Reimbursements

[Craig Dishman]

What is the name of your state? Texas
My wife and I our pregnant with our first child. We have tried for over 4 years and spent almost $20,000 on infertility treatments. We were told before that only a very small amount of the treatments were reimbursable. At a recent employee health fair, a sheet was on our insurance carrier that stated that infertility treatments are covered upto 50%. I turned in all receipts, along with spreadsheets and claim forms within the last month to our insurance carrier along with that form that states that these treatments are covered up to 50% We received a check last week for $175....everything else seems like it will not be covered. What can I do from hear? I can follow their appeal procedures, but hoping to add some "punch" to it all!

 

[CIAA]

Craig,

By all means appeal. However, there are many factors that may come into play: if your company is "national" in scope, this may apply only in some states, if it is a newly expanded benefit it may not apply to your situation, etc. The terms of your policy plan description will be most important

While your plan is most likely an ERISA plan, regulated by the US Dept. of Labor, not the State, the Texas Dept. of Insurance may be of some help in determining if the "promo" was misleading.

Finally, congratulations and the very best for you and your new one.