NWR: Health insurance rant/ BC help needed

JCbride2015

I cried angry tears at work today.  Thank the Universe I have an office with a door that closes because I was raging.

As most of you know, I have some existing health issues that really require insurance.  My health insurance enrollment process got unnecessarily dragged out from when I started on Oct. 1, and to make a long story short I was "enrolled" but with no ID card or online access so I couldn't prove my enrollment--> couldn't go to the doctor.  I was already getting to the end of my rope with this.  I figured my biggest problem was getting myself into physical therapy.

On Saturday I went to the pharmacy to get my BC and whaddaya know, I still can't access my insurance info and thus can't get my Rx.  I emailed Benefits AGAIN.

Today Benefits emailed me back and kindly offered to have their rep call the pharmacy.  Awesome!  Yes!  Then I get the email back:  My NuvaRing is "covered" but because it's not generic, I have to pay $297 toward my deductible.  What the everloving fuck.  They have a very short list of generic BC they'll cover, and they're pretty much all pills (or IUD).  I don't want a pill, I like my NR.  I've been on these hormones for five years and they work for me, and I can't fuck it up because it's there all the time.

And on top of all this, I need to start my cycle tomorrow.  If I had actually been really enrolled on Saturday when I tried to get the Rx, I would've known about this.  Now it's the night before and I'm scrambling to make a decision about whether to change my BC or pay fucking $297 monthly until I reach a total of $1500 out of pocket.... which is frankly insane.

I spent a very long time on the phone with insurance today and their explanation is that NuvaRing doesn't count as "preventive care" (which is supposed to be fully covered under my plan) because only generics are "preventive."  It's a total bullshit non-answer.  I'm so pissed.

I am beyond full of rage about this and sort of even having a hard time articulating how belittled I feel that I can't make this choice for myself.

Now it's 9:50, I just got home from work with at least another hour to do at home, and my doctor was able to squeeze me in at 8:15 tomorrow morning to at least call in a Rx for me.  I have approximately 10 hours to complete this work project, sleep, and make a major health decision.  Funtimes!

All of this is to say-- anybody have feedback (good or bad) about any particular generic BC?  Any recommendations about IUDs?  I can't get one early enough to start this cycle but I might switch to one permanently if my only other choice is a pill.

JCbride2015

smichek said:

I am on the generic BC patch Xulane. I was on the name-brand, Ortho-Evra, but then some bullshit went down with the numerous branches of my health insurance consolidating and my particular branch got dissolved, so they put me on a different branch of their health insurance that didn't cover Ortho Evra but did cover Xulane. So I switched to Xulane and I've had no weird affects. Exactly the same as Ortho Evra. Would you do a patch? It is weekly, like the ring. H doesn't even notice the 1"x1" patch on my lower stomach. I have been on teh patch for 5 years and never had problems with skin irritation or the patch peeling off throughout the week, but those are the most common complaints that I know of.

@smichek I used to be on the patch and my stupid skin had a reaction to it.    Also they don't cover any versions of the patch at all, anyway.

theartistformerlyknownas

I had the same problem with NR and insurance. My doctors wanted me to try it because they thought oral BC might have been what was making me puke, but it wasn't covered. My doc just hooked me up with "free samples" for like a year. Tell your doc you don't want to change, you're scared if forgetting a pill after all this time, but you need a month to figure it out and is there any way you can please get a sample.

Otherwise, I tolerate the low-dose generic (low ogestrel) the same as the NR.

holyguacamole79

I really don't have any good referrals for you, but I hope this can get resolved quickly and affordably.  <hug>

JCbride2015

@lolo883 That's a great idea!  I wonder if she can do that.

And something else just occurred to me.  My prescription was already filled at the pharmacy... am I going to get billed for this????

Back to the phone lines...

theartistformerlyknownas

JCbride2015 said:

@lolo883 That's a great idea!  I wonder if she can do that.

And something else just occurred to me.  My prescription was already filled at the pharmacy... am I going to get billed for this????

Back to the phone lines...

Not until/unless you pick it up.

kat1114

Up until last year, I had been taking Trinessa which is generic orthotricyclen. I had no side effects from it (that I could tell) and it was covered as free by my insurance once Obamacare went into effect. The only reason I changed is because I've been lower right ab pain that the doctors can't figure out, and my OBGYN wanted to try a different pill to see if it helped.

I'm now on Reclipsen, which is a generic, but I'm not sure what the name brand is. After a year, I've no complaints, and my periods have been even lighter than they were before. I pay $10 with my insurance. Without insurance, it's $30.

Hope you get everything figured out soon!

hellosweetie1015

I hope you get that worked out! That's such a mess, and it'd stress me out so much I'd skip a period anyway.

