Infertility or IVF denied: how to appeal
The insurer denied fertility evaluation or treatment. State infertility mandate citation (where applicable).
Why this denial happens
- Plan excludes infertility treatment
- State mandate not invoked
- Diagnostic criteria not met (12 months of attempts)
What overturns it
- State infertility mandate citation (where applicable)
- Complete diagnostic workup
- Reproductive endocrinologist letter
Evidence checklist
- ✓Diagnostic workup
- ✓Plan document language
- ✓State mandate citation
Roughly 20 states have infertility coverage mandates; verify your state law before appealing.
Draft an appeal for a "Infertility/IVF" denial
Free analysis identifies the cited policy and missing evidence. Then a finished letter.
FAQ
What does "Infertility or IVF denied" mean on a denial letter?+
The insurer denied fertility evaluation or treatment.
How long do I have to appeal?+
180 days from the date of denial for ERISA group plans and ACA marketplace plans. 60 days for Medicare Advantage. Check the denial letter for your specific deadline.
What is the success rate for this kind of appeal?+
Outcomes vary, but medical-necessity and step-therapy appeals overturn at meaningful rates when the appeal cites the insurer's own policy and the chart documents the required criteria.
Other denial reasons
Not legal or medical advice. This page is a self-help resource. You make your own decisions. Strip personal identifiers (name, date of birth, address, member ID) from any document before uploading or sharing. The information here summarizes commonly-published payer policies and federal rules; confirm against your specific plan document and the current denial letter before acting.