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mnmsoinlove
Mommy to 2 sweet girls!
Member since 3/09 8585 total posts
Name:
Melissa
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beyond disgusted
Today I received a letter in the mail from my insurance company AETNA. They letter explained that I would only be allowed to do one more iui and that all further fertility treatments have been denied. In addition it says I am only allowed two more sonograms. When I called them I got no where. When I first enrolled in the fertility program I was told I had unlimited iui and now this. At first they didn't even want to let me do this upcoming iui but I lost it on the phone, and I've already done clomid this cycle. I have no idea what we are going to do...I just want answers.
Did I mention I hate insurance companies.
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Posted 10/26/09 7:55 PM  |
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shelby34
Love being a twin mommy!
Member since 5/07 2934 total posts
Name:
Michele
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Re: beyond disgusted
Ugh! I am so sorry! I TOTALLY feel your pain....my insurance covers nothing for IF. Not one IUI, no IVF, no meds, and I pay $244 for every sono....
These insurance companies are the worst! They will spend money covering viagra for old men, but no IF treatments for us! So insane...
Good luck! I hope you can get somewhere with your insurance company.
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| Posted 10/26/09 8:12 PM |
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smp123
Praying for the LOs!
Member since 1/09 1630 total posts
Name:
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Re: beyond disgusted
UGH i hate insurance companies SO MUCH. i fought and fought and fought with my insurance company until they covered my IVF cycle. just keep annoying them...and i mean ANNOY. i called them every day. i got the private number of the main nurse in charge (somehow) and called it every day. if they already told you they would cover all iui's, they cannot change it now. did they ever send you information regarding your coverage? if you ever got certified to go ahead with the iui's, did they send you anything?
if you have anything in writing let them know they cannot chance their minds now. good luck and keep trying - they usually give in if they are annoyed enough!
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| Posted 10/26/09 9:46 PM |
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sasha96
lovin' my 2 little ladies!
Member since 5/05 7401 total posts
Name:
Julianne
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Re: beyond disgusted
does your company's health insurance plan include an advocate? DH has aetna and the company also includes an advocate if you need (which is like an oxymoron to me...yes, we like this plan but here is someone to fight them).
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| Posted 10/27/09 6:21 AM |
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nycgirl
Angels!
Member since 3/09 7721 total posts
Name:
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Re: beyond disgusted
I would contact them & find out WHY.
It could be a paperwork thing.
I have switched to Aetna just 1 month ago and the coverage is pretty good. I did need to have some work done before they declared my "infertility."
I did not have them for my IUIs and work up.
Maybe you hit your annual max? It's easy to do if you have had some testing, IUIs, sonos ect. These things add up fast.
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| Posted 10/27/09 8:47 AM |
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Blu-ize
Plan B is Now Plan A
Member since 7/05 32475 total posts
Name:
Susan
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Re: beyond disgusted
Most people's plans are dictated by their companies they work for since it's an extra benefit that they fund.
Just because you have the same insurance company as someone else doesn't mean your benefits will be the same.
I agree with the PP...get on them every day until they change their minds.
Speak to whomever you have to.
Good luck, and I hope you get it covered.
I think it's awful what insurance companies do. They make people jump through hoops for IF coverage and cover everything else under the sun.
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| Posted 10/27/09 8:59 AM |
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lolipep
My prayers have been answered
Member since 10/08 3642 total posts
Name:
Lori
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Re: beyond disgusted
Insurance companies stink!!!
I am so sorry you're dealing with this. Make sure you fight hard and good luck!!!!
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| Posted 10/27/09 9:12 AM |
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maybeamommy
Blessed beyond belief
Member since 10/07 17048 total posts
Name:
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Re: beyond disgusted
I'm so sorry!
I had issues with my insurance too.
We started seeing the RE and then found out that ALL of our benefits would be ending (even diagnostics!)
We ended up having to pay OOP for our IVF and FETs.
As part of budget cuts, my job dropped IF benefits to save money.
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| Posted 10/27/09 10:54 AM |
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michele31
LIF Adult
Member since 5/05 3372 total posts
Name:
Michele
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Re: beyond disgusted
It is not Aetna but the plan that is purchased by your employee. I know that Brooke Shields has a non-profit to help you understand your insurance coverage. I thought it was illegal NOT to cover diagnostics in NYS?
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| Posted 10/27/09 11:54 AM |
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skinny
3 boys and a princess!
Member since 11/08 8178 total posts
Name:
Momma
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Re: beyond disgusted
Did u contact your HR to find out if there was a change to the company's IF benefits? If not, I definitely would. I would keep calling back until I was told a reason.
Sorry u r dealing w/ this.....like IF isn't stressful enough on it's own!
FWIW, an IUI cycle is usually around $500 for a full cycle. I know that's not "cheap" but it's nowhere near the cost of IVF. There are grants for IVF that u can look into if u get to that point.
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| Posted 10/27/09 12:08 PM |
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mnmsoinlove
Mommy to 2 sweet girls!
Member since 3/09 8585 total posts
Name:
Melissa
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Re: beyond disgusted
After 3 hours on the phone this morning I was able to get this all sorted out. They (the insurance company) are not sure where the letter was generated from or why I have been denied. My benefits clearly state that I have unlimited iui and 6 sonos per cycle. So I was told to go ahead with my iui's as planned and they will work it out on there end. I'm so happy right now. I just hope they are right and I'm not socked with a huge bill.
Thanks everyone for listening and all the advice. It really is so aggravating to go through if treatments and than to run into a road block with insurance.
Message edited 10/27/2009 1:45:56 PM.
