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.