Infertility Insurance Tips
When obtaining information on insurance coverage, don’t just rely on a phone call to your 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.
What else should I do?
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?