Infertility Insurance
- Infertility Insurance State Mandate

Fertility Insurance Providers

Infertility Financing

Fertility Treatment Costs/IVF Costs

Insurance for Infertility Treatment in Connecticut

Infertility Insurance Coverage

Health insurance can add to the complexities of the decisions you will have to make when choosing infertility treatment options. At RMA of Connecticut, our goal is to alleviate some of that stress and help you work with your insurance company to determine what your level of coverage is, what your out-of-pocket expenses will be (if applicable) and to help educate you on the specific details of your insurance plan for infertility treatment.

You can be your own best advocate by thoroughly understanding your benefits. It is important that you review your specific policy requirements for covered and non-covered infertility services. In order to help you get started, we have included some infertility insurance tips and information about the recent breakthrough in legislation pertaining to a state insurance mandate for infertility diagnosis and treatment.

It is also very important that both you and your partner provide us with your insurance information. Often times your partner carries their own insurance with different requirements.

Types of Insurance Plans for Infertility Treatment

HMO (Health Maintenance Organization) - these plans usually only offer in-network benefits and will normally require referrals or authorizations. Authorizations are usually required for all covered services. If your partner is covered under the same plan, he will need to have referrals and authorizations for infertility services rendered to him as well.

POS (Point of Service) - these plans usually offer both in and out of network benefits. Most POS plans do require referrals or authorizations for the maximum benefit and the least payment out of your pocket. If you chose to come without a referral, you will likely be subject to an out of network deductible and higher coinsurance. Authorizations are usually required for all infertility treatments. If your partner us covered under the same plan, he will need to have referrals and authorizations for services rendered to him as well.

PPO (Preferred Provider Organization) - these plans usually do not require referrals or authorizations for infertility treatments, but you should check with your insurance company as some do require notification of services/cycles. If your plan covers IVF, you will need a pre-determination letter from your insurance company verifying benefits in order to avoid paying for your cycle up front.

Infertility Insurance Tips

When obtaining information on insurance coverage, do not just handle it over the phone. If you simply call and ask about coverage for a certain procedure, you run the risk of getting incorrect information. We strongly suggest you request a written pre-determination letter or document from your insurance company detailing your exact benefit, 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.

Establishing a point of contact with a representative at the insurance company is a good idea and may enhance follow-up. Be sure to document all phone conversations with your insurance company, including the date and time of the conversation, and with whom you speak.

Here are some important questions to ask the insurance company:

• Are there any specific procedures that I need to follow to get infertility treatment 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 infertility benefit? (i.e. previous attempts? Certain number of IUIs before being able to move onto IVF?)
• Is there a dollar maximum associated with infertility treatment? If so, what is that dollar amount 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?
• Do I have to 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?

Common Insurance Terms

Referral - an insurance authorization number initiated when a primary care physician or OB/Gyn refers a patient to a specialist. Obtaining referrals is the patient's responsibility. A specialist's name written on a prescription pad does not constitute a referral.

Authorization - a number issued by an insurance company authorizing a specific service or medication. Some insurance companies require patients to obtain authorizations and some require the specialist to do so.

Pre-certification - a number issued by an insurance company for a surgery or in-office procedure.

Pre-determination letter - a written verification of benefits for your specific plan from your insurance company.

 

Check infertility insurance providers.

Contact us for more information about infertility insurance & fertility costs.