fvck you blue cross. . .

redsoxbono · April 2010

(sorry, for swearing, but nothing else seemed strong enough)

My doctor submitted the request for IVF to my insurance (we're very lucky in my state because insurance is required to cover it).

The doctor and the nurse told me Blue Cross allows coverage is you are over 35 after six months. They didn't make any promises, but neither of them seemed worried. It even says in the Blue Cross literature "women over 35 who have been trying for six months may be approved for IVF."

I got the letter yesterday and they said they will not cover it until I have been trying for a year. I was SHOCKED. I burst into tears. I am going to be 40 a week from tomorrow, I feel like every cycle without "help" is valuable time wasted.

I talked to the nurse today and she was also shocked. She said Blue Cross always approves women my age after six months. I have no idea why I'm being singled out.

She said my doctor would appeal it, but I am just heartbroken. I was mentally prepared to do IVF and not have it work (I know I would be devastated, but I knew it could happen, you know?) I just wasn't mentally prepared to not even get the chance to try.

Thanks for listening ladies.

Haribo1 · April 2010

Ugh, that sucks =( I really really hope the appeal works. I'm not sure about other specialties, but I know that if your physician appeals and can "back it up", there is still a good chance it will work out. Fingers crossed and keep us posted! Insurance sucks!!

izzourclue · April 2010

I think "fvck you" is the perfect sentiment for this situation. Insurance companies are crooks and liars. That's the main reason I was personally happy about the health care reform. Its about time they are held accountable for some things. Sorry you are dealing with this and good luck with your appeal.

09Bride03 · April 2010

That is so freaking unfair! Fingers crossed that the appeal works.

BCBS sucks balls. Ours won't pay for anything *artificial*.

lizette0626 · April 2010

I'm so sorry redsox. I hate insurance companies!! I hope your appeal goes through quickly.

curlyhairedboys · April 2010

Ugh! That is so annoying. Any way you can get on the phone and read to them what it says in their handbook?

JilliansMoma · April 2010

This is so wrong. It's like selective enforcement. If you don't offer for everyone after 6 months of trying then don't write it up in your literature that way. So sorry RedSox. Fight 'em like hell and good luck.

CharBart · April 2010

That is some serious bullshite they are throwing around. You should call them and try and appeal yourself too. You never know what can happen. You should also find out what their reasoning is for not covering it.

Strunella · April 2010

Grrrrrr. Maybe it's a mistake? I would first have your company's HR help you out. If it's covered after 6 months, it's covered, just as the handbook states. How would they know how long you've been trying...are they basing it on when you first saw the RE? I'd also see if your regular ob/gyn could help you establish a date if he/she was the first person you turned to before seeing the RE. Good luck...don't let those suckers get away with it!

Erlyjo · April 2010

When did your benefit period begin? I would first make sure you haven't started a new benefit period with an infertility benefit that states you must wait a year. If your current benefit period booklet states 6 months, then you should work with your physician ASAP to get an appeal filed. I recommend you get all of the facts together (benefit booklet language, start and end date of benefit period, procedure and diagnosis codes submitted). Sometimes benefit periods are not based on calendar year and therefore if you are on a group policy...your company may have changed the level of benefits offered to their employees. If you are on an idividual policy (ie. you purchased the policy directly from BC), make sure you have the current benefit booklet. If in fact the benefit booklet states something differently than what BC is stating, then you can file a complaint with your state's Department of Insurance. Good luck...

LizzyB11 · April 2010

I would be swearing too! I can't believe that they would not cover your IVF! Maybe if your doctor appeals it, he will be able to get them to approve it. That is just really wrong. I say F U to them, too.

shyntrue · April 2010

That sucks! {{{Hugs}}}

kinsalebride · April 2010

I'm so sorry you are dealing with this. Unfortunately this is true for BCBS. I had BCBS when we were TTC DD#1. I got pg naturally after 6 months, but wound up having a mc. When we contacted BCBS to see when I could start having treatments, they said I couldn't do ANYTHING unless I didn't get pregnant again for 1 year after the mc. I couldn't believe it either, that I had to wait a full year after mc. I wound up getting pg again naturally a little over the 1 year mark, just as we were starting to look into fertility treatments but had yet another mc. BCBS then let us move forward with IUIs (which I had unlimited coverage for that) and then we did an IVF, which is how we had DD #1. BCBS allowed up to 3 IVFs. I hope that your appeal works. best of luck.

redsoxbono · April 2010

Thanks ladies! I wish I could fly you all up to Boston and we could march in as an angry mob!

We could find the doctor who signed the rejection letter and barge into her office and let loose with all of our TTC anger and frustration!!!

I will not know about the appeal for a while (grrr. . . ) but I will let you know. I'm not feeling hopeful. . .

FrannyS · April 2010

You can request an expedited appeal. They will have to give you a decision sooner than a regular appeal. These are usually reserved for a quick clinical decision on an inpatient admission but maybe they can put it in as one due to you needing to start your IVF quickly.

Good luck and I bet that BCBS reverses the determination. They have no grounds if that's the state law (and their own rule). Hang in there!

ougrad1 · April 2010

I have blue cross and they wouldn't cover a cent of anything-ever.

mjencook · April 2010

So sorry you are dealing with this, what a shock, and the FYOU is well deserved!

I am glad you vented tho as my DH's new job uses BCBS and thought that I would switch as I heard they covered more...so might have to do some digging into their policies vs my current coverage now....keep us posted on your fight! GL!

OscarQ · April 2010

Totally F U worthy. I'm sorry that they denied you and hope the appeal is processed quickly - and that you are approved for IVF.

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