My insurance is refusing to cover my Heraprin

[macksmom]

Ooopps bad spelling - that should be *Heparin*

Not sure how much traffic this room gets.....

Anyone who is or has been on Heparin - did you have a hard time getting it covered? If so, what did you do?

I have been trying to get it since 35 weeks (I am 37W). After a lot of shenanigans and back and forth my insurance flat out says no. That it's a "Part D" drug and they wont cover it. Meanwhile they have covered the Lovenox the whole pregnancy!

So I am going to pay out of pocket and start the fight to get reimbursed

Just looking for any insight that will help my battle!

TIA!

[Marquette Fan]

I have no experience with this or advice to add - sorry you are going through this. I hope you are able to get reimbursed later but I know that can be quite a pain.

[3andMe]

I don't know anything about your specific insurance question, but I have the following ideas.

Can you ask your physician or his/her billing office to talk to the insurance company and explain why you need it? Alternatively, can you ask the insurance company what you would need to provide them in order to have it reimbursed?

Remember to remain calm and ask them for assistance in solving your problem. I know a lot of the inexplicable stuff that you have to deal with sucks when insurance claims are denied, but being calm and reasonable rather than angry and entitled (even if it's deserved) actually gets you a lot farther.

[macksmom]

Thanks. I believe the OB wrote a "letter of necessity" and had faxed it to them when they were trying to get the script to go through. They really handled it because I couldn't do much of anything. Every time I called they would put the blame on someone else and tell me the doc had to do XYZ.

I picked it up today and it was surprisingly only $90. Not that I have that to throw around but it wasn't as much as I had anticipated. I will still try to get reimbursed though! My copay for some "non-formulary" drugs is $50 as it is so $90 wasn't too brutal.

When I go to my next doc visit I will ask for all their paperwork so I can work on my claim. It's not that I feel entitled but it just makes no sense to cover Lovenox and not Heparin - they both do the same thing but I am not supposed to go into labor on Lovenox. I don't think I would die but they said they have a drug that can reverse the Hep immediately and that I can't get an epidural on Lovenox. Ironically I would like to try to do w/o the epi but that is still my choice to make. Considering the out of pocket wasn't that expensive it really makes no sense why it wasn't covered.

[3andMe]

I was going to ask if you could provide follow-up and say how much the heparin cost, because I was curious and was guessing it probably wasn't too expensive, and then thought better of it and didn't want to offend with a nosy question so I deleted that part of my reply. I do appreciate you putting that part in, though, because it is common for drug prices to vary a huge amount, from $5 to thousands, and most people don't know what each drug might cost unless they have personal experience with it.

I'm glad that whatever the end result might be, it's not going to break the bank. I know $90 is more than nothing, but it could be a lot worse.

ETA: I didn't think you were coming across as angry and entitled, but I do know that some people take that approach in dealing with companies because they think the squeaky wheel will get the grease, when a lot of times the gentler and reasonable approach will get more help much faster and will make people want to do more for you.