3 iui's before able to move onto IVF

iloveflipflops · June 2013

Anyone had their insurance say they need to do three iui's before they will be authorized for IVF treatment I have atena health insurance and they basically denied us for IVF because we hadn't had three cycles of IUI completed yet even though the Re told them he wanted us to go to to IVF first. I'm beyond frustrated. Anyone out there had this same experience?

kjf114 · June 2013

We were afraid of this too bcbsil requires 3 medicated iuis. However we have severe mfi and they actually did approve.. I have read your re can write a letter and you can try to appeal.

sunflowermama42212 · June 2013

The urologist had a letter written out stating that the only way my DH can have children is IVF w/ ICSI not just IVF. ICSI is not something i wanted unless we had failed attempts but because of my DH's low count and low morph its our only option. So with that the insurance company didn't ask us to try IUIs we just had to submit like 4 SA that all show consistent results.

mmhopeful · June 2013

Yup! We have Connecticare Ins. and were told the same thing. Good luck! Our RE could not override it even with our age!

bklyninri · June 2013

Yes. We have GHI and they required 3-6 IUI's before IVF. I am pretty sure if there was a major issue on DH's side they would have granted it sooner. I also know that age plays a factor. Less IUI's needed once you hit 35

belgirl · June 2013

Be thankful--Aetna usually requires six IUI's, regardless of age and they don't usually accept letters from the RE pleading a patient's case. Frustrating, but very typical.

vpine · June 2013

I don't see your diagnosis on your siggy - is there a reason why RE and you do not want to attempt the 3 medicated IUIs?

lisabugg444 · June 2013

Yep. I have Aetna and had to do 3 IUIs with injectables before they would consider IVF. I did the IUIs and Aetna approved my IVF. But be prepared to pay a lot OOP anyway. Aetna doesn't cover embryo freezing, and it covers meds at 50, but doubles the prices so you pay the same amount as if you had no insurance.

MrsSJE2011 · June 2013

vpine:
I don't see your diagnosis on your siggy - is there a reason why RE and you do not want to attempt the 3 medicated IUIs?

This. It is actually pretty standard insurance practice (for insurances that cover IF) to require three IUIs (if not more) before authorizing IVF unless you meet specific criteria (ie SA results). I recommend you contact your insurance to get a copy of their infertility criteria before putting in all the time and energy to an appeal. Not to be a downer, but realistically if you do not fit their criteria I would not anticipate a successful appeal.

It is completely a financial thing for them as research shows if an IUI is going to be successful for you it will happen within the first three attempts (not to say that it can't happen on >3 attempts) so they would be silly (financially) to let you go on to IVF without giving IUI a legitimate try. At the same time, most have criteria that would allow you to go to IVF sooner based on what statistically would indicate you have little to no chance of success with an IUI.

As frustrating as it is, they have to make decisions looking at the whole instead of the individual case!

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