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  1. #11
    FWR
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    4everEvolving, I do have advice, but it also comes with questions.

    If your insurance isn't paying because they are self-insured I'd suggest using the argument that research shows people without insurance transfer more embryos during an IVF cycle, increasing the risk of outcome costs associated with high risk pregnancies, premature birth, NICU expenses, and future healthcare expenses for mother/child. People with insurance benefits are able to make decisions based on medical needs, not finances. You can find these facts/resources at Infertility Resources for Conversations About Fertility Insurance Coverage - Fertility within Reach. Instead of the employer helping with a $10,000 IVF cycle, they could be looking at $100,000+ in outcome costs.

    You could ask your employer if they would ask their insurance broker if you could purchase a rider, allowing you to buy extra insurance for infertility treatment.

    Do you not qualify for the mandate because of medical reasons? You can find out different strategies to effectively communicate with policy decision makers at Infertility Insurance Coverage and Benefits Information - Fertility within Reach.

    Please let me know if I can help you any further.

    All my best,
    Davina

    Davina Fankhauser
    Fertility Within Reach
    admin@fertilitywithinreach.org


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  3. #12
    4everEvolving
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    Hi Davina,
    Thank you so much for your advice! My husband is going to go to his HR dept with a fact sheet in hopes they may be willing to reconsider their coverage package. I didn't know about the rider option and I'm so glad you told me, so he can go to that meeting even more prepared. Oh, and we are excluded because his company is self pay, not medical reasons. Thanks again!!


  4. #13
    maybabyhopes
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    I am so sad. I have low amh and one blocked Fallopian tube. After all testing, re recommended strongly ivf. All set to move on and start meds on the 26th. Protocol was laid out. Today I heard back that my insurance is refusing to cover ivf. They want me to try medicated cycles, iui... This is unbelievable . Has anyone ever dealt with this before? My doctor is strongly recommending ivf. Also- some male factor as well- count is good but not optimal.
    How can I appeal with the insurance company to push this coverage through? I cannot imagine having to go through treatments that I have been told are not Adequate for my situation just to satisfy insurance company! Any advice? I would be grateful....


  5. #14
    JennaAtFertilityAuthority
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    Fertility Within Reach : Access Infertility Insurance

    Maybabyhopes,

    Have you asked your doctor to write a letter to your insurance stating the medical necessity and try to appeal for you?

    Best of luck,
    Infertility & POF Advocate - Follow me on Twitter
    RESOLVE Ambassador
    Event Chair, RESOLVE Tri-State Walk of Hope 2015


    IF Timeline
    Dx: Premature Ovarian Failure

    07/2010 IVF #1 - Cancelled d/t Poor Response
    08/2010 IVF #2 - Converted to IUI #1 - BFN
    10/2010 IUI #2/3 - BFN
    11/2010 IVF #3 - No Eggs at ER - Given the DE Speech

    12/2010 - 6/2014 ON BREAK

    06/2014 IVF #4 - Cancelled d/t No Response
    10/2014 IVF #5 (Known DE) - Chemical Pregnancy

    04/2015 Matched with Donor - 6 Frozen Eggs
    08/2015 DE IVF #6 - BFP!!

    03/2016 Twin Boys Born


  6. #15
    maybabyhopes
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    Thanks for your reply! My fertility clinic informed me that he will do a peer to peer... More waiting... This is exhausting and I haven't even started treatment yet! Lol
    I am praying that they listen to the medical necessity. Not sure how often these peer to peer reviews work. We are going to appeal as well and so is the clinic.
    Likes JennaAtFertilityAuthority liked this post


  7. #16
    LynnNJ
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    I am 41 and have been trying for almost one year. I am working with a fertility specialist who thought I was a good candidate for IVF. Insurance denied me because it had not been a full year. Since then we did 2 IUI and am getting ready for another IUI. We did an appeal, which was denied. We were told that insurance will not look at my case until December since the request was originally sent last December. However, September will be a year. I live in NJ, which has a mandate. The doctor thinks my chances of pregnancy without IVF are very slim, given my age (over 40). How how I find out if I am eligible in Sept. under the NJ mandate?


  8. #17
    FWR
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    Hi LynnNJ,
    We are currently working with legislators in NJ to update your infertility mandate to say infertility treatment is warranted after 6 months of trying for those over the age of 35. I would be happy to connect with you and give you some guidance on what to communicate and resources to share with your insurer for your appeal. If you are interested, please use the link, fill it out and email back to me at admin@fertilitywithinreach.org. (http://www.fertilitywithinreach.org/...aire6_2015.pdf) If you let me know your availability next week, we can arrange to spend about 20 minutes on the phone to talk about your best options to gain benefits.

