Oct 11, 2016

17 Weeks!

Another week has come and gone and I really can't believe it. This pregnancy is flying by at a much quicker speed than the first one. We are 2 weeks away from our next ultrasound that will tell us if Baby Goofy is a boy or girl. TWO! How is that even possible?

Baby size: Onion.
Any symptoms?  weak gag reflex. I coughed and got sick right as we were leaving to go to church Sunday and we were actually going to be early. Headaches every single day. The pure exhaustion has reduced to a normal level of tiredness.
Cravings? pizza. I only caved once and got a single slice Thursday while I was out running errands.
Favorite part this week? Not feeling as tired is definitely my favorite. Also got my progesterone shot mess figured out.
Least favorite part this week? getting sick before church
Boy or Girl? We find out on 10/27!!
Names? As of right now, Baby Goofy. I'll let you guess who picked that one out ;)

Let's start with a funny story that our babysitter shared with us after church on Sunday. She told us that she has known for about 2 months that we were having another baby but never said anything. A couple of weeks after we found out, I had her watch Tucker one night while Danny was working so I could go out to eat with some girlfriends. As she was getting Tucker ready for bed, she asked him to go get his toothbrush. He went off to the bathroom and returned with one of the pregnancy tests! I had been storing the few that I had taken in one of the drawers. I was in shock and disbelief that we were actually pregnant so I held onto them for a while. So, she finally got to share that story with us on Sunday.

Now for my progesterone shot/health insurance nightmare. I'm sharing this in case anyone runs into this in the future. I can't be the only one.

My OB informed me after I had Tucker that in my next pregnancy/pregnancies I would receive weekly progesterone injections from 16-36 weeks to help prevent preterm labor. Great, anything to help. About 3 weeks ago, my OB's office called with news that our health insurance doesn't cover the medication. There are no alternatives as they were recently banned by the FDA. Recently as in end of 2015 or beginning of 2016. I forget. There is only ONE option and my insurance doesn't cover it. I called the drug company, Makena, to ask how much each injection costs: $4,000. The rep failed to mention its $4,000 per order and each order contains 5 injections. Either way, $4,000 was financially impossible. They offer financial assistance, which I qualified for and said I'll take it. I didn't bother appealing insurance because that could have taken months and I only had about a week to find a solution. This was the Friday of that week.

The next Thursday my OB's office called again and said there is a problem with my assistance. In order to receive the assistance, I had to file an appeal with my health insurance. That would have been nice to know a week ago since I now had 5 days until the 16 week mark. My OB was able to get an emergency vial sent to her office so I could begin the injections as planned. I was able to find a fax number for urgent appeals through my health insurance. I faxed that over on Friday morning and from that point my health insurance company had 72 hours to respond. If my appeal was approved then I only had to pay $100/order. If it was denied, then I received the medication for free.

The next Friday (we are now up to last week), I call to get an update since I hadn't heard anything and it has now been a week. After being put through the ringer by people not knowing what they are talking about, I find out my appeal was approved. Finally getting somewhere. I give my consent to pharmacy to allow my OB's office to schedule shipment and give my credit card info. It's all settled!

Yesterday my OB's office calls telling  me I need to call and give consent and a credit card for my $100 copay. I tell them I already have, I gave them my credit card, the Makena rep gave them my assistance info and the pharmacy told me to call my OBs office and tell them to order my medication. The nurse was returning my call. She said she is going to call them back and tell them this. She found out that the pharmacy rep had given her the completely wrong information and that it was another patient who needed to do all that.

As of right now, it is all settled. Finally.

So, here is rundown of what to do if you need Makena injections and your insurance doesn't cover them.
1. File an urgent appeal with your insurance company. Not a regular appeal. Get the info for the Urgent Appeals department. Go ahead and do this first since it takes a few days. It is a medical appeal and not a prescription appeal even though it is a medication.
2. Call Makena to see how much assistance you are eligible for. This was done in about 5-10 minutes.
3. When the appeal has been approved or denied, get the information back to Makena and its all gravy from there.

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