Denied Prior Authorizations

Hi all – wondering if anyone has been through something similar and would love any advice!

My company provided insurance is out of California since that's where they're headquartered, but my wife and I live in Illinois.

My actual benefits say that we have up to $20k lifetime max to use towards infertility treatments and IVF. We were just told that all our pre-auths were denied and when I called the insurance company they said my policy was tagged with a policy exclusion because I'm an Illinois resident.

So, I don't qualify for the California policy because I don't live in California and they aren't required to honor the Illinois mandate because they aren't HQ'd in Illinois.

We talked to a nurse care advocate and some folks on the benefits team who think we have a good shot at appealing.

Has anyone been in this situation? Any advice for appealing the denied claim?

submitted by /u/rosehipster_89
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