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benefits: reasonable & customary charges for Menopur


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#1 muffin#1

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Posted 14 September 2016 - 08:14 PM

Hi, Would anyone please share their cost paid per vial of Menopur 75? Or have any tips dealing with their group benefits medication coverage?

 

My group benefits is claiming that I was charged more than the "reasonable and customary charges" for DIN 02283093. As far as I can tell I got a great price of $70 per vial (less than Shoppers and Glen Shields!). I am looking for recent charges within Ontario.

 

Any advice much appreciated!

 

 


Me: 39 43 and DH: 33 37, TTC #1 since August 2014
Dx: Unexplained / egg quality? / asymptomatic endometriosis! (? cervical factor), some low morphology but high overall counts

 

1 missed m/c, 12 medicated cycles, 5 IUIs, 3 IVFs
 

Feb to May 2018 - FET#1

3 months of Lupron Depot, acupuncture, adding in Prednisone, intralipids, PIO, Fragmin, and the kitchen sink

Feb 27 - Lupron #1, Mar 27 - Lupron #2, Apr 23 - Lupron #3

May 25 - Transfer 1x 3AB now 6AA hatched blastocyst

Jun 1 - 7dp5dt HPT BFP!

EDD: Feb 10, 2019 - hoping our luck continues!!

 

(data dump in 'About Me')


#2 idream

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Posted 15 September 2016 - 05:07 PM

Hi, Would anyone please share their cost paid per vial of Menopur 75? Or have any tips dealing with their group benefits medication coverage?

 

My group benefits is claiming that I was charged more than the "reasonable and customary charges" for DIN 02283093. As far as I can tell I got a great price of $70 per vial (less than Shoppers and Glen Shields!). I am looking for recent charges within Ontario.

 

Any advice much appreciated!

 

 

 

what do they say is a reasonable charge?


Tough Times Never Last, but Tough People Do


#3 Watermelon

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Posted 15 September 2016 - 06:26 PM

Hmmm I paid $70/vial in 2014 from my clinic. I'm pretty sure it would be a little more now. I don't think my clinic had unusually low costs...

Perhaps your insurance company could point you (and heck all of us) to this 'reasonable' cost source they believe is readily available....unbelievable...

Me -29 31- unexplained poor egg quality. I was told I had endometriomas.....but repeat ultrasounds at other clinics have said no sign of endometriomas. Maybe PCOS-like ovaries, but no PCOS - AMH, AFC are great. No one can explain why my eggs are so poor sad.png

DH 30 - severe teratospermia, count and motility are excellent.

May 2014 - 2.5mg femara - BFN (ovulated night before)

June 2014 - IUI with 5mg femara - BFN (ovulated night before)

August 2014 - IVF with ICSI - Antagonist protocol, 150Bravelle, 75 menopur, stimmed 8 days

- 19 follicles (all 15-22mm at trigger), 12 eggs retrieved, 7 mature,, 5 fertilized with ICSIsad.png

- only 7 mature eggs with an estrogen of 20000?! wtf?! Sigh...Freeze All

-only one BB Blast made it. Freeze "all" became "freeze one". All others arrested between day 3 and 4 sad.png

January 2015 - FET of lone embryo - c'mon little figher

- BFP!!! Beta 1 475 at 10dp5dt , Beta 2 - 1495 at 12dp5dt

Baby boy born Sept 28/15


#4 muffin#1

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Posted 15 September 2016 - 07:31 PM

They won't tell me what is reasonable and customary... They feel that about $43 per vial is the going rate? Hahahaa.

Not sure what to do other than tell them that Rexall and Shoppers charge about $97/vial. They have covered all of my other fertility injectables almost fully (which is great!). But not the Menopur!


Me: 39 43 and DH: 33 37, TTC #1 since August 2014
Dx: Unexplained / egg quality? / asymptomatic endometriosis! (? cervical factor), some low morphology but high overall counts

 

1 missed m/c, 12 medicated cycles, 5 IUIs, 3 IVFs
 

Feb to May 2018 - FET#1

3 months of Lupron Depot, acupuncture, adding in Prednisone, intralipids, PIO, Fragmin, and the kitchen sink

Feb 27 - Lupron #1, Mar 27 - Lupron #2, Apr 23 - Lupron #3

May 25 - Transfer 1x 3AB now 6AA hatched blastocyst

Jun 1 - 7dp5dt HPT BFP!

EDD: Feb 10, 2019 - hoping our luck continues!!

 

(data dump in 'About Me')


#5 ilovemydogs

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Posted 15 September 2016 - 10:35 PM

I paid $76 last year and had no trouble claiming.
Finally seeing the light at the end of the tunnel.

See "About Me" for details.

#6 muffin#1

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Posted 16 September 2016 - 07:06 AM

Thanks, idream, Watermelon, and ilovemydogs, I wished you all worked at Manulife and were dealing with my claim ;)


Me: 39 43 and DH: 33 37, TTC #1 since August 2014
Dx: Unexplained / egg quality? / asymptomatic endometriosis! (? cervical factor), some low morphology but high overall counts

 

1 missed m/c, 12 medicated cycles, 5 IUIs, 3 IVFs
 

Feb to May 2018 - FET#1

3 months of Lupron Depot, acupuncture, adding in Prednisone, intralipids, PIO, Fragmin, and the kitchen sink

Feb 27 - Lupron #1, Mar 27 - Lupron #2, Apr 23 - Lupron #3

May 25 - Transfer 1x 3AB now 6AA hatched blastocyst

Jun 1 - 7dp5dt HPT BFP!

EDD: Feb 10, 2019 - hoping our luck continues!!

 

(data dump in 'About Me')


#7 Yearning

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Posted 16 September 2016 - 10:19 AM

I am going to take a bit of a wild guess and say there is confusion between the way the pharmacy billed the vial of Menopur and the way the insurance company wanted it billed. Call Manulife and ask them whether they think you got 1 ml rather than 1 vial which has 2 ml. I have seen this on several occsions.
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#8 muffin#1

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Posted 28 September 2016 - 09:31 AM

Thanks Yearning, I think there is definitely something weird going on. I got 2 different Shoppers that have my drug plan on file to give me a quote. Both pharmacies resulted in "patient pays" numbers much much closer to 90% of the $97 they charge per vial. 

 

I will continue to pursue this!


  • Yearning likes this

Me: 39 43 and DH: 33 37, TTC #1 since August 2014
Dx: Unexplained / egg quality? / asymptomatic endometriosis! (? cervical factor), some low morphology but high overall counts

 

1 missed m/c, 12 medicated cycles, 5 IUIs, 3 IVFs
 

Feb to May 2018 - FET#1

3 months of Lupron Depot, acupuncture, adding in Prednisone, intralipids, PIO, Fragmin, and the kitchen sink

Feb 27 - Lupron #1, Mar 27 - Lupron #2, Apr 23 - Lupron #3

May 25 - Transfer 1x 3AB now 6AA hatched blastocyst

Jun 1 - 7dp5dt HPT BFP!

EDD: Feb 10, 2019 - hoping our luck continues!!

 

(data dump in 'About Me')


#9 Yearning

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Posted 28 September 2016 - 04:55 PM

It can be a bit of a challenge to figure out how an insurance company wants something billed sometimes. One insurance plan will want the pharmacy to bill by the number of vials the patient gets and the next insurance plan will want it billed by how may mls the patient receives. You don't always know which way is right. It is not the pharmacy or the insurance company trying to pull a fast one but a miscommunication between the two.