My insurance is Changing!!!!

[PumpkinsMomma]

I'm not sure what to think about it yet.....We hyst started TTC. We had intended to try a few months ago but things came up so we waited. I had had an appt with and OB in town who was really nice and who had contacted my insurance United HC. She had explained my previous 2 pregnancies and got pre-approval that at the first time I need IV's that they would hospitalize me, give my Zofran and arrange home health care! We were so excited, since in the past we were in the military and they weren't proactive and they don't do home health care.

My hubby is in grad school. We found out the school opened up their contract for new bids and UHC lost, our new insurance starting in August will be Chickering Group / Aetna. Does anyone know how good they are about HG?

My OB suggested trying to get pregnant right away, so that my old insurance can set up the home health care. She thinks it's more likely the new company will accept the plan if it's already in place....The only way this works is if I'm already pregnant. I will find out in a week or so.

If I'm not pregnant then what should I do about the new insurance? Should I have my doc contact them and see what they will do or should I wait? I'm nervous about this!
marie

[theannex]

That's so annoying after you went to all that trouble to get pre-approval! I'm sorry you have to face this on top of the stress of TTC and facing HG.

My two cents - I was in a similar position this pregnancy facing the unknown of a new insurer compared to my last one. I was also a little paranoid - I didn't want to alert my insurance company ahead of time that I was likely going to be a costly pregnancy (thinking that would make them more likely to micromanage it.) So I sussed out my OB and found that she was quite experienced with working insurers to get HG-ers proper care. That to me was all I needed to know. Knowing that my OB would take that burden from me when I was sick with HG rather than stress me out by having to harass the insurance company directly. Luckily the only expensive part of this pregnancy so far has been Zofran, and they have been letting me have as much as I need of that without complaint.

From being on this site a while, to me it seems very few American women here have trouble getting home health covered as far I can tell, especially those with a prior HG pregnancy. The few exceptions I think that come up are women on Medicaid or military insurance, as those seem to be more restrictive. Most of the regular insurance complaints I see are about Zofran pills and how many they let you have per month. Eventually, though, most OBs are able to get an over-ride. It sounds like you have a great OB willing to go to bat for you with insurance companies to get you the care you need. I would let them do the worry about the new coverage, and then you can focus on managing all the other stressful parts of prepp-ing for HG.

[aaronsmommy]

Aetna is usually a pretty good company to deal with, as long as your policy covers home health care, I can't imagine that you would have trouble getting it approved.

[krdoty]

I had Aetna from 1997 to 2000. Obviously, things could have changed in the last seven years. But here's my experience with them, totally unrelated to HG.

I was diagnosed with fibromyalgia when I had Aetna. I never had a problem with them covering every day charges like visits with my primary care doctor. I don't recall any issues with getting medications covered, but I wasn't on anything expensive like Zofran. My biggest issues were with getting alternative services covered - chiropractic, biofeedback and massage therapy. But they DID cover them. The catch is that I had to really know my plan. I read our insurance booklet from cover to cover. I kept a spreadsheet of all visits so that I couldn't lose track of what had been paid and what hadn't. Alternative charges were ALWAYS denied the first time. I appealed the denials, always quoting from the coverage booklet. Once I had the first one overturned for a service and provider, I kept that review/case number. That way the rep I talked to with each new denial could look up the old appeals. They didn't have to do the same research themselves, and so the subsequent appeals were much faster. I rarely had to appeal a denial more than once. It was maddening to begin with, but once I understood the system it worked in my favor. My care providers all told me that they'd never had a patient get so much covered.