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Blue Shield reports fixes after reviewing infertility denials; will expand specialty pharmacy access
Summary
Blue Shield told the SFHSS board it reviewed 215 infertility cases from 2018–2019, overturned 54 prior denials, has four pending cases expected to be approved, and plans additional pharmacy contracts by November to ease access to fertility medications.
Blue Shield presented an update on infertility claims and access after board and member concerns about denials.
Blue Shield said its clinical review found 215 infertility cases for SFHSS members for 2018–2019. Of those, 54 prior denials were reprocessed and overturned, seven were determined not to be covered services, and four cases remained pending but were expected to be approved…
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