I've just been informed that my insurance company won't cover any BCPs. I guess I shouldn't be surprised, given how biased the system is, but I'm still p*ssed, especially because Yasmin in my area costs a minimum of $36/month! That's hundreds of dollars of out-of-pocket costs for me every year.
I was considering writing to them because I don't take BCPs primarily for birth control, I take them to control my PCOS symptoms. When I am not on the pill, I lose my hair in clumps, grow hair where I don't want it, and get acne. While I don't necessarily feel like BCPs are treating my underlying causes, it at least keeps me halfway under control!
Has anyone tried this with their insurance company? What kind of documentation did you use? Would it be enough to write it all myself, or should I get my doctor involved? Any input would be welcome.
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If you are taking this medication for another Medical reason besides just birth control they have to pay for it. Its like any medication - If someone needs heart meds I don't think they would turn them down. Its to control symptoms - -I would write your letter and see what happens.
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WHen I was in college, my insurance covered birth control pills because I was taking it because of amenorrhea. My doctor wrote them a note. Although, from what I recall, I had to pay for them upfront, send a copy of the receipt to the insurance, and they reimbursed me. Even with the inconvenience, I was happy that it was somewhat covered. Perhaps you can call your insurance. Tell them you're on BCPs because of something else. It's worth a try!
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Even with getting a doctor's note saying the BCPs were for medical reasons, my insurance refuses to pay. Our policy with them states specifically no contraceptives/contraceptive devices, regardless of use. Which is interesting because there was a law passed in CT that went into effect on October 1, 1999 requiring all insurance companies that met a certain definition (this one falls under that) to provide MANDATORY coverage of BCPs. I recently sent them a letter complaining about the fact that they don't cover them, as well as a copy of the text of the law and a threat to take it to a higher authority if I do not get satisfactory results. I've had enough... It's not fair. The worst part with my insurance is that they'll cover 6 pills a month of Viagra (or similar product for male or female) and ELECTIVE abortions, but not contraceptives of any kind. Ridiculous!!
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Thanks for your input, ladies. I have a claim in right now to try to get them to cover the GYN visit at which I was prescribed the pills (they denied it because it resulted in a pill prescription, which they don't cover! unbelievable!), and once I hear about that, I'll probably start by sending in a letter. It's such a pain that we have to go through this. As far as I'm concerned, BCPs (whether they're used for contraception or PCOS or whatever!) are just as much primary healthcare as any other prescription. Why should women have to pay more for their healthcare than men?!?
Severine--it's interesting that you mention the CT law. That law was introduced in the Montana legislature this year and I wrote letters in support etc. It looked really good, and then the bill stalled in committee. How aggravating!
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I say file the grievance with medical documentation to show why it's needed. I work (until the end of this week YEAH!!) in health insurance and I've seen quite a few things over turned because people fight the system.
However, on my insurance, Yasmin's on the third tier of the formulary. That equates to a $35 copay. Yeah. I went off of if for that reason, but find that I need it. I'm going elsewhere to get my meds. So, if your drug plan has a formulary, if they allow Yasmin, most likely, because it's a non-formulary drug, will be at the highest tier.
Our insurance, for better or for worse, doesn't work that way. We pay 100% out of pocket for everything until we reach our MASSIVE deductible. But they are saying they won't even apply the OOP expenses I have for BCPs to our deductible! It's crazy... I am going to fight it; just have to get some info about what I should send along. Thanks, Caelda, for the "inside" scoop!
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I am wondering if there might be some roundabout way to have the seperate components of BCPs prescribed and covered... some sort of estrogen therapy and some sort of progestin... and have insurance cover it as "hormone replacement?"
Or could you get BCPs from Planned Parenthood?? I don't know what they charge, or if they offer Yasmin... but perhaps you could get something through them and then, would your insurance cover a prescription for spiro??
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RD: Those are good ideas. I'll keep that in mind if they come out against my first appeal. I'll update the thread with what I find out.
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I had been prescribed Nuvaring, and the insurance decided that it was "not covered," and suggested pills instead. I wrote to try and explain I cannot take pills because of the high estrogen, and there is no generic to the ring, but I still got declined. Funny thing is they pay for the patch, who is getting sued now, aren't they? Stupid insurance. I hate them--don't cover anything even remotely fertility related, not even Clomid pill, but they cover Viagra and (once again) elective abortion.
Can you try cvs.com for the Yasmin? I think they might be cheaper than $35!
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BCPs and insurance--anyone have luck appealing? 