    I look forward to connecting.

    All my best,
    Davina


  9. #18
    FWR
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    Hi LynnNJ,
    We are currently working with legislators in NJ to update your infertility mandate to say infertility treatment is warranted after 6 months of trying for those over the age of 35. I would be happy to connect with you and give you some guidance on what to communicate and resources to share with your insurer for your appeal. If you are interested, please use the link, fill it out and email back to me at admin@fertilitywithinreach.org. (Nothing found for Aire6_2015 Pdf) If you let me know your availability next week, we can arrange to spend about 20 minutes on the phone to talk about your best options to gain benefits.

    I look forward to connecting.

    All my best,
    Davina


  10. #19
    tak212
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    Quote Originally Posted by FWR View Post
    4everEvolving, I do have advice, but it also comes with questions.

    If your insurance isn't paying because they are self-insured I'd suggest using the argument that research shows people without insurance transfer more embryos during an IVF cycle, increasing the risk of outcome costs associated with high risk pregnancies, premature birth, NICU expenses, and future healthcare expenses for mother/child. People with insurance benefits are able to make decisions based on medical needs, not finances. You can find these facts/resources at Infertility Resources for Conversations About Fertility Insurance Coverage - Fertility within Reach. Instead of the employer helping with a $10,000 IVF cycle, they could be looking at $100,000+ in outcome costs.

    You could ask your employer if they would ask their insurance broker if you could purchase a rider, allowing you to buy extra insurance for infertility treatment.

    Do you not qualify for the mandate because of medical reasons? You can find out different strategies to effectively communicate with policy decision makers at Infertility Insurance Coverage and Benefits Information - Fertility within Reach.

    Please let me know if I can help you any further.

    All my best,
    Davina

    Davina Fankhauser
    Fertility Within Reach
    admin@fertilitywithinreach.org
    My employer offers coverage for 3 ovulating inductions but does not offer any IVF coverage. Due to 2 hydro tubes (1 removed), IVF is my only option. Can you tell me more about the insurance rider? I may ask my hr dept about this, but would like to understand it a little better. Do you know if it is usually very expensive to add?
    Me: 36, 1 tube removed, 1 hydro tube
    DH: 34, no issues
    2008: 1 hydrosalphinx tube removed
    2011: remaining tube hydrosalphinx
    2012: egg freeze cycle (21 retrieved, 17 mature/viable for freezing)
    Sept 2015: IVF #1 BFN
    Jan 2016: FET #1 BFP!


  11. #20
    tak212
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    Quote Originally Posted by FWR View Post
    4everEvolving, I do have advice, but it also comes with questions.

    If your insurance isn't paying because they are self-insured I'd suggest using the argument that research shows people without insurance transfer more embryos during an IVF cycle, increasing the risk of outcome costs associated with high risk pregnancies, premature birth, NICU expenses, and future healthcare expenses for mother/child. People with insurance benefits are able to make decisions based on medical needs, not finances. You can find these facts/resources at Infertility Resources for Conversations About Fertility Insurance Coverage - Fertility within Reach. Instead of the employer helping with a $10,000 IVF cycle, they could be looking at $100,000+ in outcome costs.

    You could ask your employer if they would ask their insurance broker if you could purchase a rider, allowing you to buy extra insurance for infertility treatment.

    Do you not qualify for the mandate because of medical reasons? You can find out different strategies to effectively communicate with policy decision makers at Infertility Insurance Coverage and Benefits Information - Fertility within Reach.

    Please let me know if I can help you any further.

    All my best,
    Davina

    Davina Fankhauser
    Fertility Within Reach
    admin@fertilitywithinreach.org
    My employer offers coverage for 3 ovulating inductions but does not offer any IVF coverage. Due to 2 hydro tubes (1 removed), IVF is my only option. Can you tell me more about the insurance rider? I may ask my hr dept about this, but would like to understand it a little better. Do you know if it is usually very expensive to add?
    Me: 36, 1 tube removed, 1 hydro tube
    DH: 34, no issues
    2008: 1 hydrosalphinx tube removed
    2011: remaining tube hydrosalphinx
    2012: egg freeze cycle (21 retrieved, 17 mature/viable for freezing)
    Sept 2015: IVF #1 BFN
    Jan 2016: FET #1 BFP!


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