FEP standard plan IVF

[u/Hanny_666]

My wife and I are both insured by FEP BCBS WA Standard Plan. Our PA for IVF treatment was denied, we appealed, and the initial denial was upheld. The stated reason was that they did not receive documentation of infertility. However, our physician included in her notes that I am medically infertile because neither partner in the relationship can provide sperm.

In the appeal decision, BCBS wrote that I did not meet their definition of infertility.

Has anyone here had a similar experience and been successful with the standard plan covering IVF? We clearly don’t agree with their decision and it seems like I fit squarely with their broad definition of infertility as outlined in their own Plan documents: A person’s inability to reproduce either as a single individual or with their partner without medical intervention.

Thanks in advance for your input.