A Fertility Story – A Patient’s Experience With Her Insurance Benefits

By: SUZANNE – A patient at Lane Fertility
(Names in the article have been changed to protect patient identity)

This is my second time getting help from a fertility treatment facility. The first time I paid out of pocket. While this was expensive, in a way it made everything easy, because I did not have to deal with the insurance company and I could focus on just staying calm and getting ready for the journey. We underwent a cycle of In Vitro Fertilization (IVF) and had a successful pregnancy the first time. When my daughter was almost 2, we decided to try again.

The second time we had insurance coverage. We thought that this would be great from a financial perspective. However, in order to access the benefits, I had to go through a very painful and emotional process in order to obtain insurance approval. This felt like the last thing that I needed as I started my fertility treatment!

After visiting the clinic and developing a treatment plan, the fertility treatment clinic submitted a request to have my treatment authorized. This took a long time and left me very nervous. I was constantly thinking “What if they don’t approve me?” “Who are they to decide whether I can have more children or not.” After weeks of waiting, a representative called from the insurance company to ask questions, and ordered me to get some lab work done. The fertility treatment clinic had anticipated this and had asked me to take care of the bloodwork several weeks before. I explained to the nurse that my physician had already sent the results along with a letter explaining why I needed the specific treatment. But the representative was unaware of this and asked me to do it again. She also said that a nurse would be calling me in 24 hours to go through a questionnaire.

Lane_Mag_2015_Questions_AskedI waited and waited, and finally three days later I received the phone call from the nurse. Conveniently, I was right in the middle of taking a walk with my daughter and my dog. The nurse then began to ask questions that were very emotional and somehow painful. It felt awkward to answer these questions in the street, but all she wanted to hear were straight answers. There was little sensitivity to the private nature of the questions she was asking.

After answering the questions, the insurance company completed its process and the treatment was approved. However, after the initial cycle was unsuccessful, Suzanne’s insurance refused to authorize her to do a second round of IVF. Suzanne’s fertility treatment center has appealed this denial on her behalf.

I have found that the insurance process involves great deal of frustration and personal intrusion. It is important to understand this if you are going to use your insurance benefits to obtain fertility treatment services.