Aetna & IVF Meds - WTF?
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Anonymous
| We switched to Aetna during open season because they offer better coverage. Got started on our first round of IVF 10 days ago. Supposed to switch to stimming on the 13th, but Aetna still hasn't authorized the meds. The order was put in on the 3rd. The pharmacy told me yesterday that Aetna has 72 hours to authorize, but that they still haven't heard back even though we're past that window. Now I'm going to have to call and fight with them today or I won't have the meds in time to start. WTF???? Is anyone else having this problem? And if you are with Aetna and expecting things to be working, you might want to call and check. |
Anonymous
| I just switched to Aetna too. I am doing an IUI. I was on the phone with them, doctor's office and pharmacy yesterday for about 2 hours. Procedure approved, meds not yet authorized. So annoying. Anyway good luck I hope it all works out for you. Everytime I call Aetna I seem to get a different person and have to explain why I am calling all over again! |
Anonymous
| I used Freedom pharmacy and they are very agressive with getting the approvals with insurance companies. Your problem may be that the pharmacy you picked sucks. You might have better luck with another Pharmacy. Call Freedom and ask if they take your Aetna plan. |
Anonymous
You don't have a choice -you have to go through Aetna's specialty pharmacy to receive benefits on fertility meds. The problem is that Aetna requires multiple authorizations, and it seems like someone along the line drops the ball on one of them. The problem is pinpointing what exactly is missing. So, no, the problem isn't that OP's choice sucks. OP has no choice. |
Anonymous
| Pp- this is OP. We were told the same thing. Everything is authorized except meds. Today we were told they have 14 days to authorize meds!!! I had the pharmacy ping Aetna again and tell them that we are supposed to start the 13th. Maybe that will move them. So frustrating. And no, no choice on pharmacy. Besides, it's not the pharmacy that's the hold up. |
Anonymous
|
OP, you might need to call a couple of places to find out what specific piece of paper they are missing: auths from doc (describing meds), some auth that Aetna processes...but I wouldn't necessarily rely on the pharmacy.
I dealt with Aetna last year, and getting everything in place was one of the most stressful parts of the whole process. Just keep calling around -we finally found out that even though our IVF authorization had been filled out by our doc and approved by Aetna, a drug auth of some sort from the doc was missing. It always amazed me that Aetna has their own pharmacy that deals with a lot of infertility patients, yet noone can seem to easily figure out why something isn't processing. Good luck. I've been there, too. |
Anonymous
| Given the fact that you are so close to the start of the cycle I would engage your HR rep in charge of insurance to navigate this on your behalf. They will have access to people other than the front line customer service reps and might be able to clear this up easier. |
Anonymous
|
I've just gone through similar with Aetna. They are so awful!! I'm supposed to start shots tomorrow and I'm waiting for my meds to be delivered this afternoon. This is after a couple of weeks of freaking out about not getting my meds in time. What I learned is that after your cycle has been authorized by aetna (the start date was authorized for 2/6--I am supposed to start meds tomorrow 2/10!!!), then the specialty pharmacy percertification department (866-503-0857, option 2) takes the paperwork and certifies your meds. The information is then fwded to the pharmacy itself and a nurse is supposed to call you to schedule delivery (it will be sent overnight).
I called the general specialty pharmacy line-their fertility dept (866-782-2779, option 4) to check up on my meds precert and explained told them my hurry and gave them the start date for meds. They said they'd send an email to the precert. dept to see if it could be expedited but they also suggested I follow up with the precert dept. as well-which I did. Yesterday, I heard from my dr.'s office that my meds were authorized and that the nurse from aetna should be calling. Of course they did not, so I called them myself and they set up the delivery. Be prepared to give them your credit card info. They send the meds UPS and apparently schedule the delivery for the morning. Of course I didn't know this because UPS always delivers to my house in the PM. So I was out when they delivered this morning, but I got lucky and was able to get them to come back (would otherwise have to go to Laurel to get my meds!) I can't tell you how much I hate aetna after all of this. Call me paranoid but I can't help but think they make it difficult on purpose. And to think they do this to people who are already stressed out going through infertility tx!!! So wrong. But, all the best to you. You're right- really think the best thing to do is be persistent-keep calling back and speak to supervisors if you need to. |
Anonymous
| Another one here, I just called the pharmacy again and they have no record of my prescriptions or authorizations. I start the 14th so I have a few days but what a mess! |
Anonymous
| I just called back again and this time they said they have the prescription but it is not valid so I need to get another one with the Dr's signature and a cycle sheet attached. I was like, hello, first you dont' have it, now you have it but its not acceptable... was anyone going to tell me that??? |
Anonymous
And if you call back again to confirm what you just heard, I am sure you will get a different story. Aetna was such a pain, when I needed more meds part way through the cycle, I just went to Grubbs and paid out of pocket. The price difference wasn't huge, and Aetna was giving me an ulcer. |
Anonymous
| This brings back memories! I did two IVF cycles with Aetna before switching to MDIPA which is about 4K cheaper for meds and no hassle! My favorite Aetna story was when they were out of the trigger shot and weren't getting it in for 3 months. Despite the fact that they didn't have it they wouldn't authorize me to get it anywhere else! I finally decided it wasn't worth the cost of the shot out of pocket to spend hours of my time on the phone fighting with them. I just got it from my local pharmacy. Seriously, if you check the price of the Aetna pharmacy vs. others the prices difference isn't that much since Aetna almost doubles the cost of their meds. One thing I did learn is order your meds ASAP as there is always a break down in the system and make sure you tell them you need them a week before you actually do - then you might get them on time. |
Anonymous
| How much was the trigger shot out of pocket? |
Anonymous
| I'm so sorry you ladies are going through this. I went through 2 cycles with Aetna 3 years ago and I still remember how upsetting it was when they f'd up. It's ridiculous. |
Anonymous
| You are lucky most insurances don't cover any ivf |