Aetna Insurance

Does anyone have Aetna? They are instituting something, new to me, and my doctor hasn't dealt with this yet, where to be qualified for certain meds, I have to enroll in their Woman's Group or something like that, then was asked a million questions to prove that we are infertile, then my doctor has to call at the start of each cycle to get authorization for anything, even clomid. Every month. My doctor is used to doing this annually or every six months. Oh, and the nurse at Aetna did qualify me as infertile. The rules said she shouldn't, because I was pregnant in July. I was pregnant in July after 2.5 years of trying, testing, drugs, etc. she said the calendar restarts after cessation of pregnancy, and I would normally have to wait another year to qualify, but they made an exception. Hello. If I was infertile for 2.5 years of trying, don't you think I still am?

Re: Aetna Insurance

Well, I'm new to this journey so I don't know what Aetna was like before. But I have Aetna and just started seeing an RE.

I also had to call to register with the Infertility group or whatever. However, they deemed me "not infertile", instead I have "recurrent pregnancy loss". So that will affect what is and is not covered.

What's frustrating is when the clinic called they approved me. So now I'm totally confused on what's covered and what's not.

Insurance stinks.

Aetna Insurance

I have been taking meds, seeing doctors, all sorts of tests for a year. Now when I tried to get one prescription it turned into a nightmare. I am sorry you are dealing with it too.

Re: Aetna Insurance

I got pg with my dd in 09 with an RE and I had Aetna than. I had to register with their infertility department. I did not know this in the beginning and my first two visits including sonos were not covered. They basically evaluate you to see if you meet their requirements for someone who they believe needs to have fertility treatments. After you are enrolled I barely heard from them until I got my bfp and then they wanted to know about the pregnancy.

Re: Aetna Insurance

I have aetna too. Yes, I had to go through their questions in order to be deemed infertile. Although i've never had to get preauthorization for clomid. I have had to get preauthorized for injectible medicatinos, IUI and IVF.

I'll share with you my experience and a word of caution - find out ahead of time if it applies to your plan, which if its' Aetna, it probably does:

ALL of my injectible medications had to go through Aetna Specialtiy Pharmacy. It's a PITA!!! the doctors have to send them the scripts, wait for authorization and then they get shipped to you by them. You can pick up the script at a local pharmacy one time ONLY (even if it's a different medication). The whole process typically takes about a week before I ever got anything gets mailed. They do ship overnight (fedex and the meds come on ice), however, no deliveries are made on Sundays (no fedex that day). I think there were challenges with getting meds on Mondays too because they dont ship on Sundays, but i cant really remember.

There are also certain prescriptions that Aetna needs a hard copy original (NO fax) for. I know that Ovidrel and any other HCG medications like it. Apparently it's a NYS law and aetna is really strict about getting it in hand. Some of the local pharmacies, like Kruptners, may be a little more lax, but not Aetna.

Just make sure if you have to get any injectible medications, that you get them in advance and you get more than you actually need.

Lastly, i recommend that you stay on to of Aetna Specialty Pharmacy - make sure that they have everything they need, that the authorization is in process, call back to schedule delivery (even though they say they will contact you, i've never gotten that call), get a tracking number. Write it all down just in case. I've called so many times, I think i've gotten all the reps by now! LOL

GOOD LUCK!!!!!

Re: Aetna Insurance

Re: Aetna Insurance

I have United Healthcare and they made us do the same thing. A nurse checks in on us every few months. Other than that, no major issues.