Federal AETNA Open Access and Male Factor - Confused!

[Anonymous]

I've been searching this forum and have found some discussion around this topic, but I still don't think I have my answer. I'm looking at my husband's federal AETNA Open Access Plan. Has anyone on this plan had the experience of having them provide an insurance benefit for IVF BEFORE 2 years of documented infertility?

My husband has 1% morphology. Is this considered male factor, and if so, will this AETNA plan provide coverage sooner than 2 years? We will have been TTC #2 for exactly 1 year by time the plan would start in January 2010. If we would need to wait for another year, I'm not sure I see the point in switching to this plan until 2011. While AETNA does provide IUI coverage at 50%, the premiums are much higher than my current plan (CIGNA) and we would be losing other benefits. And there's always the chance (let's hope) that I'll get pregant early in the year and will be stuck with those high premiums!

This is a tough call, but the 2 year detail is a big deal. I've read the fine print and called but still confused. So I'm looking for someone's personal experience with this. Thanks!

[Anonymous]

As I understand it, when there is male factor you can immediately go to IVF.

[Anonymous]

I had the same situation as you--covered by federal Aetna Open Access, had been trying for fewer than 2 years, we were both 30, and husband has morphology problems. Our clinic (Muasher Center, which I highly recommend) submitted all of our testing info to Aetna per their requirements, and they authorized us to go straight to IVF. We were told beforehand that "you never know" what they'll do. Based on reading their policy, speaking with Aetna reps and our clinic, they do NOT have to authorize IVF right away with male factor. IVF is only authorized if Aetna determines based on your overall picture that a less expensive (IUI) method of treatment will not be effective. Sounds like our husbands are drinking the same water, LOL, because they had the same morphology results. I wish I could say that guarantees an approval for you, but they could still stick it to you and require you to do rounds of IUI before doing IVF. My clinic had this happen with Aetna and other insurances--the insurance companies reportedly hope that the patients will just end up doing IVF but pay for it out of pocket.

On the positive side, overall I had a good experience going through Aetna. They did approve the IVF without forcing us to do other things. We did one round (unsuccessful) and they really did pay 50%--PLUS we saved money because just having some kind of coverage means that you pay half of the negotiated rate b/w the insurance company and the doctor. If we had no coverage, the rate would be much higher. After my experience, I would advise to keep this coverage.

[Anonymous]

OP, we were male factor though w/o insurance coverage. I'd recommend speaking with your RE's office about this. Our clinic nurse had tons of experience dealing with the insurance companies and knew how other patients had been treated. We found our nurse to be very helpful with this stuff.