does anyone else have GHI?

So, my husband and I will be switching to his insurance January 1st, which is GHI so we have some IVF coverage, right now we have no IVF coverage. The billing lady at LI IVF says the new insurance requires 6 failed IUIs before going on to IVF. We're currently on IUI #3. I feel like after 3 failed IUIs my chances of getting pregnant with IUI is slim and I would love to move on to IVF, I was hoping to just do this IUI and one in December and then January be able to move forward. Has anyone ever been able to fight this 6 failed IUIs rule? If so how? If not, I'll do 6 IUIs it just feels like a waste of time. What do you think? Has anyone really gotten pregnant after 3 failed IUIs on a subsequent IUI?

Also, my other thought would be to do injectables to increase my chances with IUI, we're currently on clomid getting approx. 3 follicles/cycle, my only concern is I don't want anything more than twins and don't want to face selective reduction. Thoughts?

does anyone else have GHI?

I do, it depends on what the issues are. I only had to do three IUI's because of my age, 41 I was able to move on to IVF.

Re: does anyone else have GHI?

i believe it depends on your plan sponsor / employer. Aetna required that as well if you were under 37, until I called their IVF hotline and the rep looked at my plan and said Newscorp does not require this with their IVF coverage. So I went right to IVF.

(I had already done 3 medicated IUI's and 2 rounds of clomid and timed intercourse..so I would have been almost covered with that anyway).


some insurance companies will waive it if your dr writes an appeal.

does anyone else have GHI?

I have GHI and after 2 IUIs based on our diagnosis of MF my RE was able to write a justification letter as to why IUI wasn't beneficial in our case and should be bypassed for IVF. So depending on your diagnosis your doctor can do that

Re: does anyone else have GHI?

I have GHI and I also work for Emblem so I could help you with any benefit questions. Just send me FM!

you can bypass the IUI requirement if you meet other requirements. For example I did 1 IUI and then went straight to IVF because of my DX. I have tubal blockage due to endo stage III. The RE has to submit the documentation requesting to advance to IVF.

Re: does anyone else have GHI?

When we did IVF it use to be 12 iui before they would pay

My doc wrote a letter and they agreed to pay

Re: does anyone else have GHI?

And also clomid did nothing for me

I would either switch to femara and I would def try one cycle with injectables before going to IVF

does anyone else have GHI?

Thank you so much for all your responses. I'll definitely be meeting with my RE to see if there is any grounds for writing a letter of appeal.

does anyone else have GHI?

I had the iui rule as well, Michelle at liivf appealed for my and got it approved. She also appealed for me when ttc my 2nd dd. They wanted me to use my frozen instead of fresh but I would have ran out of $ then.

Re: does anyone else have GHI?

I did 0 iuis because I have pcos and because of my age. I was 26 when we first started (higher chances of multiples)

does anyone else have GHI?

I have GHI. We had to do 6 IUIs before IVF because I was under 35 and unexplained. I did IUIs with Clomid and injects. I was not successful with IUI even though they thought I would be. My RE was ready to move to IVF after IUI 4 but we had to do 6 with GHI. GL

Re: does anyone else have GHI?

I have GHI and after age 35 you only have to do 3 iui cycles... if they fail then they will pick up IVF at 75%. However, depending on your diagnosis, the doctor can send in a medical necessity letter to show why you may need IVF rather than doing more iui.

If you are producing 3 follicles, it probably isn't necessary to do injectables and that is why the RE is doing clomid. Injectables will def increase your chances of multiples.

Re: does anyone else have GHI?