I was on Sprintec (a 21/7 pill cycle, as opposed to the 24/4 cycle I started off with) for the last year or so. Before Obamacare went into effect, it was $10 with insurance. After Obamacare, it was $0 with insurance. When I aged out of my mom's plan this September, it jumped to $30. Unfortunately, $30 is unaffordable for me, so I'm currently not on anything.

WinstonsGirl

I've been on Ortho Tri-cyclin and the low version after.  I switched to a copper IUD and am now on my second one.  I wanted to try non-hormonal, so that's why I switched, though I had no problems on BCP.  I was paranoid about taking them though.  I had a daily alarm set, and DH had 2 on his phone too, so I always took them at exactly the same time.  

They IUD gave me cramping for about the first 6 months or so, which sucked, since I've never had cramps before.  They did get less and less over time, and now I just feel kinda sucky on the first day of my period.  Insertion sucked, but the second time was much better.  Feel free to bug me if you have questions about it.    

JennyColada

I was on generic brands of OrthoTriCyclin for like 10 years. Through the years I had like 5 different brands (just depending on which Planned Parenthood I got my prescription from). They were all fine. But I seem to have way fewer side effects from hormones than my friends, so your mileage may vary. I wasn't really the best at taking it on time, and would often be 2-12 hours late. Whoops.

I'm on Mirena IUD now and like it. Love the no periods. DH can feel the string (which my gyno doesn't really believe, but oh well) and as a result he's kind of avoiding sex (since it's uncomfortable for him). So I'm kind of thinking about going back on BC pills.

wandajune6

I've been off of BC since March but was on OrthoCyclen (or generic) for about 15 years. I never had any problems with it and would buy it- not using insurance - for $8/month at Walmart. In the years when I didn't live near a Walmart, I would preorder with them and buy a year at a time.

Let me also recommend comparison shopping. I've found that Walmart and Costco have frequently cost less without insurance than my insurance-negotiated cost at other places.

larrygaga

I have been on norgestimate for about 6 years now, and so far so good. I have had the actual brand change a few times. I worry sometimes that I might be infertile, because it works that well for me. I doubt I'll change it until I'm ready for kids, which might be another 5 years if ever.

Only side effect is that I weigh about ten pounds more ( but I don't actually seem to have 10 more pounds of weight, just the number goes up) and I am very headache prone. I have been taking it for so long, that these might just be baseline for me. 

I'm sorry this is happening to you. Our health care system is so jacked up.

JCbride2015

Thanks for all the feedback everybody!  I am bringing the printout of covered meds to my doc tomorrow and I'll keep all this in mind.

sophhabobopha

UGH HEALTHCARE MAKES ME RAAAAAAAGE.

lurkergirl

Don't know about the BC, but we are dealing with insurance shit right now.  Within a week, we have found out that FI has not one, but 2 hernias, and they will both be operated on this week. 

I freaking wish his out of pocket were $1500!  Nope, his is $7k.  Bye-bye wedding flowers and liquor!!

Oh, and it's also not considered preventative care (although the insurance is still going to help) because I guess having his colon sink to his scrotum or having an incarcerated bowel is a better alternative.  FI's livelihood depends on his ability to bend and lift, so the doctor says he absolutely needs to have this done because otherwise he WILL face those complications at some point.  Did I mention that in a worst-case scenario, those complications could cause gangrene, and he could lose his dick?  Fuck insurance so fucking hard!!!!!!!

Sorry for the angry rant.  I've only had a couple sips of coffee, and I have spent all week being pissed about this.

charlottesmom0626

I have nuvaring and it isn't covered either, but the nuvaring company makes a coupon that you can print out that will cover up to 50%, it kind of acts as second insurance. So Im supposed to pay $30 a month for it. But it ends up being $15. Does that help you?

porkchops926

Ugh... insurance. Does anybody ever feel like we're just paying them to deny various aspects of our healthcare? Oh wait.... that IS what we're doing. 

loro929

@JCBride2015 I am in shock that the NuvaRing really so expensive out of pocket. I am absolutely baffled. I pay approximately $30.00 per month for it - out of pocket not covered in insurance. I just really don't even understand have having insurance would make the price inflated by such a large margin!

littlemushroom

@hellosweetie1015‌ I am on Sprintec and it is $9/mo without insurance at Walmart. Maybe that brings it back into affordability range?

flyingfoxes

I've been on generic BC for about 15 years - at least the last 10 years I've used it to skip periods so that I only have 4 per year.  I think it's free right now because of Obamacare.  I think I'm on Reclipsen too (they change what they send me so I don't know the names). 

 

I'm actually kinda sad because I'm going off of it this weekend so I can be tested to see if I still ovulate in a couple of months.  I don't want to have periods every month.    Here's hoping for ovulation and a quick getting knocked-up in the spring after the wedding!

Couggal12

I'm wondering if your doctor can write you a letter explaining to the insurance company that this is the only form of BC your body tolerates without significant side effects. I forget what the process is called but, it's basically asking your insurance for an exception to cover the NR in the same sense that they cover a generic version. 

