NJ couple fought Horizon insurance denial to have a baby and won

After four miscarriages and denials from Horizon Blue Cross Blue Shield of New Jersey to cover fertility treatments, Deanna and Jon Harkel braced themselves for more disappointment.

But when they read through the letter from the doctor who reviewed their appeal of the insurance denial, they were heartened. The doctor agreed with them. The service should have been covered. Horizon’s decision was overturned.

“It’s been so many years of such bad news continually, I was pretty shocked,” Deanna Harkel said.

The Harkels are among an increasing number of New Jerseyans who are appealing their insurance denials with the state Department of Banking and Insurance. And they are finding success. More than half of the insurers’ denials in recent years that have gone to appeal have been overturned.

It’s a sign, state officials said, that consumers are more aware of the option and are more aggressively fighting back.

They are jumping into a fray between doctors and insurers over what constitutes medically necessary treatment. And it could intensify as new, costly breakthroughs become available.

But as the Harkels show, the process is emotionally draining, forcing them to find time to take off from work, plead their case in front of Horizon’s insurance board and lose sleep.

“The consumer can sometimes be put in the middle of that and can be forced to make phone calls back and forth, which just adds stress to the consumer’s health care experience, which is really unnecessary,” said Theresa Edelstein, a vice president at the New Jersey Hospital Association, a trade group.

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