Medical Monday - Infertility Treatment Insurance

infertility insurance coverage tipsThe language of infertility can be daunting. IUI, HSG, ICSI, IVF, and more.

 

Then there's the infertility treatment insurance. A whole other language to learn. Our finance department has been doing this for twelve years and want to share the things that they've learned are important for you to know.

 

We're here to help, of course. Educating yourself though is empowering and ultimately, hands back some of the control to you. 

 

Let us know if you have any questions. I'll pass them on to our extremely capable finance department. ~Lisa Rosenthal

10 Tips About Infertility Insurance Coverage

When obtaining information on infertility insurance coverage, don’t rely on just a phone call to the insurer. If you simply call and ask about coverage for a certain procedure, you risk getting incorrect information.

 

Instead, we strongly suggest that you request a written pre-determination letter or document from your insurance company detailing your exact benefits and any requirements that must be met in order to ensure coverage. This written document is your most effective tool if you need to challenge a decision or file an appeal for payment with your insurance company at a later date.

 

Establishing a point of contact with a representative at the insurance company is a good idea and may make follow-up easier. Keep a log of all phone conversations with your insurance company, including the date and time of the conversation and the name of the person with whom you speak.

 

During that conversation, get answers to these important questions:

 

  • What specific procedures do I need to follow to ensure that my infertility treatment is covered? For example, do I need separate referrals or authorizations for each office visit, blood work, ultrasound or procedure?
  • What are the qualifying criteria for receiving my infertility benefit? (i.e. previous attempts, a certain number of IUIs before being able to move onto IVF)
  • Is there a maximum dollar amount associated with infertility treatment? If so, what is it and how much have I used to date?
  • Is there a limit to the number of attempts allowed for intrauterine inseminations (IUI)?
  • Is there a limit to the number of attempts allowed for in vitro fertilization (IVF)?
  • Do I have prescription coverage?
  • Do I have a separate prescription plan?
  • Must I get my prescriptions from a particular pharmacy?
  • Is there a separate phone number I need to call to find out about my drug benefits?
  • Does fertility medication require prior authorization?

 

Visit RMACT's page about affording treatment for additional information.

 

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Topics: fertility insurance, Medical Mondays

Lisa Rosenthal

Lisa has over thirty years of experience in the fertility field. After her personal infertility journey, she felt dissatisfied with the lack of comprehensive services available to support her. She was determined to help others undergoing fertility treatment. Lisa has been with RMACT for eleven years and serves as Patient Advocate and the Strategic Content Lead.

Lisa is the teacher and founder of Fertile Yoga, a program designed to support men and women on their quest for their families through gentle movement and meditation.

Lisa’s true passion is supporting patients getting into treatment, being able to stay in treatment and staying whole and complete throughout the process. Lisa is also a Certified Grief Recovery Specialist, which is helpful in her work with fertility patients.

Her experience also includes working with RESOLVE: The National Infertility Association and The American Fertility Association (now Path2Parenthood), where she was Educational Coordinator, Conference Director and Assistant Executive Director.

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