It has been awhile- a plethora of things!

Well, once again I find myself apologizing for lack of posts. As I have said before, I find it hard to keep things out of my blog and so when I knew I was pregnant but wasn't ready to share the news I couldn't think of anything else to post about. And once I had shared it, life got busy and then I wound up in the hospital and now we have been told the sex but once again aren't ready to share with FB because it was early to find out and we don't want to have to retract it! So, April 5 will be the big announcement.

Thanks for all the support during my hospital visit. That certainly was no fun. But we got through it none the worse for wear. For those of you keeping track of my letter writing to hospitals, I did write a letter to Scripps Encinitas commending all my nurses. They did a wonderful job and tried their hardest to make me more comfortable. I felt it was important to make sure they got the pat on the back they deserved.

Currently I am dealing with my insurance company trying to get the progesterone shots. Aetna is giving me the run around, saying it needs approval, etc. Let me give you some background information. On March 10th the story broke that the FDA had approved one company to manufacture the shots, brand name called Makena. It was supported by the March of Dimes and Ob's because then there would be universal oversight. Unfortunately the price increased from $10-20 per shot to $1500 per shot. No one seems to have realized this would happen. Aetna was quoted in newspaper articles as saying they would approve the shots for their patients.

On March 11th my OB's office faxed my RX to the Aetna specialty pharmacy per Aetna's instructions- they did not order Makena, they just ordered progesterone shots. I received a phone call from Allere health systems on March 14th telling me they are the service who will come out and teach me how to administer the shots but that I need to have the shots on hand before I call to make an appointment. I called my OB to make sure the shots were ordered and was told they were. After my OB appointment on March 17th I called the specialty pharmacy and was basically told that they ignored the RX because they had a question. Um, ok. So my Ob's office provided additional information on Friday the 18th. I called Aetna again yesterday only to get more of the run around. I talked to a "supervisor" who said the medication needed to get approval. I am going to be 16 weeks tomorrow and that is when I am supposed to start the shots. Luckily there is a window until 20 weeks, but I am not telling Aetna I am ok with waiting.

I decided to call Allere to find out how long it takes to get a nurse to come out once I do get the meds and I finally got the real story. They provide the service of providing the meds and having a nurse come out each week to administer the shots. Two insurance company's, Cigna and Aetna would not allow them to provide the meds and instead would provide the meds to their patients from their own compounding pharmacy. They only allowed Allere to send a nurse out once to teach how to give the shot. Once the FDA approval came through all compounding pharmacies were supposed to stop production (I know some people reading this probably thought they were still allowed to compound, but this is what Allere told me- it's obviously a confusing point since my OB's office also didn't know that they couldn't order the compound). Cigna immediately told Allere they could start providing their full service (providing Makena and administering it once a week) to all Cigna patients. Aetna has told Allere nothing. They are still trying to decide what to do. So, the woman at Allere said that unfortunately I am stuck in this gray area while Aetna figures out if they want to cover this very expensive shot.

Luckily, I have a fallback if their decision making takes too many weeks. Allere can provide me their service and a month worth of shots for $175 per week. I guess they must subsidize the cost of the shot. And it only takes about a day to set the service up. So if Aetna doesn't approve the meds and I am nearing 20 weeks I can order a month of the service and hope that Aetna approves it in the next month. Maybe I can get reimbursement for the out of pocket expense. We shall see.

As you can imagine, I was a stress case yesterday. I will try calling Aetna again today to find out if having my OB order Makena will help this process along. I doubt it. It's frustrating to know that had the meds been ordered a few days earlier, it would have been shipped to my house and I would have had it. However, I had to be 14 weeks to order it (insurance companies won't take the Rx otherwise) so I couldn't have had it ordered any earlier.

Anyone have any connections at Aetna? ;-)

Otherwise we are all doing well. I will be better about neglecting this blog.