Knowing Your Benefits
Fertility Insurance Texas
KNOWING YOU BENEFITS
There are several ways to determine if your insurance benefits include infertility coverage. The best way to determine your benefits is to have them listed in writing from your insurance company. Your insurance policy booklet is a good source for this information. Be certain to check both your medical procedure coverage as well as your prescription coverage. Also check the "exclusions" section of your policy manual to see if there are exclusions or limitations on infertility coverage. Limitations may include higher co-payments for infertility treatment, prior authorization requirements, limits to the number of cycles or dollar limits on benefits, and annual or lifetime limits. If you do not have a policy booklet, contact your human resources manager at work or your insurance company to obtain one.
Contact Your Insurance
Another way to determine your infertility benefits is to call the 800 number on your insurance card. Tell the representative that you would like to verify your benefits for infertility coverage. Please remember that a verbal confirmation is not a guarantee of benefits. Also keep in mind that it is still necessary to obtain this information in writing from your insurance company.
Coverage In Writing
The best way to ensure your insurance coverage for infertility treatments is valid is to get a written commitment for coverage prior to beginning treatment. This is called predetermination. To obtain this, send a written request to your insurance company for a determination of your coverage. Be certain to send this request prior to any procedure. Always ask whether the procedure or medications you need are covered and whether there are any limits (in dollars or number of attempts). If you need assistance with writing the letter, contact the Center's billing department. They have form letters available to patients who wish to request a predetermination of benefits. If your claim is denied by your insurance company, you may appeal your claim. First, contact your insurance company to ask what section of your contract specifically excludes your claim. If no specific exclusion is listed, your case will be stronger. Also determine the exact reason your claim was denied. Your physician may assist your appeal by writing a letter of medical necessity to your insurance company if he/she deems it appropriate in your case.
The Center is contracted with most major insurance companies. However, each policy is different. Coverage is not determined by the insurance company you use. It is determined by the type of policy you have. If you are insured through your employer, your employer chooses your benefit coverage or policy type. Some policies cover only diagnostic testing, some policies cover nothing at all, and some policies cover 100% of treatment.
For more information on Insurance Benefits, please contact CARE Fertility.