KatieinBkln

I am on Vestura, a generic for Yaz. I like it very much, and have been on some version or other of Yaz for the past 8 years or so. Other generics are Gianvi and Loryna (I've been on all of them--have never noticed any kind of difference in the way I feel.)

Yaz has had some lawsuits (I think MOST oral contraceptives have, actually). The one I'm thinking of I believe had to do with blood clots forming specifically in young women (like under 18 young? I am not sure). However, as a non-smoker and otherwise low-risk person, I am considered a good candidate and I like it. It's only 4 days "off" rather than a full week, which I like because my period is usually about 4.5 days long and quite light.

Obviously you're in a tough situation at the moment, but have you considered looking into the insurance marketplace? It sounds like your plan at work is pretty shitty for someone who needs regular care (PT, BC, etc.) with its big deductible. You might be able to find an affordable plan on the marketplace that doesn't have a giant deductible (or any at all!) that might better suit your needs? I am not sure, but depending on pricing/usefulness it might be worth un-enrolling at work and finding something better.

Last thing: I am not sure whether or not this is an Obamacare thing or just a thing with my particular insurance, but my pills are free. It's pretty awesome, frankly.

daria24

I've been on Lutera/Alesse for years and have zero side effects. I stopped getting my period after about two years on it. For awhile I would still have some mild period-related symptoms at that time of the month but it's been years now since I had anything. Even though I have a HDHCP I don't pay anything for the pills. 

I've been on Ortho Novum, Yaz, and Ortho Tricyclin as well, and had some minor side effects with those. Yaz made me feel a bit depressed. Ortho Tricylin gave me worse cramps. 

esstee33

Add me to the list of generic Ortho Tri-Cyclen -- I think the last one I was on was Tri-Sprintec, and it was great. 

I'd also echo the PP who suggested asking your doctor for a sample just to get you through a month until your insurance is straightened out. 

hellosweetie1015

littlemushroom said:

@hellosweetie1015‌ I am on Sprintec and it is $9/mo without insurance at Walmart. Maybe that brings it back into affordability range?

REALLY IT IS THAT MUCH CHEAPER? Yes, that's closer to affordable. I'll be moving my prescription today if my walmart's price is the same as yours.

ETA @littlemushroom you are the BEST. 

AprilH81

Ask the pharmacy what it would cost if you payed out of pocket as if you didn't have insurance.  I can't imagine it would be what the insurance is telling you it would be.

loro929

AprilH81 said:

Ask the pharmacy what it would cost if you payed out of pocket as if you didn't have insurance.  I can't imagine it would be what the insurance is telling you it would be.

Yes, I agree with this. I also use the NuvaRing and it is not covered in my insurance and I pay $30.00/ month, which seems much more reasonable than what you have to pay with insurance "covering it".

VulgarGirl

I'm just impressed you're brave enough to post about BC again considering what happened last time.

melbenso

I was on the NuvaRing for a couple of years and switched back to the pill about a year ago.  I use Ortho Tricyclen Lo.  It's the lowest hormone dose available in the pill.  (Aside from the ease of use of the NuvaRing, lots of people like it because it is a low hormone dose.)  But honestly, my best advice would be to make an appointment at Planned Parenthood and talk to a doctor/nurse practitioner there about your birth control options.  They are pretty much the experts, and if you are having problems with insurance, their birth control is all low cost or free.

Brought to you by your friendly neighborhood Planned Parenthood Volunteer Community Council Member. 

loro929 said:

Yes, I agree with this. I also use the NuvaRing and it is not covered in my insurance and I pay $30.00/ month, which seems much more reasonable than what you have to pay with insurance "covering it".

That likely is covered by insurance.  Mine was about $20/month with my insurance.It was much more without it before my insurance covered it.  Despite the ACA's free birth control rule, not all health insurance plans are required to provide completely free birth control.  Some plans like mine, especially for small companies, have been grandfathered in.  So I still have to pay $20/month for it.  Boo.

huskypuppy14

It sounds like you have pretty crappy insurance OP. I'd definitely ask what it would be without insurance.

I count my lucky stars that I have wonderful insurance. 

littlemushroom

hellosweetie1015 said:

littlemushroom said:

@hellosweetie1015‌ I am on Sprintec and it is $9/mo without insurance at Walmart. Maybe that brings it back into affordability range?

REALLY IT IS THAT MUCH CHEAPER? Yes, that's closer to affordable. I'll be moving my prescription today if my walmart's price is the same as yours.

ETA @littlemushroom you are the BEST. 

Aw, thanks! I really hope your Walmart has the same price.  Shop around if they don't.  I know Schnucks has a $4 prescription thing that covers different things than Walmart, so you might have a store near you that has it on their cheap prescriptions list.  Walmart just happens to be the most convenient to me, so I haven't shopped around much.