I've been dealing with two different people at my insurance company. I correspond with one person thru the insurance company web site. I've been talking to the other person on the phone. The lady on the phone says -- and she read me the plan word for word- the plan pays for "infertility diagnosis and treatment". I faxed her a letter requesting this in writing. I asked the lady over the insurance company web site if "IUI" was covered. She sent me an e-mail from the plan summary that says "artificial means of conception and support services" are not covered under the plan.

My question - what is the difference between infertiltiy treament which is covered and "artificial means of conception" which is not covered? Has anyone else run into this?

I'm waiting for a return fax from the lady on the phone, and then I'll get the insurnace company to reconcile the discrepancy.

Thanks,
Mindy

My insurance is kind of worded that way. The way they explained is this way. Infertility treatments that still allow for normal intercourse to produce the pregnancy is covered. Though things like IUI and IVF in which intercourse between the couple is skipped is not covered because it is artifical.

Infertility diagnosis and treatment are the tests that are done to find the problem or diagnosis and the treatment or procedures that would be done to fix the problem.

Lucylou,
Thanks for the reply! This whole insurance thing is very confusing to me, and everytime I ask the insurance company a question, it takes them a month to answer.
Since IUI or IVG don't fix the problems, they just circumvent it, is that why they are not covered? Also, should endo be covered, since this is something they can fix to allow normal conception? Where does Ovulation induction therapy fit it with timed intercourse? Is that treatment to fix or artifical means of conception?

To all,
I'm formulating an appeal to my company that they should provide insurance coverage for artificial means of conception. Does anyone know of something similiar with regards to a the male reproductive system they might cover? I was hoping to say, "Since you cover this similar problem for males... you should cover IUI/IVF for females"

Thanks,
Mindy

Hi Mindy! I actually work for an insurance company and I'd be happy to answer your ?'s! Endo should be covered, this is not relating to your infertility diagnosis, but this is medical, that is 2 completely different things! As far as treatment and diagnostic that does sorta stink because we all know that the tx $$ well outweigh the actual diagnosis of infertility. But like you HSG should be cov'd. and stuff. Just ask me if you have any more questions!

Mommawannbe,

You are a site for sore ears and tired fingers. I've been on the phone and corresponding with my insurance all month. I just want a contract or a plan summary. The insurance company says to ask my company. My company says they're not available. It's very hard for me to challenge the insurance company without a basis for my argument. Do you know how to get a plan summary or copy of the contract?

Also, my new dr. gave me a sample letter to request "predetermination" of benefits. I faxed it in last week. Do insurance companies do this and if so how long does it take?

I appreciate any information you have.

Thanks,
Mindy

[This message has been edited by Mindoo (edited 03-12-2003).]