My insurance denied me!

[dreambaby]

I am still so upset. I can't believe they said I was not within their infertility guidelines. My insurance was going to pay 50%. They said that since I have been able to conceive (even if I miscarried all of them) that I am not eligible for this benefit. There are three different criteria that you can qualify for IVF benefits. The last one says, "if you are unable to attain a successful pregnancy." I would have thought a successful pregnancy would be having a baby, not just getting pregnant. My doctor is going to write an appeal for us but I'm not too hopeful.

:cry

[hoping4bfp]

dreambaby - That's so terrible, I'm so sorry! I hate the insurance companies and I think it's just so unfair that they can have such vague guidelines that basically allow them to just do what they want. I wonder if it would be worth talking to a lawyer to find out if they can even do that when it states in their policy "if you are unable to attain a successful pregnancy." that you are covered?

I wish you the best of luck!

[kholtan]

dreambaby~

Do not give up!!! Just know that sometimes you have to fight a little with your insurance companies. A letter of appeal will be very useful. I have had to do this type of thing before for different reasons. You're lucky your insurance will even consider it. Mine covers nothing!

Don't give up hope! Remember that often times the person responding at first is an hourly paid person who can't make decisions other than what they are told to do. Always pursue it further until you get someone in a place of command.

Good luck to you!
Kimberly

[claire3rdtime]

Hi Dreambaby,

Don't give up. Keep on pushing your doctor for the appeal and maybe you can appeal too! My ins told me (when we first started) that only IVF counts against the lifetime maximum, but apparently they included all the IUIs as well! I'm going to fight them. So should you!

Good luck!

[kbat]

I would definately appeal and/or have the doctor's office/clinic act on your behalf. If it's something that you want to pursue, I would definately fight tooth and nail. Have you tried calling the insurance company? My insurance will covers 100% of the procedure up to 6 tries. I have had 3 failed tries. I then got a letter saying that I was approved once more and had to have it done by the end of Aug. I had called my doctor's office b/c we are still in the process of updating all of our tests. After a year, they make us go through all the tests again. I figured that's why the insurance approved me for one more. So, I called up the doctor's office and said what's up--is it b/c we haven't updated the tests yet. So told me that my insurance will only approve one at time these days (before they approved 3 at a time.) I decided that I would not stress of it because the next time could be the time for me to get pregnant. But trust me, if it doesn't work and I don't get approved for a 5th and 6th one, I am going to be a pain in their buttocks!!

But if you have the strength, I would definately pursue it. I don't know if you watch the Today show, but about a week ago, they had a segment on about insurance companies denying people for procedures. In the segment, they basically said that the insurance companies are banking on the fact that people won't appeal it. They said that you could get your doctors to look into it, that you can try to appeal it. Sometimes, it's just a matter of a test or something from the doctor's office saying that you are eligble.

Remember if you push for it, it could very well work out for you.

Good luck.

[dreambaby]

I had my doctor write an appeal. We are going to try again this month naturally while we're waiting to hear back from them. They said they have to review it w/in 30 days but don't have to make a decision until 60 days. I hope the appeal works. The last statement that talks about why they will cover says, "if you have been unable to attain a successful pregnancy." I have had 5 miscarriages so far and I would think I'd be covered under that criteria. Thanks for your responses. Hopefully the appeal will work out:)

Lauren

[kbat]

Good luck w/ the appeal. I hope it works out for you. Remember don't give up. I know this is important to you so sometimes you have to fight for what you want.

Best of luck to you!!!

[Rotobay]

hey Dreambaby,

You might need to make a complete nuisance of yourself to get the coverage that you are entitled to. I had the same experience a few years ago with Aetna. I had coverage but originally they declined my coverage. I became a complete pest to them and eventually got my coverage. I would encourage you to write a letter (do you have any friends who are lawyers?) and quote the clause in your coverage that says 'if you are unable to attain a successful pregnancy...' then go on to explain that indeed you have NOT been able to attain a successful pregnancy yet you are being denied this benefit (this constitutes fraud).

Also, when you call to speak with the insurance company do NOT speak to the customer service rep who answers the phone (they are following a script). Insist on speaking with a supervisor.

[JennC143]

hi

i am sorry you are going through this with the insurance company... but DO NOT GIVE UP!!!!! i was denied for my IUI's... i fought it and not only did i get approved for IUI's... i got approved for IVF.

i called them EVERY DAY... wrote letters and emails to them... stating that the reason for denial was unfair and not accurate.

(they orignially denied me because they said i had to have been trying for 1 year with no conception... i had an ectopic in february...so they counted that... and wanted me to start over from february...therefore..wanted me to try again for a year from the date of my loss)

i just kept fighting with them... and sure enough... got approved... and very quickly at that.

i got in touch with a great woman at my insurance company...she helped the best she could and here we are.

keep at it!!!!!