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Infertility treatments coverage

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Grumpy70

Junior Member
In New York -

I am trying to learn more about infertility treatment coverage.
I currently live in NY and have Oxford Healthy New York as my primary Health insurance (not through employment, I lost my job due to the economy) - for who is not familiar with this insurance, this is for low income people and they have affordable rates - the insurance is pretty good though it doesn't cover everything (but which insurance does?!).

I am trying to learn more about infertility treatments coverage to be able to fight the insurance company in case they tell me they don't cover it - actually I KNOW they do not cover fertility treatments but I was reading on line something interesting:

"Determine whether you live in a state that has mandatory infertility insurance coverage New York, for example is one of several such states. Under the mandate, your state must ensure that insurers provide fertility insurance as part of a standard plan, or as an option to purchase for a reasonable price."


What does it mean?
I understand that New York State has mandatory infertility insurance coverage? Did I get that right? Does it mean that by law they HAVE to cover infertility treatments? So why very few insurances (if any) cover infertility treatments and most of them deny them?

If I get to fight with my Health Insurance what kind of letter should I send them? What should write them? Can you help me with the format so I have an idea? Somewhere I read this:

"If your infertility insurance coverage is rejected by your insurer then you appeal against it to your insurer. You can do it by stating that it is a legal process and an inevitable medical treatment in your case"

Can you help me write an appeal letter?

Please please please help me fulfill my dream of becoming a mother, please help me.
Any help is really appreciated.
 


Zigner

Senior Member, Non-Attorney
I'm sorry, but you have no job...how do you expect to support this child you are attempting to create?


In New York -

I am trying to learn more about infertility treatment coverage.
I currently live in NY and have Oxford Healthy New York as my primary Health insurance (not through employment, I lost my job due to the economy) - for who is not familiar with this insurance, this is for low income people and they have affordable rates - the insurance is pretty good though it doesn't cover everything (but which insurance does?!).

I am trying to learn more about infertility treatments coverage to be able to fight the insurance company in case they tell me they don't cover it - actually I KNOW they do not cover fertility treatments but I was reading on line something interesting:

"Determine whether you live in a state that has mandatory infertility insurance coverage New York, for example is one of several such states. Under the mandate, your state must ensure that insurers provide fertility insurance as part of a standard plan, or as an option to purchase for a reasonable price."


What does it mean?
I understand that New York State has mandatory infertility insurance coverage? Did I get that right? Does it mean that by law they HAVE to cover infertility treatments? So why very few insurances (if any) cover infertility treatments and most of them deny them?

If I get to fight with my Health Insurance what kind of letter should I send them? What should write them? Can you help me with the format so I have an idea? Somewhere I read this:

"If your infertility insurance coverage is rejected by your insurer then you appeal against it to your insurer. You can do it by stating that it is a legal process and an inevitable medical treatment in your case"

Can you help me write an appeal letter?

Please please please help me fulfill my dream of becoming a mother, please help me.
Any help is really appreciated.
 
Last edited:

ecmst12

Senior Member
If this is a state funded plan, it may very well be exempt from the rule. The taxpayers don't like to pay for unnecessary, optional, expensive treatments to create children which they will also have to pay to insure....you're going to have to wait until you can afford better insurance or pay for the treatments out of pocket.
 

You Are Guilty

Senior Member
If I recall correctly, even if there is coverage, it is pretty limited. There is basic testing (both for men/women) and maybe 2-3 IUI procedures. That's it.

And the reason I even bring this up is those procedures are not particularly expensive (compared, say, to IVF), and I imagine, one could work out an out-of-pocket payment plan with the treating physician's office.

As for supporting the potential kid, while not a legal issue, it is certainly one you will need to answer.
 

OHRoadwarrior

Senior Member
You really need to get your priorities straight. Sounds like you want tax payers to get you knocked up so you can have them support you indefinitely.
 

ENASNI

Senior Member
You really need to get your priorities straight. Sounds like you want tax payers to get you knocked up so you can have them support you indefinitely.
Not Cool and not Legal. This is not YOUR call at what is in their life. DO NOT GO THERE.

inoho.. not cool at all.

done
and done
 

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