Intro- new member

LynnNJ

Hi,

I'm a 41 newlywed and TTC our first child. I went to my ob/gyn early on for a problem I was having. Through the clomid challenge test, he determined that my ovarian reserve was borderline. He referred me to a fertility specialist. We went through all the necessary tests. The fert. spec. felt I needed a myomectomy to remove the fibroids I had for many years. She felt I was a good candidate for IVF and wanted to do an egg retrieval, make embryos to freeze for after surgery. However, because we had not been TTC for very long and had not tried cheaper methods, insurance denied it.  While waiting for the scheduled surgery, I went through two IUIs to check them off the list knowing that the chances of them working were less than 1%.  I had the surgery a couple months ago and can TTC again in August.  I will be doing another IUI because insurance will not budge. 

A year will pass in September, but insurance says they will not look at my situation again until Dec. (with no guarantee), since that's when the IVF request was put in. There is a state mandate for infertility. After a year of trying, I should be eligible, from what I understand, yet they want me to wait a few months after the year since the doctor put in the IVF request a year ago. 

Does anyone else have experience with fighting insurance companies for IVF? The doctor feels it is very unlikely I can get pregnant without it. Does anyone else have any experience with dealing with insurance companies to get IVF? This will increase our chances of eventually having a 2nd child. I am very nervous about being able to use my own eggs.  

Jenniferk08

I can't help specifically with IVF appeals but you can try to appeal based on medical necessity. Get a copy of your medical records and write to them requesting them to review the information. Be as precise as possible but not too emotional, they care about facts.

emsmama15

Welcome and good luck.  I have no insurance coverage for IVF, so I can't help with that, but I wish you good luck with that as well!

dolphin012

Welcome! I don't have insurance for ivf, but wish you all the best.

bookworm40

Welcome and good luck! I haven't had to fight for coverage but I would think that the person in charge of insurance claims and finances at the MD's office could help out a little and maybe the RE himself writing a letter as to the chances of getting pregnant on your own is very low may help.  Just a suggestion.  

lady+bee

I have no experience in dealing with the insurance coverage for IVF, but just wanted to say welcome and wish you luck!

suziq1978

Welcome and good luck!

I work in Benefits and am a state employee in Illinois.  We do have coverage for infertility.

Definitely appeal the IVF denial.  Work with your doctor to provide the insurance company loads of medical documentation that indicates that there is no way you are going to be able to get pregnant through any other means.  Depending on what state you're in, you might be able to get the coverage sooner due to medical necessity, but this is a tough one because there is no mandate that fertility/infertility has to be covered by insurance.

If you don't win the appeal then you should be able to at least start the treatment at the one year mark.  You just need to have your doctor provide the insurance company medical documentation that shows the date you began trying to get pregnant.  The insurance company is going with December because that is the date they found out you were trying to get pregnant.  Once your doctor provides medical documentation that proves a start date of TTC in September, the insurance company will have to backdate the beginning for the one year countdown to what is indicated in the medical documentation.

Sorry this is so long.  Hope this information helps.  

Knottie16743552

Hello! Welcome! Unfortunately I don't have any advice from you but I think the other ladies' seems sound. Best of luck!