Health Insurance defines IVF cycles such that our procedure was not covered
My wife and I have been undergoing IVF treatment. Our health care policy with Health Net of California says that “Infertility services are now covered at 50% coinsurance up to 2 treatment cycles per lifetime.” So we figured we’d get one egg retrieval done, then attempt two transfers (implantations), with all this covered at 50%.
We underwent the following treatments:
However, our insurance has informed us that they will only cover the 50% coinsurance for the egg retrieval and IVF transfer #1. They consider these two procedures to be the full “2 cycles”, and told us we are responsible for paying IVF transfer #2 out-of-pocket. This doesn’t make sense, as in my research I’ve seen that “an IVF cycle” is counted as either:
Neither of these definitions would count the egg retrieval as one cycle, and then the transfer as another cycle. What makes things even more confusing is that in our rejected appeal, they cite the following:
“You have had a total of three (3) in-vitro fertilizations to help with pregnancy (Date D, Date E, Date F).”
First off, these dates don’t match with our procedure dates, so we have no idea what they are referring to, and secondly, they cite we’ve had “3 in-vitro fertilizations”, which sounds inaccurate since we’ve actually had 1 egg retrieval and 2 transfers, and only transfers can result in fertilization.
My questions:
Can anyone help to point me to a standardized definition of an IVF cycle?
They’ve told me that our only recourse left is to request an Independent Medical Review through the Department of Managed Health Care. Is there anything I can cite or help bolster our case in the review request?