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419309 tn?1326506891
Aetna/Insurance Change During Treatment
Two part question, would appreciate your two cents:

(1) Has anyone had to change health coverage/insurance carriers during treatment?  Due to misinformation from my pharmacy and current HMO as well a low prescription maximum, my husband may have to change insurance carriers during treatment.  Besides making sure all his doctors are still "in-network", is there anything I should be checking on before changing policies?  (Thankfully, pre-existing conditions are not at issue, so we're ok there.)  Any pitfalls that I should be on the lookout for?

(2) For any one with (or experience with) Aetna POS coverage -- any issues with medications, rescue drugs, and so many labs and doctor visits?  I'm also wondering if anyone here has used the mail-order 100-day supply option to fill their Peg/Rib prescriptions, and if so, was it good or bad?  Any disconnects between provider-insurance-pharmacy while on Aetna?  (Any issues with extending treatment?)

Would appreciate any thoughts.  
~eureka

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96938 tn?1189803458
Although I did not change coverage during either treatment, I did have Aetna for both.  For at least the Peg, they will probably require that you receive the meds from their mail-order specialty pharmacy. You and hubby need to be careful that there is no disruption in your refill process from one to the other.  You don't want to get to shot night an be empty handed.  As for non-standard treatment 'stylizing' including extension, Aetna required a bunch of lab stuff and doc's statement (could be doifferent processes based on coverage).  Again, you and the doc need to stay on top of it to know who wants what and when.  If you speak to someone at an insurance place, get names and numbers so you can re-contact when necessary. They might want to dispense Peg under the 'medical' portion of your policy and not the 'pharmacy' portion.
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I have Aetna and had to receive my ribavirin and peg as well as rescue drugs (Neupogen/Procrit) via their Specialty Pharmacy with delivery by UPS.  Did it for a year without any interuption whatsoever but had a few 'moments' that I would.  My doctor and NP were excellent as far as contacting them and handling everything when it was needed.

Go for the riba-pak ribavirin as that is what I used and was also told that it wasn't has harsh and had less sx's which I believe it did because I made it through tx successfully.

I am waiting for my 6 mos post PCR lab results to come in the mail any day!

Good luck to you,
TV

Oh, you definately can't go to your regular pharmacy for the meds they will want to use their pharmacy/delivery.  The UPS guy always came around the same time and it wasn't a problem.
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179856 tn?1333550962
I have Aetna POS - it's great insurance for the most part. The only problem I had was years ago when I wanted to extend they had said it was experimental treatment and wouldn't pay (but the drug company paid for all my meds for free for that last six months anyway).

POS is good cause you don't need referrels to go any place....nothing is perfect but basically I'm pretty happy with it.

Good luck!
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Make sure to do the change over just AFTER you have received the next month’s supply of meds if possible. It will take time for the doctor and new insurance company to recertify the meds. I had BCBS then went to Aetna POS, and had a partial pause in TX because of not notifying the doctor’s office of the new insurance in the yearly change over. After things were straightened out the meds came just like clock work by UPS. Good Luck with the transition.  
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419309 tn?1326506891
You folks are just GREAT... dunno where else I'd go with all these questions!

FlGuy:
You read my mind, exactly we want to avoid: getting to shot night without meds in hand, plus hubby's got "non-standard" alinia added to tx, so I'll definitely be calling the Aetna reps next week with some good questions... (with pen & paper ready and taking names)!   Thanks for the input... and didn't know it was possible to have prescriptions deducted from the "medical" side of benefits... will have to check that out, too.

TeeVee36:
My NP had mentioned the riba-pak, but my current HMO doesn't offer it.  I hear so many horror stories about insurances, it's good to hear you didn't have problems (having on-the-ball docs and NPs doesn't hurt either)!  I'm not very good at "waiting" so have some hesitation about mail-order, but it seems to be the most cost-effective thing to do if I elect Aetna.  I appreciate your encouraging words!  And, wow, lab results in the mail?!?  I sure hope they say UND!  Good luck to you!

nygirl7:
I remember all the rescue meds you had to add on during tx, so hearing you call Aetna "great insurance" really puts my mind at ease!  My current HMO has a $25,000 max cap on prescriptions and though they're offering to talk to Roche for free meds when I reach the limit, there's no guarantees I'd get approved, and even of more concern is what to do if rescue drugs need to be added to the picture.  It's a tough decision because I really like the current HMO (and may have to change PCPs), but when looking at hep c treatment, $25,000 looks like measly coverage.  Trying to find the best road to where you are... SVR!  Congrats to you!

geterdone:
Thanks for the good advice... I'll definitely refill as much as I can before the the date of change-over... maybe even give my doc and NP a call a month ahead to make sure things start rolling with the new insurance sooner rather than later.  

~eureka
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