Aetna Maxed out
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Anonymous
| Just maxed out Aetna benefits. I've got fed coverage. Which plan to go to next? |
Anonymous
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I just asked this question a couple of days ago. Seems the general consensus was MDIPA. I called MDIPA to find out about coverage and they said a couple of good things:
1. if you have proven infertility, then you do not need ot have the required 2 years TTC (which is important for me because we did 5 IVF cycles to have my 2nd child who is now 8 months old) AND 2. if you are already with Shady Grove (we are) you can stay there AND 3. they do not count cycles with other insurance plans against you...your 3 cycles per live birth count while you are covered WITH THEM. |
Anonymous
| For fed coverage, MDIPA covers IVF. I had MDIPA last year and it is much better than Aetna (which I have this year) for IVF coverage because it is a lot less expensive for IVF meds and you don't have to wait and pray for days and days for meds and refills. Freedom Pharmacy is one of MDIPA's vendors (based on my experience last year) so you can call Freedom and get the meds that you need right away, including refills. With MDIPA, you only need authorization for IVF treatment and that is what authorizes you to get meds. Unlike Aetna, no additional authorization for meds is needed. In my experience, Aetna takes about two weeks to authorize meds for you and they don't even give you the amount of meds the doctor orders. If you need more meds, you have to go through the entire process again. I needed refills on one of my meds today (since Aetna did not authorize me for the amount that my doctor originally ordered) and Aetna still has not authorized my refills so I can't get the meds. I am in the middle of treatment and I can't get meds that I need from Aetna. In terms of meds, after experiencing both MDIPA and Aetna, MDIPA is a thousand times better. One word of caution, with MDIPA, once you start injections for IVF, it counts as one treatment even if the cycle gets cancelled. |
Anonymous
PP, did you have trouble getting IVF coverage with Federal-Aetna after switching (assuming you maxed out your MDIPA coverage last year)? I currently have MDIPA (now maxed out IVF coverage). We will pay oop for another FET this year, but if it doesn't work I'm considering switching to Aetna for whatever minimal coverage we can get. |
Anonymous
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I am also a Fed and have just maxed out on my Aetna coverage and plan to change to MDIPA during Open Season. I am already with Shady Grove and have had 3 failed IVF cycles in the past. It sounds like this won't count against me as a pre-existing condition for MDIPA?
Also, I know you need a referral with MDIPA to go to SG. I want to begin my next cycle ASAP in January. Does anyone know of any reason why I would be delayed from doing so? (ie, because of changing insurances, needing a referral etc.) |
Anonymous
I was already a patient at SG and did not need to get a referral when I switched to MDIPA last open season. I needed to have a PCP's name registered with the insurance and tell SG who it was, but I never had to get in touch with PCP for a referral. SG filed for approval the first week of January, and my IVF was approved in late January. |
Anonymous
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Thanks for your reply. A few more questions, if you don't mind.
1) If you have a husband or partner, did you sign up for the MDIPA Family Plan? It is quite a bit more expensive than the Self Plan but I figure you need it bc normal inusrance (though my husband's work) won't cover his part of the IVF. Is this right? 2) Can I register a PCP now with MDIPA and/or SG. Or do I have to wait for the first week of January? If possible, I would like to do my stims in early January so it would be good to have as much done now in advance as possible. Thank you! |
Anonymous
I was only working part time and my husband is the fed, so the health insurance was through him. I'm not sure how it works if you guys have different insurance. I don't think you can register your PCP with MDIPA now, before you are a member. What I would do, though, is pick a PCP who takes both your current insurance and MDIPA, and become a patient now. I hear a lot of PCPs don't accept new patients that have MDIPA HMO (of course, you might have the same issue with Aetna, I don't know, but my previous PCP would take new BCBS patients but not MDIPA). I think early January might be optimistic for starting stims, although I have heard of people here for whom everything was approved within a week. Not for me, and SG told me that at the beginning of the year, when lots of people switch, approval can take up to six weeks. I think it took about 3 weeks for me. And then I had to wait for my next period, of course. I ended up with a transfer during the last week of March. |
Anonymous
| Thanks a lot for the information, very helpful. |
Anonymous
NP. I was a patient at SG and switched to MDIPA this year. I did have to get a referral from my PCP even though I was already a SG patient. If you switch to MDIPA next year, expect January to be a down month getting paperwork and approvals in order. I was ready to start IVF in early feb. |
Anonymous
PP here. I did not have any trouble getting Fed-Aetna coverage after switching from MDIPA. Aetna did not count the IVF cycles I did with MDIPA towards my max. |
jindc
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I have a few questions since so many of you are experienced - which is a huge help for me!
If I'm going to select MD IPA for open season, if I find a doc who takes both (GW docs do) and get a referral to the RE for treatment/IVF before January - before I'm on MD IPA, will they make me go back, or will that document transfer over? the Aetna I have (CDHP PPO) has no fertility coverage, but if I get a check up and say I need this, I'm sure I could get it....I thought if I could do that before January if it can work well that way, I might as well. Second question - is there a reason to do "self plus family"? My husband and I were both just going to get our own insurance plans - maybe even the same, just individual self plans. Along those lines, if next year we get on the same plan, do my three attemps with MD IPA start over as long as I'm under the lifetime limit for cost? Lastly! From experience, what is the cost difference with FET? I'm hoping with an ER procedure, I can have some to freeze and avoid using my three chances, if I have to, right away....do the drugs count the same, or do you pay for them out of pocket? I don't know these things. Thanks, all - this is very educating! |
jindc
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FYI, I tried to preemptively make an appointment with someone who takes MD IPA so I could avoid an IVF delay as much as possible, and the FIRST appointment at GW MFA for a new patient was Jan 14th 2013 so if you're thinking of changing and will need a referral, get in there.
That'll delay us, for sure. |
Tizzy
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| Hmmm. Is there a reason why anyone doesn't choose Kaiser? From the information, it seems like it's not a bad bet. Anyone used Kaiser? |
Anonymous
| Kaiser sends you out to Shady Grove for fertility treatments. So you don't get a choice about which clinic to use. |