Insurance Coverage

soon2bmommy · 10-19-2006, 12:13 PM

Ugghh!! I'm so annoyed and I guess I just want to vent.

When I did my IVF cycle, my doctor's office said that the meds weren't covered by my insurance and that I should order from Freedom Pharmacy so I did and paid over $1700. This time for my FET cycle, I still have to order almost all the same meds so I called my insurance company (Aetna) just to make sure they weren't covered and I was told that they are covered - WITH A $0 CO-PAY, but I have to order them through the Aetna Specialty Pharmacy. So, I'm glad that they are covered but I'm soooo mad that I paid all that money before. I don't think that there's anything that I can do about it now though!

Uggghhh....

Girls - always double check everything!!!

Writinit · 10-19-2006, 01:40 PM

Oh that totally sucks. I'd be so frustrated.
Thanks for the tip, my dr's office said the same thing but I'll be sure to call and check for myself.

dukercook · 10-20-2006, 12:13 PM

soon 2 be- can you send in a claim for the meds to your insuance company?

soon2bmommy · 10-20-2006, 12:25 PM

I'm going to try but I know when I called about my most recent meds, they said that they would only be covered if I went through the Aetna Specialty Pharmacy

MoesMom · 10-20-2006, 12:50 PM

soon2bemommy-I also have Aetna (since July) and we still haven't been able to get a full benefits explanation yet but I did recently find out that they will cover IUI and injectibles. If I don't get pregnant this cycle (clomid) I'll be moving on to injec. Just wondering how do you go about ordering stuff through Aetna pharmacy?

dukercook · 10-20-2006, 01:46 PM

I have ordered through IVP care. The nurse orders the meds and the call me to get shipping instructions. That is how IVPcare works.

soon2bmommy · 10-20-2006, 01:46 PM

Hi MoesMom,

Your lucky that your Aetna plan covers IUI's & injectibles. Mine doesn't. I just have basic infertility coverage which covers diagnosis & necessary treatment. I had to pay for all my IUI's and the meds. I know Aetna has told me before that they don't cover injectibles but I guess they do as long as it's through the Aetna Specialty Pharmacy. It's so confusing. At least I'm getting these meds covered. I had my doctor fax over the prescription. I live in FL and here the phone # is: 866-782-2779. The Fax # is: 866-329-2779.

Good luck! I hope you get a BFP with your 1st IUI and you don't have to go through all this!

dukercook · 10-20-2006, 01:47 PM

soon2 be - I woud still try and send them in. Send them in as "horomone therapy"

soon2bmommy · 10-26-2006, 06:15 AM

UPDATE: I called Aetna and was told that of the 5 different meds, 2 were covered and I will be reimbursed!!

It's confusing because the Repronex, Gonal-F & HCG are not covered because they are injectibles, however, the Lupron & PIO are covered. I don't know about you guys, but I have to inject the Lupron & PIO. Anyway, at least I'm going to get some of the money back!

dukercook · 10-26-2006, 07:57 AM

YEAH! My meds are covered if they are used to treat non-ivf stuff. Lupron and PIO can be used to treat homronal imbalances and such.

10-19-2006, 12:13 PM	#1 (permalink)
soon2bmommy Registered User Join Date: Oct 2006 Location: Plantation, FL Posts: 57	Insurance Coverage Ugghh!! I'm so annoyed and I guess I just want to vent. When I did my IVF cycle, my doctor's office said that the meds weren't covered by my insurance and that I should order from Freedom Pharmacy so I did and paid over $1700. This time for my FET cycle, I still have to order almost all the same meds so I called my insurance company (Aetna) just to make sure they weren't covered and I was told that they are covered - WITH A $0 CO-PAY, but I have to order them through the Aetna Specialty Pharmacy. So, I'm glad that they are covered but I'm soooo mad that I paid all that money before. I don't think that there's anything that I can do about it now though! Uggghhh.... Girls - always double check everything!!!

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10-19-2006, 01:40 PM	#2 (permalink)
Writinit Registered User Join Date: Sep 2006 Location: NC Posts: 1,492	Oh that totally sucks. I'd be so frustrated. Thanks for the tip, my dr's office said the same thing but I'll be sure to call and check for myself.

10-20-2006, 12:13 PM	#3 (permalink)
dukercook 300-399 post 5 of hearts Join Date: Apr 2006 Location: FORT RILEY, KANSAS Posts: 376	soon 2 be- can you send in a claim for the meds to your insuance company?

10-20-2006, 12:25 PM	#4 (permalink)
soon2bmommy Registered User Join Date: Oct 2006 Location: Plantation, FL Posts: 57	I'm going to try but I know when I called about my most recent meds, they said that they would only be covered if I went through the Aetna Specialty Pharmacy

10-20-2006, 12:50 PM	#5 (permalink)
MoesMom Registered User Join Date: Apr 2006 Location: Ohio Posts: 144	soon2bemommy-I also have Aetna (since July) and we still haven't been able to get a full benefits explanation yet but I did recently find out that they will cover IUI and injectibles. If I don't get pregnant this cycle (clomid) I'll be moving on to injec. Just wondering how do you go about ordering stuff through Aetna pharmacy?

10-20-2006, 01:46 PM	#6 (permalink)
dukercook 300-399 post 5 of hearts Join Date: Apr 2006 Location: FORT RILEY, KANSAS Posts: 376	I have ordered through IVP care. The nurse orders the meds and the call me to get shipping instructions. That is how IVPcare works.

10-20-2006, 01:46 PM	#7 (permalink)
soon2bmommy Registered User Join Date: Oct 2006 Location: Plantation, FL Posts: 57	Hi MoesMom, Your lucky that your Aetna plan covers IUI's & injectibles. Mine doesn't. I just have basic infertility coverage which covers diagnosis & necessary treatment. I had to pay for all my IUI's and the meds. I know Aetna has told me before that they don't cover injectibles but I guess they do as long as it's through the Aetna Specialty Pharmacy. It's so confusing. At least I'm getting these meds covered. I had my doctor fax over the prescription. I live in FL and here the phone # is: 866-782-2779. The Fax # is: 866-329-2779. Good luck! I hope you get a BFP with your 1st IUI and you don't have to go through all this!

10-20-2006, 01:47 PM	#8 (permalink)
dukercook 300-399 post 5 of hearts Join Date: Apr 2006 Location: FORT RILEY, KANSAS Posts: 376	soon2 be - I woud still try and send them in. Send them in as "horomone therapy"

10-26-2006, 06:15 AM	#9 (permalink)
soon2bmommy Registered User Join Date: Oct 2006 Location: Plantation, FL Posts: 57	UPDATE: I called Aetna and was told that of the 5 different meds, 2 were covered and I will be reimbursed!! It's confusing because the Repronex, Gonal-F & HCG are not covered because they are injectibles, however, the Lupron & PIO are covered. I don't know about you guys, but I have to inject the Lupron & PIO. Anyway, at least I'm going to get some of the money back!

10-26-2006, 07:57 AM	#10 (permalink)
dukercook 300-399 post 5 of hearts Join Date: Apr 2006 Location: FORT RILEY, KANSAS Posts: 376	YEAH! My meds are covered if they are used to treat non-ivf stuff. Lupron and PIO can be used to treat homronal imbalances and such.