. I learned this thanks to DCUM. My TSH would rise during BCPs and stims, and my doctor would check this.

NP here. Order meds as soon as you possibly can. I used Aetna and basically had to obsessively call them to make sure all the authorizations went through. SOmething I didn't know is that the group handling the IVF treatment approval was completely separate from the pharmacy portion. So I had to call each group independently and make sure they faxed information to each other. So don't assume that just because you've gotten medical authorization means that you've also been authorized on the pharmacy end.

OP here -- thanks, this is really helpful. I am doing insurance (Kaiser) so the authorization is a good thing to know about. How far in advance did people order meds (and extras)?

Nothing, wells teally I did scramble at the last minute to find a nurse to come to my house at 11pm to do the trigger because DH couldn't do it. Thanks DCUM!

Anonymous wrote:Nothing fell through the cracks - you do have to be organized though to keep tabs on everything. Keep tabs on how much medicine you have and order more in time to have it delivered. I did not have insurance so did not have to deal with that aspect (unfortunately for me).

I also kept rack of my cycles (med dosage each day, any measurements and my E2) in a google docs. if you have to do IVF again it is handy to have your own records for comparison's sake.

I did this too! Spreadsheet in google docs! Came in handy on a day when my nurse called me with 1/10th the number for afc, and I had to insist she double check. I certainly hope they would have caught that on their own, but it's good to pay attention, write it down, track it yourself, and ask questions.

Nothing fell through the cracks - you do have to be organized though to keep tabs on everything. Keep tabs on how much medicine you have and order more in time to have it delivered. I did not have insurance so did not have to deal with that aspect (unfortunately for me).

I also kept rack of my cycles (med dosage each day, any measurements and my E2) in a google docs. if you have to do IVF again it is handy to have your own records for comparison's sake.

we are also OOP at SG. my nurse was good at reminding us of anything that was missing. even when you do the PGS your nurse gives you the consent forms and then you give it back to her with everything signed and she forwards it on to the testing people. You do need your spouse to be present at some point to sign the consents that are witnessed by the nurse (we did this at our injections class.) we paid in two checks but the second one they couldn't find for a week for some reason, but my word was good enough to not delay the cycle (and i guess that they had half the money already.) so they are pretty reasonable about working with you, not delaying things over glitches, in my experience. they pretty much have everything down to a science at SG, for better or for worse, so this part is pretty easy. you will be asked to watch videos of risks, and they actually know if you've watched them all, which surprised me! good luck to you and let us know if you have anymore questions. it all seems like a lot of paperwork and testing, but i finally have my retrieval tomorrow, it will be there before you know it! if you have insurance stuff that needs to clear, not sure how that works...

No issues, though we were 100% OOP. Signed the forms, paid IVF fee, ordered my meds and started the cycle.

Background: I had received insurance approval to do IVF at Dominion but decided to switch to SG. SG would still have to send off their own forms to the insurance, but since my file had already been marked for IVF approval, it should only take a few days to process instead of the usual weeks for the initial authorization.

So, SG told me that the authorization had been sent off to the insurance company. Multiple followups over the next several weeks with my financial counselor were essentially blown off with "I'll send your question to the financial team in Rockville" and then never heard anything until I again sent an inquiry etc. I finally called the insurance company to see what was taking so long and they told me they'd never received anything from SG whatsoever. The last note on my file was the approval from Dominion... I just about blew a gasket.

My first IVF at SG is coming up next month. Over the past 3 years on this board, I've read tons of stories of people who have had delays and issues because some random form wasn't signed, a bill wasn't paid, etc., before they started the IVF protocol. I think I've dotted our i's but can you tell me anything to make sure to check off the list so this cycle goes smoothly? FWIW we are doing a freeze-all and PGS.

TIA!