does anyone have the answer?

Does anyone what can be done if your state is one mandated to cover fertility treatments and insurance co. still denies to cover? Im in Massachusetts and we are a mandated state.What can I do?

[Helen72]

This is very strange.  I am in TX and my states also mandates that all infertility treatments, including IVF should be covered.  Perhaps insurance commission should point you in the right direction....  I am not sure where you should appeal.

[maybrie]

Have you had ivf? if so did your insurance cover it?

[ms320]

I woould contact Commissioner Nonnie Burnes if the Mass Division of Insurance.  It alway pays to go right to the top.

Good luck
Mary

[maybrie]

Are u from mass? Do u know of anyone that got good results when trying to fight an insurance co?

[Heather5]

Hi! I'm also in Texas, but I was told that the state only requires that infertility treatment needs to be offered to the company. It is then up to the company whether they want it included in their policy or not. We were covered for everything (except IVF) before my husband got a new job. The new policy won't cover ANYTHING! Not even diagnostic tests to find out if anything is wrong! It's sooooo frustrating!!!

[wanting4#1]

It was my understanding that if you are in a mandated state (I think Ohio is one, which is where I am), then the insurance company is required to list it as an exclusion if it is not covered - not that it must pay.  So, you will need to check your policy - if it is not specifically excluded, THEN it must be paid.

Hope that helps!

[SDScientist]

Texas is a "mandate to offer", Mass (where my company is headquarted) is a "mandate to cover".  If insurers provide a policy to your employer that covers pregancy related costs then they have to provide infertility insurance, although it can have a lifetime cap, which covers diagnosis and ART.  Does your company pay for the benefits or is it self-funded?  If it is self-funded (you pay through the company) or self-pay (it is an individual plan you pay for) then the state law does not apply.  It only applies if the company you work for is paying for the benefits.

[Heather5]

Yeah, that's what I thought :-(  

I guess we're on our own then, when it comes to paying for any tests or treatment. I wish Texas was a "mandate to cover" state too!!!  I also wish I had taken the opportunity to have more tests done BEFORE we got the new insurance. Oh, well. Nothing we can do about that now.

Thanks for clarifying.

[Helen72]

So far my insurance covered everything, including my laparoscopy.  I have not done ivf yet but will be doing IUI.  I think that my insurance should cover that.  

Heather, I did not know about employers refusing infertility treatments.  I guess I should check what my employer does.  Thanks for the warning!

[Helen72]

OK, so I became curious and checked what my UT insurance actually covers.  Looks like you are right.  My employer covers all infertility diagnostic testing (including diagnostic surgery) but not treatments.  I guess I'll have to pay for my IUI out of pocket.  :(
So, in the end the state mandate does not help us much....

[Heather5]

Yeah, no problem! Sounds like your insurance is far more "fertility friendly" than ours, but it might not be a bad idea to call in advance before having anything too expensive done :-) Good luck with your IUIs!!!

[Heather5]

Looks like we posted at the same time. I'm so sorry your insurance doesn't cover IUIs! My previous policy did, just not IVF. I guess it just really depends on the company.

:-(

[maybrie]

Thank u for all of ur help ladies I found out today that they will only cover diagnosis and testing no ivf.Four yrs ago they covered 3 ivf cicles for me within a 1 yr period they said I've reached my limit.I guess it's time for us to break out the check book. Thanks again ladies I knew I would get lots of help here u girls are wonderful! Good luck to all of u that are starting iui & ivf,