Aetna and RPL testing

alleycat39

Did anyone else who has Aetna insurance has difficulty having their RPL testing covered? My initial testing was covered a few months ago (tested for beta2 glycoproteins, TSH, DRVVT, cardiolipin) but after this most recent loss we did more testing and the following tests are not being covered because they are "considered experimental and exploratory": Homocysteine, factor V Leiden, prothrombin mutation, and 2 others which I think are antithrombin and ?? Right now I'm left with a bill for $1208 which I did not expect at all. That's on top of the $550 I paid for the last D&E......and I'm still awaiting the bill for the Natera chromosomal testing( however I've heard that you can make a deal with Natera and pay just $100). It just never ends!

Campow83

Yes yes yes and it sucks!!! I have Aetna ppo and had full work up in May. Same thing, am still paying off D&C from feb and my $1300 bill from my bloodwork up. Payment plans are a lifesaver, I feel your pain

alleycat39

Campow83 said:

Yes yes yes and it sucks!!! I have Aetna ppo and had full work up in May. Same thing, am still paying off D&C from feb and my $1300 bill from my bloodwork up. Payment plans are a lifesaver, I feel your pain

Ahhhh, so sorry you are dealing with this too- totally sucks!

alleycat39

PetraStonegirl said:

Most health insurance companies offer different packages to different employers to pick and choose from, making this kind o question very hard to answer, because it might be apples and oranges. I have Aetna and the policy my DHs company bought covers all testing and corrections for the causes of infertility, but stops short of covering IUIs and IVFs. They covered the full RPL panel and the extended one ran after we lost the twins. The extended panel included the tests you specified, and they did cover it. You need to get a copy of your actual policy and see what the wording is. Once armed with that, call back and ask to speak to their 'patient advocate', most companies have them and they are paid by the insurance company to work against them, to keep them honest. As for the Factor V Leiden, that is for your health too. If you have even one copy of the gene, you are at increased risk for blood clots, DVT, and stroke. You cannot be given BCP without taking Lovenox injections at the same time, and would need to take low-dose aspirin every day for the rest of your life regardless. If you lose the fight on everything else, have that one rebilled under a different ICD-9 code to reflect your medical issues, not your fertility.

Thank you so much for that advice- I am going to speak to the RE and see if he can re-code it and resubmit

alleycat39

CFearsy said:

Oh, girl! I'm the wrong person to ask about insurance. I've been fighting with my insurance about whether I even have maternity coverage or not. They told me over the phone on multiple occasions that I do have maternity but now are saying "Oh, wait. No you don't. You never did." They initially didn't cover my D&C but then sort of fixed it when I lost my shit. My latest beef with them is that they corrected the claims regarding the D&C except they won't accept the claim for my doctor/surgeon. How the heck can they "cover" the procedure but not the bill for the person actually performing the procedure?? Sorry for the rant. I guess what I'm trying to say is that I don't have any specific experience related to RPL testing, but I completely understand your frustration in general with insurance and want to offer ((hugs)). So sorry you're having to deal with this!

So so sorry that you are dealing with that nonsense! I thought all insurance plans were mandated to cover maternity as of January 2014??

jbasore1123

We have Aetna and it was covered completely. I agree that different companies offer different packages.