Does anyone have any experience with Aetna insurance and treatment? My company just switched from Anthem to Aetna. I was worried about the Anthem benefits with treatment, but I know nothing about Aetna. Anyone? I'm in California if that makes a difference.
My understanding is that Aetna writes several different coverages, but I've been very happy with mine. We have Choice POS II, which came with excellent prescription coverage -- my husband gets his treatment meds by mail order for between $8 and $15 for a 100 day supply. If you have your membership ID numbers, you can log on to their website at aetna-dot-com and check out your benefits on-line. It has very helpful links to costs of prescriptions, participating doctors and pharmacies, etc. Good luck!
Always best to call the insurance company directly and ask specific questions regarding what is covered and what isn't. If your concern is the treatment drugs then you want to ask about Pegasys or Peg Intron, Ribavirin, Procrit and Neupogen. Just keep in mind that the injectibles (everytihg but ribavirin) might be covered by a different department than the pills (the ribavirin). I remember when I first asked if Pegasys was covered they couldn't find i listed only to find out from a supervisor that the injectibles were covered by a different division, but definitely covered.
I had Aetna for two treatments and they worked fine. However, you need to uderstand the coverage - whatever the plan(s) provide to you. For me, Pegasys was covered under the medical portion and the riba under the prescription section. And, for the Peg, they required that the prescription be filled by the Aetna 'Specialty Pharmacy' (for cost control). I got the riba locally. The trick is to get it all lined up before you start and make sure you have both the Peg and riba in hand before you begin. The Aetna Speicatly Pharmacy mailed a cooled pacage every four weeks and they always made it on time. Need to be careful when you make the shipping arragnement because it comes by FedEX (or UPS) and need to determine if someone will be home or if they can leave it at your door without a signature. I thought was a good idea to have all the meds and then wait 2 more weeks to begin. That way, the refill process will begin to flow and you'll always have a two-week supply on hand in case a delivery situation arises.
You may also find that your coverage may end around week 12 unless your medical team fills out the requisite paperwork. The way it often goes is that the medical team says they never got the paperwork and the insurance company says it was sent and never filled out. For this reason you might want to start getting on top of the process yourself around week 10 if that is how your insurance company works. BTW this approval process may be repeated a couple of more times during treatment so try and find out but don't be surprised if you don't get the answers. Best protection is like FlGuy suggests, stockpile at least two weeks worth of meds before starting to give yourself a buffer.
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