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Old 08-21-2008, 10:41 PM   #3 (permalink)
Bertiebugg
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You can find information about the state mandate http://www.fertilitylifelines.com/pa...atemandate.jsp

Ohio
Mandates HMOs (but not other types of insurers) to cover infertility treatment as a "preventative" benefit. The treatment must be "medically necessary," and the Ohio Department of Insurance has ruled that GIFT, ZIFT and IVF are not medically necessary.

Maryland
Mandates insurance carriers that provide pregnancy–related benefits to cover IVF after a two–year wait following diagnosis, with no wait required for certain diagnoses. Insurance carriers are not required to provide this benefit to businesses (group policies) of 50 or fewer employees. Religious organizations can choose not to provide coverage based on their religious views. A carrier may limit IVF benefits to three attempts per live birth, not to exceed a lifetime maximum benefit of $100,000.

Basically if the services are considered diagnostic and medically necessary then your insurance will cover it. However, if you are going through a fertility cycle... and they determine that the services were in relation to that cycle then the services will not be covered. They can make this determination by requesting chart notes from your provider or by the diagnosis that is being billed.

The way I usually explain this to people is that the plan covers to diagnosis and to treat the underlying causes but will not covering anything inconnection with getting them pregnant. So your dr might do 8 ultra sounds in a month to see if your body is doing anything on its own this would be considered diagnostic.... but if your doctor says well it looks like you've produced an egg lets give you a shot to release the egg and do another ultrasound in a couple days.. this would be considered a cycle to get your pregnant and would not be covered.

I hope this helps
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