s/o Federal Aetna plan and IVF - what do I need to know?

[Anonymous]

Currently under Aetna federal plans and will be doing a fresh cycle here in a few months. I previously had Federal BCBS but switched in order to take advantage of SGF's negotiated rate for FETs.

I will need to get preauthorization from Aetna for a fresh cycle. I will qualify for their infertility coverage based on my endometriosis and having tried other less expensive ART treatments no I'm not worried about that. What I'd like to know:

- Should I just continue using Prosperity Pharmacy for meds? They are great and I've heard Aetna just jacks up the meds price. I will price it out of course, but will it be less hassle to just use who I've used in the past?
-Were you successful in getting ICSI covered? We needed it for a previous IVF so I'm wondering if that's enough justification to get it covered this time around?
- Were you successful in getting PGD or CGH covered to test for normal embryos? No known genetic issues here.
-How long does it take for preauthorization to kick in? Are we talking weeks or months?
-What else am I not thinking of?

[Anonymous]

It's been a few years and I can't remember eveything but a few responses:

The authorization took weeks not months, it was actually fairly quick. Maybe 2-3 weeks?

The meds were a mess. They do jack up the price and then you pay 1/2, but it was still cheaper (by $200-300 so not a huge savings) than getting them elsewhere. The hassle was immense for me though, at least with one of my cycles we almost had to delay because they weren't processing my order correctly. Then again, we didn't actually have to delay and it worked out.

ICSI was covered for us (male infertility) and we did not ask about or do any genetic stuff.

Good luck!

[Anonymous]

I'm surprised to see that federal benefits differ according to which clinic you go to. Is it just the same as being in or out of network? I'm new to this...

I will be in a position to choose federal health insurance this summer, and I expect this is also when we will start treatment at Columbia Fertility (not sure yet if it will be IUI or IVF). Do you have any recommendations for best federal plans for coverage? I asked this on another thread but got no reply! Would really appreciate your insight.

[Anonymous]

MDIPA, Aetna and Kaiser are the best federal plans for ivf, in that order. However, mDIPA will require primary care referrals for things, and Kaiser is extremely restrictive on where else you can go. I am currently on my spouse's non-federal Aetna plan, which covers 90 percent of infertility services but has a infertility cap of $10,000. I will be switching to MDIPA in November during open season.

To the original poster -- ICSi is usually covered, PGD/CGH is never covered by any of these plans. Pre-authorization for me was relatively painless and should be for you as well given your history. Check your lifetime fertility cap before buying meds with Aetna. I bought mine separately because they will eat into your fertility cap. And aetna does jack up the prices of its meds.

Good luck!

[Anonymous]

Thanks so much for the insight on different federal plans. I am a contractor now and on a good plan that is pretty generous with infertility, but will switch to Fed this summer. So I will likely already be in the process of treatment with the clinic when I have to switch plans. I wonder if that will cause a problem...