Reproductive Immunology and Insurance Coverage


#1

Greetings Fertility Community!

My wife and I have been in fertility treatment for the last 2 years and are currently 6-months pregnant with our first child. I attribute our success to being lucky enough to find a doctor who was not only a fertility specialist but also a reproductive immunologist and endocrinologist.

Through blood testing we were able to determine that we had elevated cytokines, natural killer cells, and some blood clotting factors that were too high, as well as some other things I don’t remember or don’t understand. We were prescribed Neupogen, IVIG infusions, and blood thinners to combat these issues, in addition to the normal IVF protocol medications.

We’re thrilled to have come this far and are SO thankful for the treatments that we were able to get. But now comes the insurance fight! We’re covered under my wife’s Aetna plan.

Has anyone had any experiences with insurance and reproductive immunology? Everything related to IVF was covered by Aetna, but the immunology pieces were not. We knew going in that the medication wouldn’t be covered, but we have since found out that the blood work itself to test for immunology issues is not covered either because it is considered experimental.

Has anyone been through the appeals process to get these sorts of lab tests covered? We’ve already received a letter of medical necessity from our doctor, but the claims are still being denied. Because we had to have the tests redone every 4-6 weeks to ensure the killer-cell levels were staying down, we are now facing $12,000.00 in bills for the lab work alone.

Any success stories, tips, tricks, or hints would be welcome. Or if you were NOT able to successfully fight the insurance companies on immunology issues, that’s helpful too! I just want to know how hard I should work to get them to cover something like this. From what I can see so far, they are indeed following their own rules, so it;s not like a mistake was made or coding was wrong or anything.

Thank you!

Dave