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| Posted 10/27/09 1:44 PM |
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MrsRbk
<3 <3 <3 <3
Member since 1/06 19197 total posts
Name:
Michelle
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Re: beyond disgusted
Posted by michele31
It is not Aetna but the plan that is purchased by your employee. I know that Brooke Shields has a non-profit to help you understand your insurance coverage. I thought it was illegal NOT to cover diagnostics in NYS?
This is correct. I live in NJ, so I'm not familiar with NYS. However, I do live in a state where IF coverage is a state mandate...HOWEVER, the loophole is how the plan is funded by your company. For instance, my company self funds, therefore they do not have to follow the state mandate. While I do have coverage, I don't have the coverage that is mandated by the state.
I do believe that Aetna has an IF line though. I know when we first started I had to deal directly with them. Again, I don't know if that's how my company has it set up, or if that's how Aetna is set up.
This is the number I have for Aetna Infertilty Hotline: 1-800-575-5999
Message edited 10/27/2009 2:06:00 PM.
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| Posted 10/27/09 1:55 PM |
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Makin-da-baby
Praying so hard this is it!!!
Member since 4/08 1391 total posts
Name:
Undercover Lover
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Re: beyond disgusted
That is excellent news!!! Glad it all is working out for you! 
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| Posted 10/27/09 2:24 PM |
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smp123
Praying for the LOs!
Member since 1/09 1630 total posts
Name:
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Re: beyond disgusted
Posted by mnmsoinlove
After 3 hours on the phone this morning I was able to get this all sorted out. They (the insurance company) are not sure where the letter was generated from or why I have been denied. My benefits clearly state that I have unlimited iui and 6 sonos per cycle. So I was told to go ahead with my iui's as planned and they will work it out on there end. I'm so happy right now. I just hope they are right and I'm not socked with a huge bill.
Thanks everyone for listening and all the advice. It really is so aggravating to go through if treatments and than to run into a road block with insurance.
that is great news! PLEASE make them send you that certification in writing!!
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| Posted 10/27/09 3:15 PM |
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BA2008
Need to find some hope!
Member since 2/08 2485 total posts
Name:
Beth -Ann
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Re: beyond disgusted
Posted by MrsRbk
Posted by michele31
It is not Aetna but the plan that is purchased by your employee. I know that Brooke Shields has a non-profit to help you understand your insurance coverage. I thought it was illegal NOT to cover diagnostics in NYS?
This is correct. I live in NJ, so I'm not familiar with NYS. However, I do live in a state where IF coverage is a state mandate...HOWEVER, the loophole is how the plan is funded by your company. For instance, my company self funds, therefore they do not have to follow the state mandate. While I do have coverage, I don't have the coverage that is mandated by the state.
I do believe that Aetna has an IF line though. I know when we first started I had to deal directly with them. Again, I don't know if that's how my company has it set up, or if that's how Aetna is set up.
This is the number I have for Aetna Infertilty Hotline: 1-800-575-5999
I think the NY Mandate is that Insurance companies have to offer IF coverage to large employers (more than 50 employees), but its up to your company whether they want to pay the money to have this coverage. Obviously, with the economy and budget cuts, this rider could get eliminated from many employer's insurance policies.
Though I think most policies cover basic IF. Its the IVF rider that is mostly denied by company's seeking insurance. But, it also depends on which policy they went with, who the insurance company is etc...
Glad to see you have coverage and that (as usual) the insurance company screwed up.
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| Posted 10/27/09 3:17 PM |
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diva7531
My Peanut
Member since 2/07 5199 total posts
Name:
Ryan 3 boys EDD 11/6!
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Re: beyond disgusted
Posted by BA2008
Posted by MrsRbk
Posted by michele31
It is not Aetna but the plan that is purchased by your employee. I know that Brooke Shields has a non-profit to help you understand your insurance coverage. I thought it was illegal NOT to cover diagnostics in NYS?
This is correct. I live in NJ, so I'm not familiar with NYS. However, I do live in a state where IF coverage is a state mandate...HOWEVER, the loophole is how the plan is funded by your company. For instance, my company self funds, therefore they do not have to follow the state mandate. While I do have coverage, I don't have the coverage that is mandated by the state.
I do believe that Aetna has an IF line though. I know when we first started I had to deal directly with them. Again, I don't know if that's how my company has it set up, or if that's how Aetna is set up.
This is the number I have for Aetna Infertilty Hotline: 1-800-575-5999
I think the NY Mandate is that Insurance companies have to offer IF coverage to large employers (more than 50 employees), but its up to your company whether they want to pay the money to have this coverage. Obviously, with the economy and budget cuts, this rider could get eliminated from many employer's insurance policies.
Though I think most policies cover basic IF. Its the IVF rider that is mostly denied by company's seeking insurance. But, it also depends on which policy they went with, who the insurance company is etc...
Glad to see you have coverage and that (as usual) the insurance company screwed up.
LOL, I spent almost 3 hours on friday and 3 hours yesterday (uhm, they told me to stop calling!) 
I was told that with Aetna, for some things you have to get pre-determination (your Dr has to send a letter stating that you are infertile, in case they didn't get that already!  )
Your ins sounds like mine, I have unlimited IUI's, b ut it seems to get sticky when it comes to injectibles, so prepare yourself! You will need the pre-determination, and it could be every month. Also, my Dr's office has someone who is dedicated to dealing with the ins. com. and they said they will handle it for me from here on out. Good Luck, I hope you don't have more issues in the future.
Oh and as for the state mandate, one of the PP's is right, if the company is self insured, then the state mandate does not come into effect.
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| Posted 10/27/09 4:27 PM |
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