I have Aetna HMO, do I need a referral to see a gynecologist for nexplanon replacement?
I have Aetna HMO (a Silver: S plan if that matters) and I am not sure if I need a referral to see a gynecologist for nexplanon replacement (birth control arm implant). Will it cover only this one visit or am I able to do a well woman exam visit in the same year?
I tried calling the insurance company's customer support line but the lady I spoke with seemed like she wasn't sure either. At first she said it covered one visit only, then she said it covered exam visits, then she said it would cover an exam visit and also a visit for the nexplanon replacement. She constantly was on and off hold and the entire thing was very confusing.
I cannot find much in my insurance information on the website. The summary of benefits states that preventative care and screening is covered at no charge as long as the provider is in network.
The policy document also says: If your Aetna plan provides coverage for obstetric or gynecological care and requires the designation of a primary care provider then you do not need prior authorization from Aetna or from any other person (including a primary care provider) in order to obtain access to obstetrical or gynecological care from a health care professional in our network who specializes in obstetrics or gynecology. The health care professional, however, may be required to comply with certain procedures, including obtaining prior authorization for certain services, following a pre-approved treatment plan, or procedures for making referrals. For a list of participating health care professionals who specialize in obstetrics or gynecology, contact your Employer or, if you are a current member, your Aetna contact number on the back of your ID card.
I am trying to put off the well woman visit for now just in case but does it seem like the insurance will cover the nexplanon replacement as my first appointment? What about if I have to get a well woman visit before hand?
submitted by /u/JunketOk595
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