IVF/PGD with GHI?

Hi,

We finally got reimbursed today after a year of fighting thanks to an appeal to OPM! I was wondering what other people's experience was. I saw there were a few posts on here where people seemed to get coverage without a problem. GHI told us that even though they covered PGD and I had pre-authorization because of a genetic disorder, they wouldn't pay for it because they had no labs in network. OPM decided that it was unfair to give coverage in the policy but not offer a provider and they forced GHI to reverse their decision. Unfortunately, they only gave us back 1,800 out of the 3,750 we paid Genesis Genetics. I was surprised that the had such low basic allowance for PGD codes. since other insurances seem to reimburse at higher rates and I'm sure there aren't any PGD labs out there agreeing to such a low contracted rate. Did anyone with GHI somehow find an in network lab or was it all done with out of network benefits?

In the end IVF/PGD didn't work out. The embryos arrested and didn't implant and I had no unaffected ones to freeze. We moved and lost IVF benefits so I got pregnant naturally. It's stressful when you know there is a chance something could be wrong but thankfully the disorder I'm a carrier for isn't too serious-- my first born who is affected is doing well.

Message edited 1/18/2011 2:06:59 PM.

Re: IVF/PGD with GHI?

So glad that you posted...I see that you also posted on my thread about GHI covering PGD. They are ridiculous. They clearly told my center that they cover PGD, but if they have no authorized lab...what is the point? I don't want to put out thousands of dollars and then have to fight to get back half!! URGH!! Thanks for posting this and good for you for fighting them and winning!!

Re: IVF/PGD with GHI?

They might have been disingenuous with me about the lab or things might have changed by now (I did PGD in the fall of 09)-- make sure you talk to your GHI coordinated care case worker and get everything in writing. It took this long to get reimbursed because they kept "losing" my claim. I think I had to send it in 6 times before I finally got my denial and review so I could move on to OPM. I saw on here that people with BCBS got back closer to 2-3k so I was disappointed.