r/extremelyinfuriating • u/shadow_balto • 2d ago
Discussion The joys of American Healthcare
T/W RPL/miscarriage
First rejection letter from insurance came through- thought no problem, I qualify under 3 I bet my doctor’s office just didn’t put sufficient info. Sent proof of 4 losses and letter from physician.
Insurance rejected and sent a new list of entirely different items to qualify.
What the fresh capitalist insurance hell is this.
First rejection:
WHY THIS REQUEST WAS NOT APPROVED
From the Medical Director:
Your doctor asked for a gene test (Chromosomal Microarray). This test looks to see if there is any extra of missing genetic material (deletion or duplication). This test is needed when any of the following criteria are met: 1) The test is for a current pregnancy at a higher risk for a gene change due to the age of the mother or positive results on other tests. 2) There were certain ultrasound findings (structural anomalies). 3) There is a history of more than one pregnancy loss before 20 weeks. 4) The test is for a pregnancy loss that occurred at 20 weeks or later. We reviewed the notes we have. The notes do not show that any of the requirements have been met. As a result, this test is not medically necessary. We used Carelon Medical Benefits Management Clinical Guideline titled Chromosomal Microarray Analysis to make this decision.
Second rejection:
We were told that you have certain signs, symptoms, or health conditions (recurrent pregnancy loss). Your doctor asked for a gene test (chromosomal microarray). This test looks for extra or missing genetic material (deletion or duplication). This test is needed when: 1) You have more than one birth defect, seizures (before the age of 3), autism, delays (developmental) or learning problems (intellectual disability. 2) Also, a cause must not have been identified for these findings. 3) You have also not had other genetic tests performed for these findings. We reviewed the notes we have. The notes do not show that requirement numbers 1 and 3 have been met. As a result, this test is not medically necessary. We used Carelon Medical Benefits Management Clinical Guideline titled Chromosomal Microarray Analysis to make this decision.