Tuesday, September 02, 2008

Red Tape

As usual, there is always red tape to get through in the infertility world. I finally looked into what needed to happen for me to be able to make a consultation appointment with the Reproductive Endocrinologist. I first spoke with a lovely woman on the Member Services line for Aetna. She answered some very general questions for me regarding all of our coverages, referrals, referral processes, and more. She could not offer me any detailed information regarding infertility coverages, though. Luckily, Aetna has its own dedicated Infertility Services department / line for the state of New Jersey. See, NJ is a "mandate state" for infertility benefits. Go, NJ!!!

The woman I spoke with on their dedicated IF line was VERY helpful. Imagine that...a helpful benefits representative! She walked me through the entire process. I need to get "authorization" from the HMO in order to go for the initial consult. The rep handled that over the phone through a brief, yet detailed interview. I am now approved and authorized to go for a consultation AND to have the South Jersey Fertility Center put me through a "monitoring cycle". This cycle will involve bloodwork and ultrasounds in order to show that all looks good and that I am ovulating. After this cycle, the Reproductive Endocrinologist will decide if any more testing for Matt or me is necessary AND / OR what the next treatment steps would be. When we get to this point, all authorizations will be applied for by the RE's office and approved (hopefully) by Aetna. I will personally be out of the red tape loop!

So, our consultation is now scheduled for Wedensday, September 10th at 3pm. I will be seeing Dr. Van Deerlin. I scheduled this appointment, of course, on the only day that Matt was not available. Given that we are "old pros" at this game, we decided it didn't matter, so I will be going solo.

Here is what I learned today about our GERNEROUS coverages:
* UNLIMITED lifetime IUI cycles (artificial insemination)
* Four lifetime fresh IVF cycles (includes past covered attempts, so we have 3 left)
* UNLIMITED frozen embryo tranfers
* diagnosis, treatments, and related meds are all covered

* cyropreservation is NOT covered
* PGD is only covered on a case by case basis, and at this point I would be denied

All in all, looks really great!!! Aetna also uses a "less before more" approach, so you have to exhaust less invasive and less costly treatments before you will be authorized for more invasive and more costly treatments. Given that I have already been through 4 IUIs (not to mention IVF and FETs), the rep from Aetna thinks I will be have no trouble getting approved for IVF right off the bat. All that needs to happen is the RE's office has to fax over my past IUI cycle information / results to Aetna so that they can review them and hopefully approve them (aka:"behind the scenes" red tape). No big deal.

That is the scoop for now.

I am including in this post some general abbreviations for amateurs in the world of Infertility (IF). This will be the last post in which I write out all the big words...just takes too much time, and, after all, this is MY WORLD...you are just visiting it!!

IF = infertility
tx = treatment
dx = diagnosis
RE = reproductive endocrinologist (aka, fertility specialist)
IUI = intrauterine insemination (aka, artificial insemination)
IVF = invitro fertilization (eggs removed / fertilization with sperm in petri dish / embryos grow / placed back into uterus)
PGD = pre-implantation genetic diagnosis (testing of embryos for chromosomal abnormalities prior to being placed back in uterus)
b/w = bloodwork
u/s = ultrasound
pg = pregnant / pregnancy
BFP = big fat positive (positive pg test)
BFN = big fat negative (negative pg test)
OV = ovulation
OPK = ovulation predictor kit (at home)
endo = endometriosis
m/c = miscarriage
s/a = semen analysis
POAS = "pee on a stick" (home pg test)

If we think of any others moving forward, I will try to fill you in!

Stay tuned...


Tanya said...

Wow this coverage is really good! So what happened at your appointment? I am so excited for you guys! This is great news! I can't wait to hear what they said at your apt! Whats the plan?Woo Hoo for you!!!!

M and M: said...

Hey, Tanya. Thanks for checking in! My appt. is today at 3pm. Expect a post regarding the appt. later on today! I will update on the boards, as well. Hope you are well!