Why TF do we need prior authorization for IVF? How do we change this?

[Anonymous]

Hi All,

My clinic - which for now will remain nameless because I like the doctor - forgot to put in my pre-authorization. My cycle is supposed to start this week. They sent it last week but insurance is saying 15-30 days. This would cancel my cycle. I just had three miscarriages in a row, and I'm in my mid-to-late 30s. Time is of the essence, and I've been trying for 13 months with those three losses in there.

Why the hell do I need pre-authorization? It's obviously medically necessary or I wouldn't do it. People don't just sign up to inject themselves with tons of drugs and risk serious side effects for the hell of it. Now a complete stranger - not even my doctor - gets to decide if I can try for a healthy baby? And take their sweet time doing it?

The kicker: insurance companies pre-authorization section won't talk to you - the patient. So I am paying for insurance and benefits - I chose this company because it covered iVF. And now I need even more permission to get what I'm already paying for?

How do you get insurance to sign the paperwork? How can we force a change in the industry. This is just plain stupid and stressful when we're already in stressful situations.

I appreciate your thoughts on how to fix this. I know everyone's understaffed, but people are making mistakes and it could cost me another 5-6 months of waiting.

Otherwise I just maybe keep trying, keep miscarrying? I've had four losses. What number makes it medically necessary? What number justifies not even needing to go through this waste of a time and money process?

Thanks.

[Anonymous]

First, recognize that you are lucky to have IVF covered. Insurance is a hassle, but thank goodness you have it.

Now, be prepared to spend at least the next day on it. Call up the prior authorization and speak to them even if they don't let you. Beg and plead, say you need it expediated. Email call your finance people at the center. Beg and plead. If you annoy enough people, and keep calling/emailing, things get expediated. I've gotten prior auths expediated this way.

[Anonymous]

Anonymous wrote:First, recognize that you are lucky to have IVF covered. Insurance is a hassle, but thank goodness you have it.

Now, be prepared to spend at least the next day on it. Call up the prior authorization and speak to them even if they don't let you. Beg and plead, say you need it expediated. Email call your finance people at the center. Beg and plead. If you annoy enough people, and keep calling/emailing, things get expediated. I've gotten prior auths expediated this way.

Me too. You just commit to spending the day on the phone and aggravating as much as possible .

[Anonymous]

This is really annoying, I’m sorry.
My clinic did the same thing. If it is truly their mistake, they should own it.
Have you had a cycle approved before? In my case, it was my second cycle (first resulted in no embryos). So I was fairly certain they would approve it.
The clinic and I cut a deal that we’d move forward as planned and they would cover the difference if it was denied. (Insurance covered only about $6k out of $15k.)
It might be worth asking the clinic if there’s anything they’re willing to do to make their mistake right.

[Anonymous]

This is a form of rationing. They hope you will give up. Even if it pushes back the treatment a few months it helps their bottom line. You are paying premiums and not getting service.

[Anonymous]

I just spent HOURS across the last two days trying to get my insurance company to approve and ship my meds. Also a preauthorization issue. They needed a document signed by my clinic to confirm that yes, in fact, I do need all these meds. Like, the doc submitted the prescriptions and you need *another* document confirming that I really do need them? And now that they have this document, it will take them 24-48 hours to process it...

Anyway, buckle up, because this will not be the first frustration you encounter on this journey. This already shitty situation is made worse by all the waiting, all the things that are out of your control, and all the people you have to hope will help you out. Like others have said, get on the phone. Call, call, call. No one is more invested in your case than you.

To your other question, if you miss your cycle this month, I would not try naturally, if you've had that many miscarriages. But your clinic could put you on BC to give your insurance time to come through. Have you asked about that?

[Anonymous]

It’s very frustrating. Here’s how it was explained to me:

Your records need to be reviewed for multiple reasons. Like some requests are for egg freezing which is not covered by many insurance companies unless there is a history of cancer. Some insurance companies only cover infertility after you’ve been with the plan for a certain period of time, so those records need to be checked.

Some infertility centers request multiple things that might not be covered by a specific plan, for example embryo cryopreservation, and PGT-A. Someone has to go through the request code by code to sift out those that are covered vs. those that aren’t.

[Anonymous]

Thanks all. I know I'm lucky. The only reason I can do IVF is because I have a new insurance company that covers it. I switched specifically for this. I've got no problem calling and annoying people, but it does require that someone answers the phone and talks to me. The pre-authorization voice mailbox doesn't accept messages. It just hangs up on you now.

I'll be on birth control for two weeks at this point. I have PCOS so my hormones are incredibly sensitive and easily go out of whack. I'm hoping this doesn't mess with it too much.

I think we should all write letters and march to get rid of this nonsense process and make it mandatory for companies to cover IVF in the first place. Several states already do. Everyone should have access to infertility treatment if they want a family.

We should all be supported in trying to have our families.

Thanks for listening to my rants.