Ugh, insurance denied our April IVF

JamaicaMon! · February 2009

I'm so bummed. We were scheduled to do IVF in April, after I finish with this current IUI cycle.

I just found out that they denied it due to the lesser before greater rule. They want me to do a few more IUIs before proceeding to IVF. I think they purposely didn't count my 2 previous IUIs because they were so long ago, in Jul-Aug 2007. And what does a "few" mean anyways? I have coverage for 6 total IUIs, does that mean I have to use all 6 of them before they will let me proceed?

Has anyone else had insurance deny IVF for this reason before?

SkypekWithoutAC · February 2009

Do you have your evidence of coverage? You should be able to get that document from HR. The evidence of coverage should tell you exactly what, how much, and when you qualify for specific services. I'm sorry you got denied for April

oct11bride03 · February 2009

I'm sorry! Usually they spell out how many cycles you have to do before you can move on...hopefully you can do what the pp said and find documentation of your previous IUIs and submit it to them. Wishing you tons of luck!

finallyreilly · February 2009

My insurance requires 3 IUIs before IVF. I am with Kaiser. They didn't ask me dates for my IUIs. All of my IUIs were in 2007 as well because we moved to IVF in 2008 and paid oop. For this IVF it will be under my insurance.

I would definitely contact your insurance to get a definite number of how many more they want you to do. I wonder if they aren't aware of your other 2 that you did earlier.

BRSaugust20 · February 2009

You should be able to get a copy of the Criteria for Authorization which should outline the reasons why/when they will approve IVF. You need to get this from the clinical concerns / pre-authorization customer service not the regular customer service.

JamaicaMon! · February 2009

Okay, so I just got off the phone with my insurance company. They told me that I need to have 3 injectible IUIs prior to IVF. But they were unaware of my 2 previous IUIs in 2007, both of which I used injectibles. So I have to fax them cycle sheets for those 2 IUIs, plus my current one, and they may still cover me for IVF in April. Keeping my fingers crossed!

CardsfanSM · February 2009

OHHHH, fingers crossed they accept those cycles!!

BRSaugust20 · February 2009

Good luck!!

finallyreilly · February 2009

GL!!! Sounds promising.

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Ugh, insurance denied our April IVF

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