Appealing Denials of Coverage
If your health insurance company tells you that fertility preservation isn’t covered by your plan, you have the right to appeal their decision. Each insurance company has its own internal appeals process, so contact your insurance company for details or look for instructions on how to file an appeal on your denial letter.
Under the Affordable Care Act, all states are required to also have an external appeals process – this is also sometimes referred to as Independent Medical Review or External Medical Review. For information on your state’s external medical review process contact your state’s insurance agency: TriageCancer.org/StateResources. This process is underutilized, but when people appeal, they are more likely to have their treatment covered by an insurance company.
There is also an option to file an “expedited” or “urgent” external medical review, where a decision must be provided within 72 hours. This faster decision can be helpful for those making fertility preservation decisions before beginning cancer treatment.
When appealing denials of coverage, it is important to argue that fertility preservation for iatrogenic infertility is not “elective” or “experimental,” but rather, a “medical necessity” to prevent infertility. It can also be argued that fertility preservation is a “medically necessary” treatment for a side effect of cancer treatment. Your health care team may be able to help you submit an appeal to your insurance company.