Hi! I'm usually just a lurker, always reading rarely posting, but I was wondering if you could give me soem insight into your insurance struggles? I was wondering exactly how you phrased your questions to them? Did you just call customer service? Did you know the whole plan from your Dr. then relay it to the insurance company? And when you went about your appeal did you get letters from your Dr. or did you write them yourself? Sorry if this is being too nosey! I just started a new job in February and I am having a really hard time gettin the insurance company to pay for treatment-I also have PCOS and the insurance company is fighting me about paying for ultrasounds! Any advice would be greatly appreciated!! Lori

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Ugh, aren't the insurance battles such a pain? I'm dealing with the same thing. I'm not sure if she responded to you yet but I asked Jenn about her experience on another forum and she responded here IUI timeframe????? so hopefully you can find some answers there. I told her about this post, too, so I'm sure she'll get back to ya. Good luck!

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Me-30 (anovulatory)
DH-29 ("super sperm")
8th IUI-Clomid+Repronex+Trigger=?

hi

i will give you all the advice that i can

my RE sent the insurance company a letter saying that he felt i needed IUI's

once they received his letter - they denied me (my doctors office told me of the denial).

i immediately called the "care management" department of the insurance company asking why they denied me.

they said "in the state of massachusetts, you need to have been ttc for at least a year with NO conception"

i explained to them that i had been ttc - and unfortunately my conception ended up as an ectopic pregnancy.

the insurance company told me that is WAS considered a conception -and the year "refreshed" from the date i lost my pregnancy.

at that point - i SNAPPED and hung up on her.

i then wrote a letter - i emailed it to care management, claims department, and the appeals department (LOL - didn't want to miss anyone) and i also sent a hard copy via mail to the same departments.

i did it all myself - without asking the doctor for an additional letter - i figured he sent one - and it got denied - so why ask again... even though i know he would have.

sooooooo - in my letter... i stated that i felt they were "unfair" in making women have to wait to see an RE and get treatment - i stated that it made no sense that they "refreshed" the waiting period after each unsuccessful pregnancy loss...it just made no sense what so ever.

i said that even though my doctor wanted me to try iui's.... i felt that i needed ivf to help avoid the possibility of another ectopic - but i agreed to the iui's.

i also said that i talked to other insurance companies and they did not have the same policy... and that i planned on pursuing the denied claim and that i would involve any and ALL necessary parties on the matter.

at that point i received several email and phone calls from the insurance company saying they were "looking into it". about 2 days later i got approved. they said they sent my claim to the medical director and he approved it saying that "i met the states definition of infertility" and i can now move forward.

in my opinion and after taking to the first person when i got denied - i don't think my claim ever initally made it to the medical director... i think the nurse denied me on the spot (when i called - i actually spoke to the woman who denied me - and she had no problem saying "i am the one who denied you").

so with that being said - i definitely urge you to pursue any denied claims - they are quick to deny you - but when you start the letters rolling - it makes them look into it a little more. the whole process took about a week from the denial - to me getting approved.

just state the facts - and tell them why you disagree - lol - in my letter, i went on and on and on and on.

you don't necessarily need to know that the doctors protocol is for you when writing the letter... because in my letter - i knew my doctor just said i needed iui's - but i actually got approved for 3 cycles of iui's and then got approved for ivf if i dont get pregnant during those cycles. not sure if it helped that i said i felt i need the ivf or not... i was shocked when they approved me for everything.

if there is anything else i can help with - just let me know... and i wish you the best of luck

Thanks so much! I live in PA and am not sure exactly what they cover and don't cover but when I called and asked about infertility treatment I was met with a BIG NO so We paid for 2 IUI's and several rounds of clomid to come to find out that on the last IUI the billing person at the RE's office submit the claim and the insurance paid for the ultrasounds and Dr's. visits so now I am fighting for them to pay from the two previous years of diagnosis and clomid cycles! What a pain! Like we need to be stressed about other things when trying to conceive! UGH!!! Anyways thanks so much for your input! And Jennysomany thanks for directing me!!! LOL!!!

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it really is such a pain - and you are absolutely right - we don't need this while ttc!!!!

just keep at it - tell them they are contradicting themselves by paying for some things and not others - give them something to think about - and hopefully they will reimburse you.

good luck with everything and keep us posted!!!!!