Insurance
Health insurance can add to the complexities of the
decisions you will have to make when choosing
infertility treatment options. At RMA, our goal is to
alleviate some of that stress and help you work with
your insurance company to ensure that you are reimbursed
at the maximum level that you are covered.
As a patient you can be the best advocate for yourself
by thoroughly understanding your policy.
It is important that you review your specific policy and
understand what will be paid and what will not.
In order to help you get started we have some insurance
tips to help you look into your benefits.
Insurance Tips:
RMA of MI would like to emphasize the importance of
reading and understanding your policy, its requirements
and the covered and non-covered services.
Tips:
When
pursuing insurance coverage,
do not just handle it over
the phone.
If you simply call and ask
about coverage for a certain procedure, the customer
service representative may give you his or her
interpretation of what he/she thinks the policy states.
You
should contact your insurance company with a request
that they provide you with a written pre-determination
of your exact coverage, and any eligibility or
requirements that must be met in order to get that
service covered. A sample letter along with a breakdown
of our fees will be provided to you at the initial
consultation visit.
It is
also helpful to get any determination of benefits and
coverage in
writing from the
insurance company. If you receive a verbal verification
of coverage, you will not have any written
documentation. Written verification of their intent to
pay is a much more effective tool than verbal if you
have a challenge.
Establishing a point of contact with a representative at
the insurance company is a good idea and may enhance
follow-up. All phone conversations regarding coverage
should also be backed up with a written record.
Here are important questions to ask the insurance
company:
-What
are the specific policy or procedures that I need to
follow to get infertility treatment covered? For
example, do I need separate referrals or authorization
for each office visit, blood work or office procedures?
-Is
there a dollar maximum associated with infertility
treatment? If so what is that dollar amount?
-Is
there a maximum lifetime amount for Intrauterine
Inseminations (IUI)?
-How
many cycles of Invitro Fertilization are covered?
Common Terms:
Referral
- a form issued by a primary care physician or ob/gyn
referring a patient to a specialist. If applicable, all
referrals are obtained by the patient
Authorization
- a number issued by an insurance company authorizing a
specific service or medication. The doctor or the
patient, depending on the insurance, can obtain
authorizations.
Pre-certification
- a number issued
by insurance for a surgery or in office procedure.
Pre-determination letter
-
a letter from an insurance quoting benefit coverage
according to the specific patient policy
