When Writing A Letter To Your Insurer, It Is Helpful To Include The Following:
1. Group and ID numbers (patient insurance identification number)
2. Name of treatment(s) and/or medication(s)
3. Reason for needing the procedure/treatment/medication
Insurance policies come in two forms: the actual contract and the summary plan description.
The summary plan description is a brief summary of medical benefits and is usually provided when you enroll in an insurance plan. You will need to request a copy of the actual contract and can obtain this information from the employer who issued the contract or from your insurance company or agent.
The summary plan description provides a general explanation of your plan and benefits. It will let you know whether you are enrolled in an HMO, PPO or indemnity coverage. In general, HMOs are the least costly plans and have more limited coverage. It is important to look carefully at the benefits your employer provides at open enrollment and consider changing insurance carriers to get the best benefits for fertility.
If you are able to get a copy of the contract, then the next step is determining how your insurer defines infertility as different insurers have different definitions.
For example, your insurer may consider infertility to be 12 months of attempted conception. However, if you have irregular or absent menstrual cycles, it would not be reasonable to attempt conception for 12 months if you are not ovulating regularly. Instead, you may consider seeking treatment for irregular cycles initially to determine if there are hormonal reasons why menses are not regular.
Questions To Consider About Fertility Insurance Coverage
Below are other infertility insurance coverage questions that you should consider before seeking treatment.
You should also examine your insurer’s prescription drug plan, as fertility medications are often costly. It is important to understand your drug benefits prior to starting any treatment. First, you should find out if you have drug coverage. Next, determine if fertility drugs are covered under your prescription plan.
Questions To Consider Before Starting Fertility Treatment
Before Visiting A Fertility Specialist Or Having A Treatment Cycle, Please Have The Following Information:
NOTE: Communicate with your insurance company in writing so you have documentation if any claim disputes arise. Get a commitment of coverage for a specific medical service before you start treatment, called preauthorization or predetermination. You should contact your insurer in writing and request a written determination of your exact coverage amount prior to receiving any procedure.
When Writing A Letter To Your Insurer, It Is Helpful To Include The Following:
1. Group and ID numbers (patient insurance identification number)
2. Name of treatment(s) and/or medication(s)
3. Reason for needing the procedure/treatment/medication
Questions You May Want To Ask Your Insurer
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