Reply to IVF authorization denied - doesn't meet "medical necessity"

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[quote=Anonymous][quote=Anonymous]Op here.  Coverage is for under 40 and I am 39, hence the urgency.   If we started before 40, perhaps it’s viewed/weighed collectively?[/quote]

18:56 PP here. No, multiple IVF rounds are not viewed "collectively". Each requires a separate authorization, but for now your problem is that you don't seem to fall under the criteria for authorization. Until a doctor can give you a diagnosis that qualifies you for IVF - you're stuck. Have you had any testing done after 3rd miscarriage? Have you done a genetic test (and your spouse as well)?  These would normally be covered by insurance and would be the first steps to document why you may need PGD and only PGD to proceed.

Call your insurance, there should be a separate team dealing with fertility-related claims. Write down your questions, have a detailed talk with them. They will not be able to reverse the previous decision on the spot, but they will give you the info that you're missing right now: what you need from your dr. in order for the claim to be reviewed and possibly approved. I can't speak for all insurance ppl, but the team who I talked to at Aetna were invariably very compassionate, friendly and patient, I never walked away from the call without the info I needed broken down to my level of non-medical understanding. Knowledge is power, go for it.[/quote]

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