It’s a new year! While this is a time for celebration and resolutions, it is also when many insurance plans change or start over. Now is the time to call you insurance provider and find out if you have an infertility benefit under your new plan and what you need to do in order to access the benefit. But what do you ask someone once you actually get past the automated prompts? To help guide the conversation with your insurance provider we asked our finance team what questions patients should ask when talking to their insurance; here are the top 5.
1. Do I have coverage for infertility?
A fairly obvious question, but one that should always be asked. Make sure to double check if your plan covers only diagnostic testing for infertility or diagnostic testing and treatment for infertility.
2. Do I need to register for my infertility services?
There are some plans (ie: Aetna and some Premera plans) that require patients to register in order to be eligible to use their infertility benefits. Make sure to ask if your plan is one of them otherwise you may not be able to use any of your infertility services when the time comes.
3. Do I need to have preauthorization for any services?
Depending on the insurance, preauthorization may be required for anything from the initial appointments through treatment (if treatment is covered). If preauthorization is required and not in place at the time of receiving services then your insurance company can deny the claims and you may be responsible to pay.
If you know you’ll need preauthorization for anything, make sure to start that process as soon as possible.
4. Are there any exclusions to my benefit?
It is important to know if your plan has any exclusions. Even if you have an infertility benefit, you could be excluded from coverage if there are exclusions listed on your policy.
A common exclusion is prior sterilization (having tubes tied or a vasectomy). In this case, even if your insurance policy has coverage for infertility treatment, it doesn’t mean you qualify for the benefit if the exclusion applies to your case.
5. What is my deductible?
Remember, those pesky deductible reset at the beginning of the year. Double check while you have someone on the phone what your current deductible is as this will need to be met before insurance will start making payments.
Once you speak with your insurance, make sure to communicate any important information with your financial counselor so they can advise and assist you along the way.
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