 Law versus Coverage
I researched some on the laws covering fertility treatments/prescription coverage after a friend at my job told me insurance has to cover me for these items. My husband and I live in NJ but work in NY, so I assume that I should look at NY laws, which state "Plans that include coverage for prescription drugs must include coverage of drugs approved by FDA for use in diagnosis and treatment of infertility." (http://www.asrm.org/Patients/insur.html#NY) Reading my husband group insurance plan it says "Effective August 1, 2004, the following prescriptions are excluded from
coverage under the Plan, unless determined by the Plan to be medically
necessary: Fertility drugs"
So would I be covered or not? I cannot see how they would not cover it since it's law stating they must. And how is it deemed that fertility drugs are medically necessary?
This really only affects me until January when I re-enrolled in my medical plan at my job which covers fertility treatments but we wanted to maybe start a bit sooner.
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Tried to conceive naturally since June 08 (Tried herbals, insulite, diet and exercise.)
05/18/09 - Started Provera
1st Clomid Cycle: 6/1/09 - 100 mg CD 3-7, Ovidrel 6/12... BFN 6/30/2009
2nd Clomid Cycle: 7/3/09 - 150mg CD 3-7, Prednisone 5mg/14days, Ovidrel 7/13, IUI 7/15 AF arrived 7/29.
3rd Clomid Cycle: 7/29/09 150mg CD 3-7, Prednisone 5mg/14days, Ovidrel, IUI 8/10...BFN
Taking a long break to focus on losing more weight, and insurance no longer covers treatments...
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They should be able to tell you what would qualify as 'Medically Necessary'.
