fertility insurance coverage

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In 2013 my husband and I started working with a fertility doctor and our insurance through my husbands work gave us $15k life time for fertility coverage. On Dec 26 2013 the financial person at the doctors office called our insurance company and asked if there were any changes coming for 2014. She was told no changes. Jan 13 2014 my husband and I had an appointment, lab work etc a few weeks later the financial person called me and told me our insurance company was denying all our claims for that visit saying we no longer had fertility coverage. My husband consulted his insurance info and confirmed that as of 1/1/14 we no longer were covered for fertility. He contacted the vice president of HR and was told that they did take fertility coverage out and were not going to replace it and perhaps we should go to obamacare to find the coverage we were looking for. My question is is there a way to get them to agree to add our coverage back in? I am told this company is a self insured company which seems to give them whatever control they want over the insurance policy but I also understand that they can add the fertility coverage back in if they choose. My husband has made contact with a few other couples at his work who are facing the same situation. I now have a $2.000 bill the doctor is expecting to be paid asap.
Your husband probably should have verified with his employer/verified his ins. coverage before having any tests etc. done. However, we have a responder on this forum who works with employee benefits - hold for that person to come along. She should be able to help you more than I can.
That would be me, I believe.

No, there is nothing you can do to force them to add coverage back in. Being self-insured gives the employer more control, that is true, but there was a reason it was removed in the first place. That reason was probably cost - the premiums to include the coverage may have made the overall plan too expensive. There has to be a balance between what the policy covers and what it costs. You can certainly asked, but be prepared for the answer to be No.

Now, with that, let me ask you a couple of questions, which might affect what appeals you have.

How much of the $15k lifetime max had you already used?

When the finance person called to ask about changes, did she specify that she was asking about fertility coverage or did she ask a generic question?

Did your husband at any time discuss this with his HR department?
Firstly thank you for replying to me and giving me some advice, I appreciate it. yes when the finance person called she asked specifically about fertility coverage and i'm not exactly sure how much of the $15k we have used but it was less than $5k. I could probably find out an exact total if needed. My husband emailed the HR dept initially and got the run around, I emailed her and she said simply "you are no longer covered" so then my husband emailed the HR vice president and his reply was essentially we are no longer carrying fertility coverage sorry.
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CT has some requirements for fertility coverage but your husband's employer may not be subject to them if they are self-insured. I will put money on their having dropped the coverage because it was increasing the cost of the plan. Have you looked into any of the state plans as supplemental insurance?
No I havent looked into alternatives yet, I am just getting by on what we are already paying... I do have another question for you though is it possible to sue the insurance company? Here is my thought process: infertility is a medical condition it is not a cosmetic procedure, we pay into the insurance every week, every year and yet they get to make the decisions on every medical decision. Everyone I talk to in IRL says I'm expecting to much from my insurance company but I say they aren't expecting enough. It SHOULD be the insurance companies are working for us not vice versa. The women I talk to on the support group chat rooms tell me I am lucky because they have already invested 30k into their procedures. I'm not saying I am lucky or unlucky I am saying it shouldn't have to be this way. We are entitled to be covered for the medical coverage we need. I understand it would be difficult because the insurance companies are so huge, rich and protected but I'm just wondering your thoughts.
The problem is that the insurance company is not liable to pay everything that you or your doctor considered medically necessary. They are responsible for paying what is in the contract, nothing more and nothing less. If the policy states that they are not liable for fertility coverage, then a lawsuit is not going to change that. No insurance policy is liable to pay for every possible medical condition - the cost of such a policy would be astronomical. They are liable to pay what the policy says they will pay.

If the policy said they WOULD pay for fertility coverage and they refused, then a lawsuit might be a viable option. But since the policy says they will not pay for it, they have no responsibility to do so and a lawsuit won't make them liable.
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