MD IPA Fed IVF Coverage

[Anonymous]

Long story short, I switched insurance plans to get IVF coverage. Before January, when the coverage became effective, we had paid for an IVF cycle. We retrieved 5 eggs and none of them fertilized and they did a rescue ICSI. We transferred 2 embryos and got a BFN this cycle. It appeared that there was a MF issue. None of the sperm even attached to the egg. The Doc said this was a sperm issue. My husband's prior SA was normal and he had gotten me pregnant in May of 2008. (we had to terminate due to anencephaly)

I had originally thought that I would be taking a break from IVF because I wouldn't have met the 2 years of trying requirement until at least May of this year because of the prior pregnancy. Because we now had a MF issue (which negates the 2 year requirement)

I just got a call that MD IPA wants a new SA, which is fine. The issue is that they don't seem to be reading the documentation from my doctor about the prior issue with the IVF cycle. Here is my fear, my husband's SA will again come out normal and MD IPA will not read the doctor documentation about the problem we had with the prior cycle.

I don't know how they interpret "2 years of trying." I am hoping it is May 2008. I didn't terminate the prior pregnancy until August 2008. I will be 42 in August of 2008. Time is rapidly slipping by.

Does anyone know how I can talk to the infertility people or send them a letter to get them to read the entire notes about the MF issue we had with the IVF cycle we paid for? I'm just asking for strategy, a phone number, an email address or something.

Thanks.

[Anonymous]

I would first let the RE describe the situation to MD IPA and then see if you get the pre-certification. If not, then I believe there is an appeal process. I had no problem getting MD IPA to approve IVF for us. DH has very low morphology, but we had also had one natural pregnancy and I was afraid that may have prevented the approval, but it didn't. Good luck!

[Anonymous]

Our RE wrote a letter to MDIPA and they approved us straight to IVF with ICSI (we have slight male factor). They may require you to do IUI first, and according to our RE, appeals can take months to be resolved, so it may be worth it to just do the one IUI. Good luck!

[Anonymous]

I'm with the PP, let the RE make your case first and then see what MD IPA says..if they make you do IUI first, then maybe that's what you'll have to do if you really want to do IVF..

[Anonymous]

OP here. I spoke with my doctor and he told me that he was going to find out exactly what MD IPA was requiring and what it means. It is difficult because one cannot actually talk to a live person over the telephone, the only contact is via email or fax. He said I shouldn't worry about the new SA coming back normal because he is going to explain to them the MF issues with the first IVF cycle we did. The sperm did not even attempt to attach to my eggs on the first IVF, which is a MF issue, but wouldn't show up on a SA anyway. We've already done fertility meds with TI, the "less invasive" method as required by MD IPA. I'm on the BC pills to start another micro flare protocol cycle. My RE said that if it takes a bit longer to get coverage I can just stay on the BC pills longer than originally anticipated with the protocol.

I'm going to let my RE handle it. I was just wondering if others had an issue getting approved and if anyone had any hints with dealing with them.