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Appealing a denial (warning bfp in post)

mpetrimpetri member
in Infertility
I put this on another board but did not get any answers. So thought you Ladies may be more helpful.

Has anyone appealed a denial from insurance to have them cover a frozen cycle...alittle back ground...

I had kids from a fresh cycle...never thought it would be an issue to get my insurance to cover the Frozen cycle. They pay up to 2500.00 for 85/15 for treatment and diagnosis.

Never thought it would be an issue to get them to cover the Frozen. The frozen cycle is covered with three medical codes. I was told they would cover them to be put back in but not the unfreezing of the eggs. Told it was not "medically needed" wth. Issue is that the unfreezing is about 85% of the cost of the cycle. Since they don't want to cover the unfreezing I would be less out of pocket to pay the whole cycle out of pocket.

Anyone appeal something like this and win?
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
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Re: Appealing a denial (warning bfp in post)

  • welovehawaiiwelovehawaii member
    I've never had this particular issue, but my insurance does not cover the thawing. I had to pay for that out of pocket.
    Good luck! :)
    Married since 2013, TTC since 2/2014
    Me : 32 with DOR 
     DH: 35 with 0% morphology 

    History:  
    IVF #1 with ICSI 2/15- Banked 3 embryos
    IVF #2 with ICSI 3/15: Banked 2 embryos
    IVF #3 with ICSI 4/15: Banked 1 embryo
    IVF #4 with ICSI 6/15: Banked 1 embryo
    FET #1: 7/25: Waiting for Beta results 

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  • MKLEWIS2010MKLEWIS2010 member
    I haven't had this specific issue. Although I am having some issues with the insurance covering the treatments.  Initially they said they didnt need a precert and now they are claiming they do so they denied it.  However my doctors office is dealing with it.  My recommendation is to appeal it because it couldnt hurt you never know you might win.  Good luck!
    Me - 32 
    Husband - 32
    TTC #1 - since 10/16/2012 
    IVF#1 6/2015 BFN 
    FET 7/2015 - BFP


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  • beckihallbeckihall member
    I haven't ran into this, but I know what it's like to fight with the insurance company. Keep fighting, don't take no for am answer, and keep calling. Every time I call I get different information, you'll call and get someone willing to help eventually, just keep trying!
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  • Wicked4589Wicked4589 member
    As someone that works in insurance, do not call. Write an official appeal letter. The customer service rep has no power to cover a loss. You need to get an official appeal. I've had to appeal three times in my life. Two were covered. I'm still waiting to hear back on the third. Be open and honest in the letter and say why it should be covered.
    Report Reply
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