Aetna Infertility Coverage

eastwesteast78

I have good coverage for fertility treatments through my employer and Aetna insurance, but I just found out that they won't approve you for IVF until you do three IUIs.  I only did one IUI because my Dr. recommended going straight to IVF after she saw my tubes, which are open but the fimbria is clubbed together.  We sent the post-op notes to Aetna and they still denied me from going straight to IVF.  They are sending me information about how to appeal their decision.  Has anyone had any success appealing a decision like this from Aetna?

 

 

lincoln79

no help with Aetna or appealing a decision, but we were in a similar situation of having to do three failed iui's before moving on to ivf. however, we had no clear reason why it could not of possibly worked...

while frustrating, i think it was helpful for my dr. to try out dosage of injectables to see how i responded. hopefully, that will make our first ivf successful.

good luck with the insurance company! 

KdgTeacher

No help.  I'd be happy with ANY coverage

mrsjami

Yes! I have them too and won my appeal:) I was 3 days into meds for IUI #2 when I got approved for IVF and here I am in the middle of my IVF cycle:) I did a few things...My doctor had a peer to peer call with their Medical Director which did not go well, but I think you need to do it anyway. I also submitted a written appeal which I thought was what worked, but in the end I think it was the last nurse I spoke to that got it overturned.  I just kept calling and pushing. Given my AMH and medical history it was finally enough. Good luck and don't give up!

eastwesteast78

mrsjami:

Yes! I have them too and won my appeal:) I was 3 days into meds for IUI #2 when I got approved for IVF and here I am in the middle of my IVF cycle:) I did a few things...My doctor had a peer to peer call with their Medical Director which did not go well, but I think you need to do it anyway. I also submitted a written appeal which I thought was what worked, but in the end I think it was the last nurse I spoke to that got it overturned.  I just kept calling and pushing. Given my AMH and medical history it was finally enough. Good luck and don't give up!

eastwesteast78

mrsjami:

Yes! I have them too and won my appeal:) I was 3 days into meds for IUI #2 when I got approved for IVF and here I am in the middle of my IVF cycle:) I did a few things...My doctor had a peer to peer call with their Medical Director which did not go well, but I think you need to do it anyway. I also submitted a written appeal which I thought was what worked, but in the end I think it was the last nurse I spoke to that got it overturned.  I just kept calling and pushing. Given my AMH and medical history it was finally enough. Good luck and don't give up!

eastwesteast78

mrsjami:

Yes! I have them too and won my appeal:) I was 3 days into meds for IUI #2 when I got approved for IVF and here I am in the middle of my IVF cycle:) I did a few things...My doctor had a peer to peer call with their Medical Director which did not go well, but I think you need to do it anyway. I also submitted a written appeal which I thought was what worked, but in the end I think it was the last nurse I spoke to that got it overturned.  I just kept calling and pushing. Given my AMH and medical history it was finally enough. Good luck and don't give up!

Great to hear that it can be done!

They said to call Member Services to get the ball rolling.  What kind of information did you put in your written appeal?

 

kyna81

No help.  My Aetna and infertility, doesn't cover IVF at all.  it is so frustrating.  They cover everything for IUI but nothing for IVF. 

GettinCrafty

Ugh, sorry to hear that. I have Aetna and have absolutely no coverage at all for fertility treatment. It sucks how one insurance provider can have plans with such different guidelines and rules. It also sucks that, even when they provide coverage, it's not easy to do what your doctor thinks is best. The system is broken, man.

scorch

I had aetna and went straight to IVF.  I don't know what stars aligned for me to do this but I didn't have to haggle with anyone.