Diagnosis: Gynecological.
Treatment: Infertility Treatment.
The insurer denied In Vitro Fertilization using fresh eggs.
The denial was overturned.

The patient is a female seeking in vitro fertilization (IVF) for infertility. She has previously had oocyte cryopreservation performed for elective fertility preservation. She is requesting IVF using fresh eggs.
At issue is the medical necessity of In Vitro Fertilization using fresh eggs.

The health plan's determination of medical necessity is overturned in whole.

The requested health service of In Vitro Fertilization using fresh eggs is medically necessary for this patient.
The patient has previously cryopreserved eggs for use in the future, especially for a time when her fresh eggs will not be a viable option for creating a pregnancy. She has infertility and the current ability to use her fresh eggs to create viable embryos. Though oocyte cryopreservation is no longer experimental, it is not as efficacious as using fresh eggs to yield a viable pregnancy egg-for-egg. Using fresh eggs to create viable embryos now and saving the eggs cryopreserved, as is in this patient's case, is the best plan for her future fertility potential.
Therefore, In Vitro Fertilization using fresh eggs is medically necessary.