Aetna insurance- makes me want to cry

[Anonymous]

I am seriously in tears right now. I HATE OUR INSURANCE. I was getting really excited about doing acupuncture after seeing that I qualify for 26 sessions per year. Except, there are no in-network Aetna providers within 200 miles of Washington DC. You would think that they would make some kind of an exception and contribute towards an out of network provider, BUT NO. No, they will not contribute ten cents since we have no out of network coverage.

And I'd pay for it myself if I wasn't already so broke from paying thousands of dollars to cover 10% of two different IN NETWORK surgeries this year and getting ready to pay 100% of IVF. I just cannot win, seriously. Some days it feels like everything in the universe is just ganging up on me.

[Anonymous]

At least you have insurance.

[Anonymous]

I'm so sorry you are going through this and especially now.

We've had similar frustrating experiences with them. Not only will they not pay a penny toward any alternative medicine, but they have also denied my claims for in-network providers because they don't think they're medically necessary (in spite of my doctor having made a referral). I cannot wait until we can switch to another insurance company during open season.

[Anonymous]

13:15: Yes, at least I have insurance and I am grateful for that. Honestly, though, I guess I have gotten lucky my whole life with excellent coverage and I just expected better. We are both well educated with professional jobs, why shouldn't we have decent health insurance?

13:17: Thanks! They are just awful. Unfortunately, neither my husband's company or mine offers any better options. That is what boggles my mind: he works for a Fortune 500 "Top 20 Company" and I CANNOT UNDERSTAND how this is possible! Mine is small, so it's understandable, but I just can't comprehend how the employees at his enormous company have not put their foot down about this. I cannot be the only person out there with infertility or even just health problems in general!!

[Anonymous]

Aetna is terrible, IMO, and we've had 4 or 5 different providers in 5 years. They are the stingiest and the worst, no contest.

Here's something to make you quake even more, OP. You will get pregnant, eventually, and if you still have Aetna, count on them paying like $125 for your entire delivery.

If your kid needs some OT, ST, and PT ... too bad! Aetna covers 0% of that (barring catastrophic accident).

Seriously, they suck. OP's husband should be mad at his supposed "top 20 places to work" employer. Whomever wrote that Fortune article didn't delve too deeply.

[Anonymous]

Anonymous wrote:I am seriously in tears right now. I HATE OUR INSURANCE. I was getting really excited about doing acupuncture after seeing that I qualify for 26 sessions per year. Except, there are no in-network Aetna providers within 200 miles of Washington DC. You would think that they would make some kind of an exception and contribute towards an out of network provider, BUT NO. No, they will not contribute ten cents since we have no out of network coverage.

And I'd pay for it myself if I wasn't already so broke from paying thousands of dollars to cover 10% of two different IN NETWORK surgeries this year and getting ready to pay 100% of IVF. I just cannot win, seriously. Some days it feels like everything in the universe is just ganging up on me.

I also have Aetna, and no there are no in-network acupuncturists in the DC area. However, I did find flex-spending to help with covering my acupuncture costs. Ultimately, it was still out of pocket, but because it was flex-spending, it took the sting out by already coming out of my check pre-tax.

I know that doesn't help that much, but it's better than nothing.

[Anonymous]

OP -what state are you in? If you are in MD - you should have decent fertility coverage. Also - when I had Aetna several years ago - they didn't cover accupuncture, but they had anotehr program that covered it if you went with a provider on their list. I used it and paid a $25 copay for each visit. i don't remember what the program was called but there should be some informatuion on it if you look at their website or if iti s a service your employer has allowed. I think it was under something called natural therapies.

Finally - I have had success getting pregnant with and without accupuncture (my trouble is staying pregnant). I can't say for sure if accupuncture helps except that it is very relaxing for me. I think your state of mind is very important if you are trying to conceive. If you can't swing accupuncture try meditation or something else that relaxes you.

[Anonymous]

OP here. We live in Virginia but I would happily (ok well maybe not happily, but I'd do it nonetheless!) move to MD if it would make a difference in our fertility coverage. DH's main office is in DC but he also works out of MD and VA during the week. I was told that whether we lived in MD or not, his company was excluded from this because it is not BASED in MD.. its headquarters is in a different state entirely and that is where the health plan is written, so it didn't matter where we lived. If anyone thinks this may not be accurate, please let me know. We are renting, so we really could, and would, move!

I will look into the Aetna program but when I called today I was begging the guy for any way to get around this and he did not seem to know of anything at all.

13:38.. I have thought about the cost of delivery and potential therapies too. Counting the days until DH can find a new job, which is unlikely anytime in the future.

[Anonymous]

Unfortunately, that sounds accurate. Insurance is governed by the state where the company is headquartered, not the states where the various employees live -- understandably, that could be quite confusing to administer. But I'm sure that doesn't make you feel better to know that the policy is awful.

[Anonymous]

Omigosh, I could have written this three months ago. I have similar Aetna insurance. I heard the same thing: covered for infertility acupuncture for 26 sessions per year. Then I discovered, like you, there are no in-network Aetna providers within 200 miles of Washington DC. So I kept asking, why can't you cover someone that is technically out of network if there is no in-network? I kept hitting brick walls - to put it politely, it was clear that most of the people on the end of the line were not trained on how to answer such a question.

After getting screaming and ripping my hair out during several lunch hours, I finally decided to calm down and just kept calling back to try to get someone else on the line, asking for supervisors, etc. Finally I did get someone to told me they CAN give me an exception: IF I got a letter from my Doctor defining the problem, identifying the problem, and then naming the exact service provider that needs to do it. It took a bit of time for my RE's billing people to do that but they eventually did and Aetna approved it. Then Aetna gave me an exception number that is like solid gold to me: It means I need to pay cash for Acupuncture and ask the acupuncturist for something called a "Superbill" that uses special insurance codes and I submit that (with the exception number written on it) and FINALLY I get reimbursed.

It is a sucky, sucky process and is ridiculous that even if we do get insurance to cover these types of things, it there is still such a runaround. I wish you luck (and patience!) and hope it all works out for you!!

[Anonymous]

Anonymous wrote:OP -what state are you in? If you are in MD - you should have decent fertility coverage. Also - when I had Aetna several years ago - they didn't cover accupuncture, but they had anotehr program that covered it if you went with a provider on their list. I used it and paid a $25 copay for each visit. i don't remember what the program was called but there should be some informatuion on it if you look at their website or if iti s a service your employer has allowed. I think it was under something called natural therapies.

Finally - I have had success getting pregnant with and without accupuncture (my trouble is staying pregnant). I can't say for sure if accupuncture helps except that it is very relaxing for me. I think your state of mind is very important if you are trying to conceive. If you can't swing accupuncture try meditation or something else that relaxes you.

OP - I am the above poster. You are correct - it depends on where your employer is based. forgot about that technicality. In the meantime, iwent on the Aetna website and found something similar to the program I referenced above:

http://www.vitalsavings.com/vision.aspx#vision
Scroll down to natural products and services.

I couldn't tell how you sign up - in the past, you could do an instant search for a provider. I think it is a different administrator. But call them anyway...you never know. Let me know how it works out!