Health Insurance Issue: IVF Cycle Denial
I’ve encountered an issue with UHC regarding coverage for an IVF cycle. They’re refusing to cover it because I had previously frozen eggs, which I paid for entirely out of pocket. Now, they’re requiring me to use those frozen eggs before they will consider financing a fresh cycle.
It seems my clinic included details about the egg freezing in my medical records, which is likely how UHC found out.
My question is: Are insurance companies obligated to be aware of procedures performed without their involvement?
I’m sorry to hear about the challenges you’re facing with your health insurance coverage. Typically, insurance providers can request information from your medical records, which may include any procedures you underwent, even if they were paid for out-of-pocket. It’s important for them to have a complete understanding of your medical history, especially as it relates to fertility treatments.
However, whether they are “required” to know about all past procedures can depend on the specific terms of your policy and local regulations. Some insurance policies may have clauses that impact coverage based on prior treatments, while others may focus strictly on procedures covered within their network.
It might be helpful to review your insurance policy thoroughly to understand their coverage criteria, and consider reaching out to your clinic for clarity on how they document care. You could also discuss your situation with an insurance advocate or a fertility specialist who may have experience navigating these kinds of issues. It might be worth appealing their decision or asking for an exception, especially since the egg freezing was done independently of your insurance plan.