Anonymous wrote:I imagine you've had all the testing done to determine the cause for recurrent pregnancy loss (i.e., genetic testing, immune testing, etc.)? No cause found/nothing came from this testing?

I think the problem you are having is that many insurance companies do not necessarily view IVF as treatment for RPL because there is no issue apparent issue getting pregnant, it's just staying pregnant that is the problem and if the reason for that is not known, IVF is not necessarily going to prevent it.

I agree with this post. I can see how IVF is not medically necessary for RPL as in your case you are able to get pregnant without ART. IVF is considered when you have not been able to conceive naturally on your own hence why it is covered in that instance. The problem like PP said is to find out the reason for the pregnancy loss (genetic, immune issues, lining problems) as IVF does not necessarily prevent pregnancy loss it just helps one to conceive.

I imagine you've had all the testing done to determine the cause for recurrent pregnancy loss (i.e., genetic testing, immune testing, etc.)? No cause found/nothing came from this testing?

I think the problem you are having is that many insurance companies do not necessarily view IVF as treatment for RPL because there is no issue apparent issue getting pregnant, it's just staying pregnant that is the problem and if the reason for that is not known, IVF is not necessarily going to prevent it.

Anonymous wrote:Why did they deny it? For medical or policy issues?

Although IVF is covered for recurrent pregnancy loss, the insurance denied it as "not medically necessary." In CT, after you exhaust your appeals with the insurance, you can go through the state who sends the case to an independent review organization(IRO--perhaps this is the practice in most places?). The IRO upheld the insurance decision that IVF for recurrent preg loss is not "medically necessary"...so even though we have coverage for it, and I assembled a file that showed me checked all the boxes for recurrent preg loss, they determined we don't need it.

Why did they deny it? For medical or policy issues?

I’m not an expert, but currently only 16 states have infertility insurance coverage laws. It looks like CT is one of them. Some states requires group insurance (insurance at work) to cover treatments and other times individuals (private insurance outside of the job) can obtain it. Here’s a link that may shed some light on what’s mandated for CT:

https://resolve.org/what-are-my-options/insurance-coverage/infertility-coverage-state/

Also, call the insurance company directly to have them explain the infertility benefits.

Good Luck!

A couple of things to consider.

1). I looked for insurance on the marketplace years ago (2016) that covered fertility treatments and had a really difficult time. Even the big name insurers had different plans on the marketplace. That may have changed though.

2). I know with my insurance, I can only change if I have a qualifying life event (marriage, divorce, change jobs, etc.). CAN you even change? I wasn’t really sure from your messsge whether you had already re-upped during open enrollment.

Just two things to think about! Good luck! Insurance is such a complicated beast.

Do you know why you were denied? Often there are hoops you have to jump through before you're eligible for IVF coverage. A certain number of months trying, a certain number of IUIs or other treatments, etc. Before switching insurance, I would find out the reason for your denial and see if it's something you can correct then reapply for IVF.

when is your employer open enrollment period??

Definitely enroll in the market place insurance. not sure what your premiums are. you will have to check with you HR dept about dropping your employers health insurance and see how that is managed. since your employer is paying part of your premiums. best bet is check with HR. You may have to continue the 6 months from your employers. also double check with the market place and make sure there isn't a waiting period. some plans wont offer fertility/IVF coverage unless you have been on the plan for 12 months prior to seeking fertility treatment with that plan.

Quick background:
-My wife and I are in CT (but this site has been such a huge help--thank you all).
-Her employer insurance does not cover fertility, so we switched to mine.
-After all the hassle of switching, IVF has been denied.

My health insurance is not a big, national insurer, which I've heard would be more likely to approve IVF in our case. I don't know if that's true, but it's worth a shot.
What's the best way to go about shopping for one's own insurance? Do I look up my state's marketplace (CT deadline has been extended to Jan 15)? If I do find insurance I want, how do I transition off of my insurance (which we just joined July 1) to our own/new plan? Would being on my insurance for less than a year complicate/prevent that?

I realize this is less a fertility question and more an insurance question, but perhaps some of you have been through something similar. Thanks in advance.