Hi all, I'm running into a pretty frustrating issue. I have called like 50 clinics in the Austin area and even though they appear on the list of clinics that take my insurance, they don't. Is the only option to pay out of pocket? My son is 3 and has a delay that was diagnosed at 2. We had speech therapy for a while and he is doing a lot better, but I am having issues getting it covered. I have an Aetna plan that is self-funded through my employer. If I could find a clinic, they would cover the sessions at 100%. My son is 3 and I have called the school district, but they said it would be next school year before they could assess and set him up, if his delay is even serious enough. He does not have autism, he has no other markers for it besides the speech delay.

I hope the flair is correct. So I have Aetna POS II through my employer and my prescriptions are handled through OptumRX. I previously had Cigna health insurance for 2024 and was forced to Aetna cause plans changed and this was the cheapest one (even though it’s not cheap) I had an auth for Zepbound valid until 3/16/25 that was initiated in September 2024. Well my provider submitted a new auth and it was denied. Optum is telling me it’s my health insurances problem. Then Aetna tells me they have no control, contact Optum. My provider is supposed to submit an appeal but I’m feeling really confused. Who has control over the prescriptions then? How have I gotten two refills since January even with my health insurance changing? (Optum rx has not changed and I had them in 2024 too) Can anyone help me understand?