My insurance plan is an Obamacare plan bought on healthcare.gov. It says infertility is covered "No charge after deductible." They had preapproved my IVF months before, and confirmed with the doctor. And then they denied it. Days before surgery, of course.
I finally got the official paperwork in the mail, and they claim infertility is not a covered benefit. Yet IVF has a whole benefit section with a bunch of hoops I've been jumping through since January.
My friend G helped me (hi G!) and we made a badass appeal. The medical part is easy when you blew a tube. The rest is regulations and rules. My goal for that appeal was that someone will look at it and send it straight to legal.
Also, I'm allowed to ask for documents, practically anything in this state. So I requested documents, a lot of documents. It's going to take someone a week to get all those documents together.
With all the pain and struggle of the last week from that brutal retrieval, my muscles are still sore, it felt GOOD to focus my anger in something I guess I can call productive. It felt good to send that little response out certified mail.
No way is this over. If the insurance company wants to fight, they picked the wrong one, with the most clear medical history possible. And now I'm angry. False advertising, state insurance regulations, Obamacare regs, I'll fight in every arena I have. I will be such a pain it will be easier to pay to make me go away, I can tell you that already.
kick their asses! I hope they change their mind and cover your claim!
ReplyDeleteIt's not really changing their minds, it's reading their own paperwork.
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