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Insurance...

aj5oh00aj5oh00
in Infertility

Hi everyone...I don't post often, but always follow what everyone is up to.  I have an insurance question.  I know every plan is different and you can't say for sure what's going to happen for me, but...

Have any of you gotten a pre-determination that says you're covered, but then have a claim denied?  Specifically for IVF?

Thanks in advance...

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Re: Insurance...

  • kimarino13kimarino13 member
    imageaj5oh00:

    Hi everyone...I don't post often, but always follow what everyone is up to.  I have an insurance question.  I know every plan is different and you can't say for sure what's going to happen for me, but...

    Have any of you gotten a pre-determination that says you're covered, but then have a claim denied?  Specifically for IVF?

    Thanks in advance...

    Yes.  Every single time.  It took hours upon hours and many tears to get it all resolved, too.  Angry


    After 2 rounds of IVF & 2 rounds of FET, we were blessed with identical twin girls!
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  • aj5oh00aj5oh00
    Did they eventually pay?
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  • kimarino13kimarino13 member
    Yes, but I had to fight really, really hard and get a ton of people involved.  I probably spent over a hundred hours on the phone with my insurance provider trying to get it all settled.

    After 2 rounds of IVF & 2 rounds of FET, we were blessed with identical twin girls!
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  • AlissaCell701AlissaCell701

    Yup, we have full IVF coverage but BCBS of MA denied us ICSI as well as the assisted hatching they had to do for our FET.. DH and I spent hours on the phone with them arguing...

    We even had to have our RE have a "face to face" conversation with BCBS so that they would cover the ICSI..they finally did!! I would keep fighting the claim denials and also use your RE's office to help you..There business office probably deals with insurance companies all the time and they know how to get straight answer...

     

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  • aj5oh00aj5oh00
    Thanks girls...looks like I've got a fight on my hands! 
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  • kimarino13kimarino13 member
    What eventually ended up helping me was getting my company's HR department involved.  They went to the Account Manager at United HealthCare, who didn't want to lose our huge account over this, and she ended up being the liaison between me and the "higher up" people making decisions/rulings on claims and benefits interpretations. 

    After 2 rounds of IVF & 2 rounds of FET, we were blessed with identical twin girls!
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  • Fundoh21Fundoh21

    Yes! My previous insurance denied everything every single time, despite the fact that I had authorization. I spent many hours on the phone calling the insurance company and working with my RE office to clear it up.

    What finally worked for me was the luck of getting an insurance representative on the phone who knew what she was talking about. If that hadn't worked, the next step was my company HR.

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