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  1. #1
    I will succeed! mrsmelody's Avatar
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    Default Insurance Coverage for HCG Trigger Shot

    Ladies,
    I mostly just lurk on these boards, but here I go!
    I am scheduled to do an HCG trigger shot in a few days. Last week, I had asked my RE's office to fax in the script since it has to be faxed by their office.
    Today I got a call from the prescription delivery company (Express Scripts) telling me that pre-authorization by United Healthcare was required and according to my RE, they "DO NOT" call for pre-authorizations (which Express Scripts said was weird.) Fine, whatever, I'll call the freaking HMO myself.
    My question to you is:
    My HMO states it covers "6 rounds of ovulation induction and 6 IUI's. They paid for the clomid script. However the HMO also states that Fertlity Meds are not covered.
    Do you think they will cover the HCG shot (s)?
    If not, does anyone know how many I will have to take and how much they cost?

    TIA!
    Baby Dust everyone!
    PCOS and Male Factor
    Metformin ER 1500mg, 50 mg Zoloft, prenatal vitamins, South Beach Diet

    ***TTC#1***

    -Round 1- IUI w/Repronex and Follistim=BFN 10/30/2006
    -Round 2- IUI w/Repronex & acunpuncture=BFN 02/01/2007

  2. #2
    Kristyn'sHAPPYmommy MikesHAPPYwife's Avatar
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    Default

    I am not sure if it is covered by hmo or not. However, I can answer some of your questions. You only need 1 HCG shot per cycle and sometimes that is not even needed if your follicles are large enough to produce ovulation. Their are various brands and I am sure each pharmacy is different but I only had to pay $13 for my shot.
    Kristyn Joy (11-14-06) (means Christlike, Joyful)

    Kari Grace (05/17/10) (means Pure of Heart, Grace of God)



  3. #3
    Registered User tweety612's Avatar
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    Default

    I just checked my insurance EOB and I think the HCG trigger shot was $33.62. You only need one per cycle and you may not even need it if you surge on your own.
    Me-Hidden Content DH
    DS1 (8yo)-conceived on Clomid Hidden Content
    m/c 7/06 @ 6w Hidden Content
    DS2 (all natural surprise!) 14 months old Hidden Content

  4. #4
    Praise God autumnleaves's Avatar
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    Mrs. Melody-I have been in this kind of situation. My insurance is not going to pay for the HCG shot but will pay for the progesterone and femara. Where I get the HCG from was only going to be 33.90. Only $8 more than what I would have had to pay with insurance.
    Me-28 DH-30
    DS


    Meds: Thyroid, Prenatals, Metformin 1000mg

    Femara 2.5mg bid Feb 27-Mar 3rd.
    BFP 3-21-07 11dpo
    Born 37w3 days due to pre-eclampsia, GD via C-Section 6lb 6.5oz

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  5. #5
    Registered User goldenjag25's Avatar
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    My insurance covers generic on the fertility drugs but not brand name. My RE suggested I do the brand name trigger b/c they have had better success with it.....she was right, I got pregnant. Anyways, it cost me 34 dollars, the generic would have been 10. Well worth it. Hope that helps.
    me 34 DH 39 Metformin 1500mg, Nifedipine, Vitamin D, prenatal
    My big girl Sarah born 4/28/07!
    My little girl Alana born 7/27/11!
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  6. #6
    Registered User Bundle of joy's Avatar
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    My insurance did not cover HCG shot at all, but I was lucky, some good lady donated some shots for those that did not have fertility insurance to my Re's office so I got it for free. You can ask your nurse if they have one for you.
    Tyra - 30, DH- 32, DS 2, DD infant
    TTC #1: 4 Rounds of Clomid = BFN; 1st Round of Femara, metformin 1500mg, hcg shot & Preseed = BFP

    TTC #2
    1ST ROUND OF Femara, 1500mg/200mg metformin, and hcg shot=BFP.

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  7. #7
    Nurse Betty Laine's Avatar
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    my insurance covers the HCG trigger but if it didn't it's still only around $33. I think what the HMO said is very confusing. It covers ovulation induction but not the meds??? Thats odd because how would they think they would induce ovulation? My insurance also covers 6 ovulation cycles. But they also pay for the meds that it takes to make me ovulate for those cycles. Ask if they can send you all your infertility benefits or if they have them on-line...mine were on-line and it helped because it was right there in black and white. HTH....good luck!!
    Kami(31) Tommy(32)
    ttc # 1 since dec '05
    Dec '07 Gonal-F, trigger, IUI ~ Hidden Content BFP on New Years Eve

    Erik Alexander 5lbs 3oz, 19 inches
    Isaac Anthony 6lbs 4oz, 19 inches

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  8. #8
    Nurse Betty Laine's Avatar
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    one last thing. my insurance covers clomid forever...no limit. it's not counted as a superovulatory drug...like gonal-f or any other injectable.
    Kami(31) Tommy(32)
    ttc # 1 since dec '05
    Dec '07 Gonal-F, trigger, IUI ~ Hidden Content BFP on New Years Eve

    Erik Alexander 5lbs 3oz, 19 inches
    Isaac Anthony 6lbs 4oz, 19 inches

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  9. #9
    I will succeed! mrsmelody's Avatar
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    Default

    Thank you,everyone!
    I spent so much time on the phone between United Healthcare and Express Scripts today. No one was able to give me a definitive answer and they kept giving me different numbers to call. So frustrating.

    Laine, The details are online, but it says it one place it covers the ovulation induction, but the next line says they don't cover fertility meds. I had to go to the RE today anyway and I asked for their help. The office mgr looked at my coverage and explained it to me. By ovulation induction, they mean the bloodwork, ultrasounds, and clomid. They do not cover any injectibles. She was very nice. Also, she told me about a local pharmacy that provides injectibles much cheaper than Walgreens.
    $33 is bad, however, I just paid $500 for one vial of sperm , so I was hoping to save money in other places.
    Still, I shouldn't complain, I should be greatful for the insurance covering what they are.
    Goldenjag, I will definitely look into the brand name shots -vs- the generic.
    Thanks, ladies, I really appreciate your input and support.
    PCOS and Male Factor
    Metformin ER 1500mg, 50 mg Zoloft, prenatal vitamins, South Beach Diet

    ***TTC#1***

    -Round 1- IUI w/Repronex and Follistim=BFN 10/30/2006
    -Round 2- IUI w/Repronex & acunpuncture=BFN 02/01/2007

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