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Secondary IF
mpetri
member
Appealing a deniel from United
mpetri
member
in Secondary IF
Has anyone appealed a insurance deniek and won?
Under my health care insurance at work I am covered for Dx treatment including IVF and IUI upto $3700 a year.
I didn't think I'd have a issues having my frozen cycle covered...but just got word from United Health Care hat while they do cover the Frozen cycle there are 3 medical codes for it and they do not cover the unfreezing of my eggs. They stated it was not medically necessary....which cracks me up because how else would you get my eggs inside me to for the frozen cycle. Also this one code is 90% of the the frozen cycle cost. From them dening be one. Name it will force 99%/of people from using their insurance and pay OOP.
I plan to appel the decision through the insurance company and I also contacted my HR to let them know that even though work covers a big portion ...United is not allowing "treatment".
If you have won a appeal for this issue...what all did you have to do.
Fingers crossed.
Under my health care insurance at work I am covered for Dx treatment including IVF and IUI upto $3700 a year.
I didn't think I'd have a issues having my frozen cycle covered...but just got word from United Health Care hat while they do cover the Frozen cycle there are 3 medical codes for it and they do not cover the unfreezing of my eggs. They stated it was not medically necessary....which cracks me up because how else would you get my eggs inside me to for the frozen cycle. Also this one code is 90% of the the frozen cycle cost. From them dening be one. Name it will force 99%/of people from using their insurance and pay OOP.
I plan to appel the decision through the insurance company and I also contacted my HR to let them know that even though work covers a big portion ...United is not allowing "treatment".
If you have won a appeal for this issue...what all did you have to do.
Fingers crossed.
Me: 31, DH: 37, TTC #1 since 06/09, dx: Endometriosis diagnosed by Dr during ER
02/10-low progesterone on 21 day bloodwork (5.2); on hold due to cyst
04/2010-9/2010 6 failed Clomid cycles with TI (unmonitored)=BFN 4/10 SA= perfect
8/10-HSG all clear
9/10-started seeing RE
10/10-Femara + TI= BFN
11/2010 through 2/2011 IUI #1-3 Femara + Ovidrel=BFN
03/2011 through 8/2011 BREAK CYCLES (had 8 babyshower to go to, house remodel, 30th b-day and College Graduation)
9/2011-Started back to RE, waiting on cycle due to it being late, and work travel had to hold off IUI #4 till 10/2011
10/2011- IUI #4 on hold due to cyst, 2 weeks BCP
11/2011- IUI #4 (11-21-2011?) Femara + Follistim + Ovidrel=Converted over to T.I. (NO Trigger) due to too many follicles=BFN
3 cysts due to follistim cycle
January 2012=IVF #1 cancelled and converted to IUI #4 due to dominant follicles=BFNN
IVF 1.2=??? on hold due to cysts, on hold w/o B.C. till they resolve
br> Aug 2012 IVF 1.2, cyst aspiration 8/7, ER8/16, Dr found Endometriosis in Left tube during ER ER:7, Fert 5, 5DT scheduled 8/21/2012, transfered 2 Blasts, hpt + 8/28/2012, beta 8/31/2012-BFP -21(chemical pregnancy
IVF #2 October 2012
ER 10/13/2012, 6R,5M,3F
10/15/12 ET:3dt 2 embies
+HPT 6dp 3dt.
1st beta 10/29/12 Positive 13dp 3dt=654
2nd Beta: 10/31/2012: 1,836
3rd beta 11/5/2012 (20dp 3dt:13,655
1st u/s 11/12/12 TWINS!!! 2nd u/s 11/26/12
02/10-low progesterone on 21 day bloodwork (5.2); on hold due to cyst
04/2010-9/2010 6 failed Clomid cycles with TI (unmonitored)=BFN 4/10 SA= perfect
8/10-HSG all clear
9/10-started seeing RE
10/10-Femara + TI= BFN
11/2010 through 2/2011 IUI #1-3 Femara + Ovidrel=BFN
03/2011 through 8/2011 BREAK CYCLES (had 8 babyshower to go to, house remodel, 30th b-day and College Graduation)
9/2011-Started back to RE, waiting on cycle due to it being late, and work travel had to hold off IUI #4 till 10/2011
10/2011- IUI #4 on hold due to cyst, 2 weeks BCP
11/2011- IUI #4 (11-21-2011?) Femara + Follistim + Ovidrel=Converted over to T.I. (NO Trigger) due to too many follicles=BFN
3 cysts due to follistim cycle
January 2012=IVF #1 cancelled and converted to IUI #4 due to dominant follicles=BFNN
IVF 1.2=??? on hold due to cysts, on hold w/o B.C. till they resolve
br> Aug 2012 IVF 1.2, cyst aspiration 8/7, ER8/16, Dr found Endometriosis in Left tube during ER ER:7, Fert 5, 5DT scheduled 8/21/2012, transfered 2 Blasts, hpt + 8/28/2012, beta 8/31/2012-BFP -21(chemical pregnancy
IVF #2 October 2012
ER 10/13/2012, 6R,5M,3F
10/15/12 ET:3dt 2 embies
+HPT 6dp 3dt.
1st beta 10/29/12 Positive 13dp 3dt=654
2nd Beta: 10/31/2012: 1,836
3rd beta 11/5/2012 (20dp 3dt:13,655
1st u/s 11/12/12 TWINS!!! 2nd u/s 11/26/12
Re: Appealing a deniel from United
TTC #3 since June 2013
BFP #1 7/21/2013--EDD 3/30/14--D&C 9/24/13
BFP #2 1/28/14--MC 2/7/14
IUI #1 5mg Femara + trigger = BFN
IUI #2 5mg Femara + trigger = BFN
IUI #3 5mg Femara + trigger = BFN
Dx: Me: Recurrent Pregnancy Loss; DH: Low Morphology (2%)
BFP#1: MC 3/1/11 at 6w1d - EDD 10/21/11
BFP#3: MC 2/8/14 at 4w5d - EDD 10/13/14
BFP#6: CP 11/6/14 at 4w2d - EDD 7/14/15
IVF #1 with ICSI & PGS: May/June 2015, ER 6/3/15, 17R/17M/15F
IVF #2 with ICSI & PGS: July 2015, ER 7/16/15, 16R/11M/9F
PGS results = 6 normal embryos (4 boys, 2 girls)
FET 9/23/15 = BFFN