Has anyone had success pushing insurance authorizations to go faster due to age/DOR?
Hello, I am in this difficult situation where my ovarian reserve has been declining very fast. I am 40, stage IV endo. In May '25 my AFC was 11, in Dec '25 my AFC was 5. I was supposed to start IVF cycle in January (missed the December one due to Christmas), but the cycle was with long priming so actual stims started in Feb, and then the cycle failed. Then the clinic asked me to wait until my next cycle (March 20) to re-start treatment, but when I called on CD1 they dropped me out (they told me they are booked until September and I won't be able to re-start treatment with them)–so a 3rd month in the trash.
I rushed to find a new clinic but obviously nobody can take me the same day, my CD1. I found a clinic that can take me for my next cycle (this Friday).
Now, my HMO plan has no in-network IVF providers. So they send you to an out-of-network clinic via referral, and the plan must authorize OON treatment due to deficiency in their own network. All referrals though need to be authorized by the plan.
My doctor placed a referral last week as STAT, but the insurance medical group has been having it on "pending review". I called several times and they keep telling me that they are "still negotiating" with the OON clinic. They are unable to answer to my question: "what if you don't finalize your negotiations by Friday when my treatment is supposed to start?". They say: "ask your doctor", which makes no sense.
I am in California. I had the impression that STAT orders are supposed to be processed in 72hrs but we are way past that.
I cannot miss another cycle. I talked to the OON clinic that I am going to pay out of pocket if I have to, if the insurance is slowing the ball, because I am so desperate. But this is so unfair because this was supposed to be covered by the insurance.