Sunday, May 15, 2011

Why I hate Aetna

I'm so furious right now. I just found out Aetna will not cover the Mirena IUD. As you can probably ascertain from the fact that we have both male and female infertility and had to do IVF with ICSI twice, I've never needed birth control.

Now while I completely understand that birth control is not always covered by insurance plans, I find it incomprehensible that Aetna would not cover this simple in-office procedure when it is medically necessary for Endometriosis patients.

Aetna would rather fork over $30,000+ every few years for me to have an operative laparoscopy to remove bilateral complex cysts and endo adhesions than to pay less than $1,000 to curb the bleeding for 5+ years. They would rather pay for all the ultrasounds leading up to the surgery, reproductive endocrinologist's visit, the surgeon's time to perform the surgery, the time for a GI specialist to be on hand, the anesthesiologist, the surgery suite and related hospital costs, all of the nurses before, during and afterwards (in the PACU), the pharmaceutical expenses, etc. etc.

If I had to do the math, I'd say it's a questions of:
60,000+ every 5 years for surgery
1,000 every 5 years for the IUD

I'm dumbfounded by their stupidity and shortsightedness. It makes NO financial/business sense, no personal sense and it just infuriates me beyond reason.

Why is Endometriosis so misunderstood, and why does it have to be such a battle? As if dealing with the never-ending pain, infertility and emotional issues aren't enough.


Anonymous said...

Hi Momma

Is the IUD necessary for endo? (excuse my ignorance). How does it stop the bleeding as opposed to an oral medication? Alternatively, do you plan on having more children (per chance!)?

I know the quandary I was in being told that despite the years of infertility "miracles" can happen and they often do. I could not do hormones. Tried the non-hormonal mirena and bled for months heavily - got severely aneamic so opted for a tubal ligation - I know it's not the same as you ~ however, perhaps if the IUD is absolutely necessary take your argument to higher powers - esp. as the Mirena lasts for years.

Anonymous said...

If you are done having babies - they may be thinking a hysterectomy is their alternative?

Twingle Mommy said...

My insurance will not cover it either. My doc said he's amazed that my insurance will cover removing my uterus but not a simple non-avasive procedure.

My Vegas said...

For whatever it is worth, you could always go to the local planned parenthood and get the IUD for a lot less money. I spent my teens and twneties getting BC from them and paid next to nothing.

Insurance sucks ass!

Dee said...

Like medical aids wont pay for IVF (approx R40 000 a cycle) but pay for NICU stays for multiples. My bill ran to over half a million, if they paid for an IVF then we wouldnt put back so many embryos as we are paying out of pocket. in saying that i wouldnt trade my triplets for anything in the world.

mybumpyjourney said...

Have sent them the numbers and cost estimate that you included here? I would fight for it! I had to fight for YEARS to get my BCPs covered for my endo, but BCBS finally did.

If not, I second the planned parenthood route. They can really help you out!

Kate said...

Have you appealed their refusal. I'd think that if you sent them a letter laying out the different costs they'll face with the two options like you stated in your post, they might possibly be clever enough to change their minds and decide that the IUD's a good idea. Maybe add a letter from your doc saying that it's a treatment for endo, not for birth control?
Sorry you're dealing with that!

Chelle said...

You could fight it. Appeal it.. But that makes you mad too, right?? That you have to? It makes me mad for you. Sorry they are such butts.

brin3m said...

i would love for you to go speak to congress and maybe get a group going to keep after the republicans that want to deny you your right to decent and less expensive health care.
i would back you up. women need to get vocal again!
your explanation of your experience is perfect!