With the first full month of the new year behind us, many of us are still trying to navigate and figure out our insurance benefits for 2014. Whenever planning on undergoing fertility treatment the financial aspect can play a large part in determining your particular course of therapy. In terms of insurance coverage, it is important to not only get a firm grasp on what kind of benefits you have available medically ( e.g. procedures/testing done in your physician’s office), but also to investigate if any coverage is available for your medication therapy. Today we will discuss the first steps in investigating your medical benefits, which is the portion of your insurance responsible for covering any testing or procedures done in your physicians’ office. To help navigate this process, it’s important to have some key questions prepared when you are reaching out to your insurance company prior to starting treatment, including:

  • Is there a referral required prior to seeing a fertility specialist?
  • Is the provider I am planning on seeing an in-network provider?
  • Are there pre-authorizations or pre-certifications required prior to undergoing fertility related treatments?
  • Beyond the testing needed to diagnose, what other fertility-related services would be covered?
  • What is the patient responsibility for services? (i.e. how much of the fertility related expenses are paid by the insurance and how much by you ?)
  • Is there an annual or lifetime maximum for services related to fertility, and if so, what is it?
  • What is the reference number for the insurance inquiry? (Important to also document the date, time, representative and information given)

Your fertility specialist will often have staff in the practice that also complete a benefit investigation prior to beginning any procedure; however, many patients find that it helps to alleviate stress to begin the process early to prepare for the amount of financial responsibility they will have. It is important to present any pertinent information that you have obtained (either in writing or via the phone) to the office when giving them your insurance information. This can help the staff in the practice ensure that both the physician’s office and you have the same expectations from your insurance carrier in terms of coverage and responsibility.

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