Thursday, December 22, 2011

The Nightmare Continues

For those visiting from ICLW, I'm currently fighting with my insurance to get approval for my IVF #1 with PGD.  I've got a diagnosis of unexplained infertility, but DH and I are both carriers for spinal muscular atrophy.  Yesterday, my authorization request was denied because they don't think I'm infertile since I had a miscarriage in 2011.  The "funny" part of that is that I've never actually been pregnant.

The first thing I learned today is that the request is still denied, despite the fact that they corrected the incorrect information.  Several hours later, I learned that the reason for the denial had changed (which CareFirst didn't bother to tell me).  Now, it's being denied because I hadn't tried IUI first.  Which is confusing the hell out of my RE's office, since they figured they made the case for why we had to go right to IVF in the information they submitted at the same time requesting authorization for the PGD.  Also interesting is the email I have from the CareFirst sales rep assigned to our account, from back in September, when she said that she checked the contract and could not find any language requiring IUI to be tried before IVF.

So now I have to appeal the denial.  The denial letter won't even be processed to be mailed to me for 5-7 business days, but fortunately I was told what I needed to say to start the appeal process before I get the letter.  So I called, and I have an address in Kentucky to send an appeal letter to.  I emailed my nurse to get a letter of medical necessity, and she forwarded it to me RE to do.

To add to the fun, when the finance person at Shady Grove ran my insurance, the report came back that infertility costs don't count towards the Out of Pocket max of $3000.  The email I have from the sales rep says that it does.  At the same time, the sales rep also told me on Monday that there was no preapproval needed for IVF, so now I don't know whether to believe anything she says!

If infertility costs don't count towards the OOP max, then we just plain can't afford to do the IVF cycle at all, probably not at all this year.  But now we have $1500 in DH's FSA for 2012, and without the cycle, I'm not sure if we can use up all of that and avoid losing any.  Probably, since DH and I both wear contacts and are running out, but I'm not sure.

Then again, I'm really not sure of anything right now.

12 comments:

  1. Here from ICLW.

    Ah insurance. The continual run-around they give you when you actually need them to pay for something. Too bad we can't do the same when they bill us monthly.

    Hang in there and don't lose hope. We ended up paying for our current IVF cycle completely out of pocket. Yes, it's scary, but financing options that we hadn't considered became available when we needed them and we were able to get a huge discount on drugs. Something will work out.

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  2. I well know the insurance run around & I'm so sorry you're having to deal with this at all, & now during the holidays. I love you! Let me know if I can help.

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  3. Gah, how frustrating to have to deal with all this!

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  4. I HATE INSURANCE COMPANIES. Sorry I shouted.

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  5. Cristy, my DH read that and asked why we couldn't get a reach-around instead of a run-around!

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  6. I hate insurance companies! Their sole purpose in life is to figure out how to NOT pay despite the legit claims. grrr. I'm sorry u have to deal with that ON TOP of the already difficult situation of IVF. As if those who go through it actually want to.

    ICLW #1

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  7. Just stopping in from ICLW :Merry Christmas

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  8. Hi! Thanks for commenting on my blog! Here for ICLW.

    I'm so sorry about the insurance ridiculousness. I am lucky to live in a state with mandatory IF coverage, but so many are not. :( It isn't fair to think of IVF as an elective procedure - we are fighting medical conditions here! Hang in there.

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  9. HRF, I live in a state that requires IVF coverage, too. If your company is big enough to fall under the mandate. If you can afford the diagnostic testing that doesn't have to be covered. In some cases, also if you can afford to try IUI first that doesn't have to be covered.

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  10. Hi thanks for stopping by my blog :) I love Love Actually too!!!

    What a pain. in. the. ass. this insurance crap is!!!

    Best Wishes!

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  11. ICLW 89. Insurance - ugh. It's a nightmare dealing with them. Best wishes for getting through all the fine print without killing someone in the process :)

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  12. ICLW 89. Insurance - ugh. It's a nightmare dealing with them. Best wishes for getting through all the fine print without killing someone in the process :)

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