Health Insurance Inquiry
I’m facing an issue with UHC denying coverage for an IVF cycle due to my previous egg freezing, which I paid for out-of-pocket without any involvement from them. They’ve informed me that I need to use those frozen eggs before they will consider covering a fresh cycle.
It seems my clinic might have documented the egg freezing procedure in my medical records, which is how the insurance company was made aware.
Are insurance companies required to take into account medical procedures performed outside of their coverage?
In most cases, health insurance companies are entitled to review your complete medical records, including any procedures performed out of pocket, to assess coverage for treatments like IVF. This is often part of their process to determine the most appropriate and cost-effective approach for your care based on your medical history.
However, whether they can require you to use previously frozen eggs before covering a fresh cycle depends on the specific terms and conditions of your insurance policy. It’s essential to carefully review your plan’s coverage details regarding IVF and any related treatments.
You may want to discuss this issue further with your clinic and your insurance provider. If you believe your situation warrants a more favorable review, consider appealing their decision or consulting with a health insurance advocate or ombudsman who can help navigate the complexities of insurance coverage.