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Questions on Aetna Insurance

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Posted 2/26/2019 7:41 PM (GMT 0)
So I've been lucky enough to have medical coverage through my employer and the insurance plan was fantastic. Very little out of pocket costs on my end and the insurance provider hasn't given my doctor or me any problems with approvals. The insurance provider operates under the same umbrella as the hospital, so the entity has two subsets, the facilities side and the insurance side.

However, i recently got a job offer to join another company and while the insurance looks just as good as my current plan, the plan is with Aetna. My main concern is my Entyvio and making sure Aetna wont mess with it. Will they automatically approve it since I've been taking it for a year and havent had any problems? I've also seen that Aetna could require me to have in-home infusions instead of going to the Cancer Center at my current hospital. I get the logic behind it, they dont want a hospital upcharging me to go there, but I was just curious if anyone else uses these in-home infusions? Are they available only on weekdays or do they have weekend hours as well?
Posted 2/26/2019 7:53 PM (GMT 0)
Generally, if you are pre-authorized for an injectable biologic medicine, currently receive it, and change health insurance companies/plans then there is no problem at all. My work changed healthcare providers and plans every couple of years; no problems/issues/delays in my remicade infusions. I also changed employers 3 times in the last 7 years and have kept on remicade continually at different companies without issue.

I think the hours/days of the home infusions would vary depending on the provider.

If you are serious about this job, ask the new employer for their plan number and group number from aetna. Give aetna a call with that information and ask them the questions you have directly. Every policy is different, but knowing the employer's plan number enables you to drill down to whatever you need to know in detail with them.

Oh, and one important thing to add: Ask aetna if there is a waiting period or if you can immediately begin using your plan from day of enrollment. Some employers say no health benefits for 30-60 days after beginning employment. And sometimes there is an exemption to that wait period when you hold insurance prior (that is no gap in coverage).
Posted 2/27/2019 6:15 PM (GMT 0)
I have Aetna and I'm not sure about how approval for Entyvio works when you are already on it. Aetna made me try and fail Remicade and Humira before letting me try Entyvio, but it is probably different when you are already on it.

I did the home infusions and it was great. I have to go to an infusion clinic for iron infusions, but the home infusion is so much better. I had my nurses come on weekday nights after work, but I believe they do have nurses that work weekends too. The nurses are contractors and the infusion company just matches you up with a nurse that works the hours that you need. You get mailed the medication a day or two ahead of your appointment. That kind of made me nervous, but I've never had a package go missing. You can also request a signature be required, but I didn't want to miss work. Also, check that the infusion company that your doctor sends you to is in-network. One time they tried to arrange it with an out-of-network one.
Posted 2/27/2019 11:10 PM (GMT 0)
I would not assume this potential new coverage with Aetna will be the same as what you have now. Aetna writes policies across the country & it is not a blanket type coverage. Each policy depends on what the employer is willing to purchase, same with the specialty drugs & script coverage. An employer can buy a low end plan to a high end. If possible, perhaps you can get enough info from the potential employer to contact the insurance to see what they do cover.Our coverage can change from year to year with insurance.

Good luck.
Posted 2/28/2019 2:59 AM (GMT 0)
This was my experience with Aetna- when my doctors first prescribed Entyvio, Aetna denied it. I then went on Humira, Remicade and 6mp. All failed. about 18 months later she tried getting entyvio again and I think it was denied again. She appealed and it was then finally approved. I started getting infusions at the hospital but Aetna began strongly suggesting home infusions. I’d get calls every few weeks urging me to do it. I finally did and it turned out to be a lot easier. I also enrolled in the entyvio co pay assistance program which helped a lot.
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