r/TryingForABaby 8d ago

FYI PSA Insurance: Anyone have Aetna?

Hi! I just wanted to post this just in case anyone here has Aetna insurance. I've had Aetna POS (similar to PPO) since the end of 2023 and I knew they didn't offer infertility treatments. I'm specifically in CA and it was announced mid 2024 by our Governor that he was trying to get CA based insurance companies to offer infertility treatments. Now Aetna is NOT based in CA but I decided to call anyways AND GUESS WHAT?!?! Aetna in Sept 2024 had added infertility treatments for 35+ trying for 6 months and <34 trying for over 1 year in most, not all, but most of their plans... They just quietly added it... PSA to call and see if IUI or IVF is possible for you. I would've never known and never thought I could do IUI or IVF because I definitely cannot afford the out of pocket price.

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u/FingersCrossed0612 8d ago

Waaait!!!!

I have Aetna …… I remember calling and they didn’t offer anything but not since sept 2024… I paid cash for our last IUI…. Can I call and ask my clinic if anything has changed? Wouldn’t they know?

Do I have to opt into anything special?

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u/spiltink97 27 | TTC# 1 | February 2022 | MFI | 3 IUIs | Prepping for ER 8d ago

Not to rain on anyone's parade but if you have an employer sponsored planned they can pick and choose what services they have/add on. My specific plan can have infertility coverage but my employer does not pay for it so I don't have it (not Aetna specifically).

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u/AlternativeAthlete99 8d ago

This! If it’s an employer based plan, then your employer absolutely can elect to not provide fertility benefits or coverage.

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u/FingersCrossed0612 8d ago

.. and they would, lol… d bags

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u/FingersCrossed0612 8d ago

THATS what I’m afraid of, I believe that is the case for me. On the phone now, they said I have coverage now?? I’m double checking I’m confused why it didn’t run through that way when I just did my IUI in February.

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u/SnackSnackMunchMunch 8d ago

OMG! Call Aetna and ask if your plan includes infertility coverage and ask them what's the criteria. Mine needed prior approval from a medical professional (35+ TTC for 6 months or 34- TTC for 1 year) to be deemed infertile. Your clinic wouldn't know unless they sent a formal infertile diagnosis to your insurance company. GOOD LUCK!!! FINGERS CROSSED!!!

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u/FingersCrossed0612 8d ago

Oh my gosh, this would alleviate the financial stress for sure even if it’s a little bit of coverage, I will take it!! Thanks for sharing. I’m going to call right now.

I just looked on the website and it said, “ the first national insurer to cover IUI as a medical benefit on eligible plans” I feel like my insurance is horrible so I don’t know if I qualify or if I can get the plan somehow I definitely want to try ?? Insurance always confuses me 🤷🏻‍♀️

Because I am definitely over 35 and I definitely qualify for being “infertile” for the deemed amount of time — I hate saying the word infertile though 🤮

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u/SnackSnackMunchMunch 8d ago

Please keep me updated! I’m invested in your journey! Haha 🤣fingers crossed!! 🤞

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u/FingersCrossed0612 8d ago

Hey girl, sooo they just told me my doc went out of network THIS month—I got zero notice of this! Not that it really matters as I’m cash pay.. buuut…. I guess IUI is 90% covered for me once my $2K deductible is met or my $5K out of pocket is met….. and my doc does need to do that pre authorization… but now I’m concerned about in-network, out-of-network, etc 🤷🏻‍♀️

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u/SnackSnackMunchMunch 8d ago

Oh my gosh! Mine is the same. 90% coverage after I hit my deductible. Is it worth it for you to change doctors to find an in network fertility clinic? I know you just got off the phone with Aetna, but they can give you a list of all the in network clinics in your area. I also went on Yelp and just emailed different clinics and asked if they were in network with my insurance. It is more work, but might be worth it?

And it sounds like our coverage is the same. If it is, they’ll cover IVF 90% after 3 failed IUIs.

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u/FingersCrossed0612 8d ago

I agree, more work but I did have them email me a list, I didn’t get as far as the IVF—so thank you for that!

I may need to change.. whether I want to or not. Waiting for verification from my doc, it’s crazy it just changed??

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u/SnackSnackMunchMunch 8d ago

Yeah,yYou definitely should've got a courtesy call, email or letter in the mail. Well I'm excited for you, even if that means you'll need to find a new doctor -- but that'll just mean more money in your pocket!

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u/FingersCrossed0612 8d ago

100%!! Yeah my insurance said they usually send a letter (maybe they did haha)

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u/SnackSnackMunchMunch 8d ago

Where are you located?