Aetna open access HMO with the Feds covers 6 monitored cycles. Those can be OI with clomid or clomid IUI or injectable IUI. But they won't approve IVF unless you've failed with injectable IUI. They told me three failed injectable IUIs to move to IVF. They cover 3 IVFs which includes all monitoring. But, if you are willing to wrangle with them and your dr goes to bat for you they will approve additional monitored cycles or allow you to move to IVF faster. They will not go over 3 IVF cycles ever.

Do not get your meds via Aetna. Get them on own from ANY OTHER pharmacy. It's actually cheaper that way and no Aetna red tape. So glad my doctor's office turned me on to this - they already knew about the nightmare.

I am in the middle of my two week wait after a first IVF cycle with Aetna HMO Open Access (federal). Once you are approved for IVF, they will pay for all your monitoring and b/w appts. Where they get you is in the cost of meds. I spent around $5k just for meds. Their cost for Menupor and Gonal-f are absolutely ridiculous. Also, working with the speciality pharmacy is a challenge. You will need to call them constantly in order to get your meds on time. I'm planning to switch to MDIPA assuming we will need to do another cycle. Btw, in older posts, there is good discussion/info on insurance pros and cons.

Anonymous wrote:

Anonymous wrote:OP here, 15:42 ... exactly. I'm just going to pay out of pocket. What they will cover is not worth paying for each monitoring and blood work appt. I'd pay more using my insurance.

Does Aetna not cover monitoring and B/W for IVF? We were planning on switching from MDIPA to Aetna (b/c we've maxed out MDIPA IVF coverage), but if I have to pay oop of B/W and monitoring I'm starting to wonder if it's worth it.

OP here. I *THINK* based on my conversation with them today, that if they approve you for IVF, they will cover the monitoring. But I also thought they would cover all of my IUI monitoring so it is hard to be sure. On the phone today they kept saying they couldn't tell me much about IVF coverage since I hadn't applied yet. It is truly maddening.

Anonymous wrote:OP here, 15:42 ... exactly. I'm just going to pay out of pocket. What they will cover is not worth paying for each monitoring and blood work appt. I'd pay more using my insurance.

Does Aetna not cover monitoring and B/W for IVF? We were planning on switching from MDIPA to Aetna (b/c we've maxed out MDIPA IVF coverage), but if I have to pay oop of B/W and monitoring I'm starting to wonder if it's worth it.

OP here, 15:42 ... exactly. I'm just going to pay out of pocket. What they will cover is not worth paying for each monitoring and blood work appt. I'd pay more using my insurance.

Now I don't know if switching to MDIPA makes sense or not. I'd have the ability to try a couple more IUI but we are about ready to move on to IVF anyway. I have a feeling it would be more simple to just move on to IVF with my current insurance.

I vaguely remember this happening to me -- I think I didn't bother because the cost of sperm washing and actual insemination are so low to begin with (compared to sonograms and dr time), it wasn't worth it.

Aeyna sucks. File an appeal. I am appealing their denial of my routine pap smear. Its a pain but do the appeal and switch insurance. I am switching, I switched to get ivf coverage which they promptly denied. I am switching to mdipa or back to bcbs. Good luck to you!

I was told specifically that Aetna allowed for 6 artificial insemination cycles only. They are now saying they will not cover monitoring for my 3rd IUI because I had prior clomid cycles covered. This makes no sense as I had 5 clomid cycles but the covered my 2nd IUI without an issue. Now someone there won't budge. Anyone faced something similar? Argh.

Regardless, despite the hassle of finding a PCP and getting new referals, looks like it's time for MDIPA.