Anonymous wrote:I am sure their "incompetence" is no accident. This is entirely consistent with other tricks and gimmicks that insurance companies use to discourage use of their benefits, as revealed in the debate around health care reform.

I am using Cigna (through DH) and only have good things to day. They covered all meds and three IVF cycles. The paperwork is minimal; everything is going very smoothly. Not all companies or plans are the same.

Has anyone been able to get refills on IVF meds from Aetna the day you need the meds? I am in the middle of an IVF cycle and need more meds today but Aetna still has not authorized my refill. My doc's office called and spoke directly with one of their representatives and was told they will try to get it done within the hour, and that was a day ago. I've been calling Aetna Specialty Pharmacy but I'm still getting the same answer... they are waiting for refill authorization. Why does Aetna make IVF patients get authorization for refills when we already have to get authorization for the treatment AND authorization for the meds (which took about two weeks to get)? It doesn't make sense!!!!!! NO IVF patient can wait a week for refills in the middle of an IVF cycle!!!!!!! Any advice from anyone who has been able to get a refill on meds quickly??? Thank heaven my doc's office gave me some meds while I wait and pray that Aetna will give me refills.

This is all interesting to me. We have Aetna Rx (BC for the health insurance). Neither covers any fertility...or so I have been told. I am kind of marveling at those who do have any coverage. Although maybe those of you with "coverage" aren't doing any better cost wise than I am out of pocket (regarding the meds).

I agree about all the incompetence seemingly done on purpose. Class action suit?

To be honest, I would expect coverage for fertility to get worse, not better. Especially under govt mandated universal coverage. Far more people are living longer. And with the skyrocketing obesity and all associated health issues, I believe insurance companies will start cutting benefits that don't have anything to to with preservation of the life of the covered person. Fertility would certainly fall into this category.

In NYS they have to cover IVF unless the employer is self-insured.

Anonymous wrote:I second 22:08. The paperwork is annoying, though I've found them to be helpful on the phone, but the benefits seem to be quite good. I just completed a cycle of IVF, and I will likely end up paying less than $2K. A lot of it also counts toward the out of pocket maximum as monitoring etc is covered as a regular visit rather than as a fertility treatment (which are covered at 50% of the negotiated rate--lower than what's billed--and do not count toward the annual out of pocket max).

My one recommendation is to try to find a PCP who takes MDIPA ASAP. Many don't, and the strict HMO structure of MDIPA means you need a referral for everything.

At what clinic was this? I paid close to 4K for my IVF cycle at SG with MDIPA. I haven't heard of monitoring visits not being billed as part of the cycle, and I believe we had to pay 50% for them.

This thread makes me glad we chose MDIPA over Aetna during the last open season. We were on the fence about them, because while MDIPA covers meds in full, they count it as one of your three tries once you start injectibles, while Aetna doesn't do that. So if the protocol doesn't work for you and you cancel the cycle, you have lost one attempt. But that seems to be MDIPA's only disadvantage compared to Aetna with regard to IVF. Gettting the meds with MDIPA was easy, you just order them through Freedom and approval was no problem. Luckily, we got pregnant on the first try, so how they count the cycles doesn't matter to us anymore.

I second 22:08. The paperwork is annoying, though I've found them to be helpful on the phone, but the benefits seem to be quite good. I just completed a cycle of IVF, and I will likely end up paying less than $2K. A lot of it also counts toward the out of pocket maximum as monitoring etc is covered as a regular visit rather than as a fertility treatment (which are covered at 50% of the negotiated rate--lower than what's billed--and do not count toward the annual out of pocket max).

My one recommendation is to try to find a PCP who takes MDIPA ASAP. Many don't, and the strict HMO structure of MDIPA means you need a referral for everything.

I am sure their "incompetence" is no accident. This is entirely consistent with other tricks and gimmicks that insurance companies use to discourage use of their benefits, as revealed in the debate around health care reform.

Anonymous wrote:My spouse is about to start a government job and as my current plan (Cigna) doesn't cover fertility, we are thinking of switching. Does anyone know if the govt offers a plan that does do a decent job covering fertility?

I had much better luck with MDIPA than with Aetna (as a Fed). MDIPA, while requiring all sorts of paperwork to be in place, seemed less frustrating than Aetna.

My spouse is about to start a government job and as my current plan (Cigna) doesn't cover fertility, we are thinking of switching. Does anyone know if the govt offers a plan that does do a decent job covering fertility?

Have to chime in that my experience with Aetna's Pharmacy was HORRIBLE too. At one point I was literally in tears on the phone with a supervisor because their incompentence resulted in the delay of my meds. FWIW, I'm not a Fed and the insurance with them still sucks. It's a racket and I'm convinced that they want to make it as difficult as possible for you to access your benefit while also making a ton of cash on fertility meds. I actually complained to my benefits department at my company about my experience.

I'm federal too.

I just can't believe the up charge on meds so they can claim a 50% benefit but you still end up paying almost the full price because they have doubled the cost. How can that be legal?

Anonymous wrote:

Anonymous wrote:Just had to add to the Aetna discussion. This is my 5th IVF with them so I know what a PIA they can be but this is new even for me. I have authorization for my cycle but I'm on an EPP which requires meds BEFORE the start of the cycle (estrogen patch) etc and they can't seem to comprehend this and won't authorization my meds until 10 days before my cycle starts despite the fact that some of the meds must be started prior to this. Ugh! Why do they make everything so difficult and why is this such a difficult concept to understand. I can't be the only pt on this protocol!

I'm convinced they make it this difficult on purpose to discourage people from using their "benefit". Call me paranoid but their level of incompetence is astounding--from their member benefits reps to the authorization office to the specialty pharmacy reps. Complete incompetence.

After three IVF cycles with Aetna, I would completely agree.

Anonymous wrote:Just had to add to the Aetna discussion. This is my 5th IVF with them so I know what a PIA they can be but this is new even for me. I have authorization for my cycle but I'm on an EPP which requires meds BEFORE the start of the cycle (estrogen patch) etc and they can't seem to comprehend this and won't authorization my meds until 10 days before my cycle starts despite the fact that some of the meds must be started prior to this. Ugh! Why do they make everything so difficult and why is this such a difficult concept to understand. I can't be the only pt on this protocol!

I'm convinced they make it this difficult on purpose to discourage people from using their "benefit". Call me paranoid but their level of incompetence is astounding--from their member benefits reps to the authorization office to the specialty pharmacy reps. Complete incompetence.

Compared to some of you, my experience is minor but still want to add that they are truthfully the WORST.

When I enrolled for fertility benefits the nicest man ever took my call had me feeling like I would be well taken care of and as if I'd chosen well. But the pharmacy is terrible.

So far, I've given up on fighting since my only real cost has been Ovidrel once per cycle. (They went from saying the Ovidrel had been ordered and was already mailed to me to saying that I had no coverage. And they kept Grubbs and CFA on the phone for hours trying to figure it out since every rep. had a very different story.) But if I do move on to injectables I fear it's going to all come out of my own bank account.

Are you all in the Federal plan or is it the same for everyone?

Just had to add to the Aetna discussion. This is my 5th IVF with them so I know what a PIA they can be but this is new even for me. I have authorization for my cycle but I'm on an EPP which requires meds BEFORE the start of the cycle (estrogen patch) etc and they can't seem to comprehend this and won't authorization my meds until 10 days before my cycle starts despite the fact that some of the meds must be started prior to this. Ugh! Why do they make everything so difficult and why is this such a difficult concept to understand. I can't be the only pt on this protocol!