Insurance
Infertility Treatment Insurance? Know Your Benefits
Use our Personal Plan Worksheet (PDF, 8KB) when contacting your insurance carrier.
It is always a good idea to also obtain your benefits in writing to find out if you have infertility treatment insurance prior to beginning a treatment cycle at either our Raleigh or Durham, NC center.
Most insurance companies will not commit to paying for a procedure before a claim has been filed, but they may confirm whether certain procedures are covered under your policy and at what percentage those procedures will be paid.
To obtain written verification, call your insurance carrier and request the name and address of a person to whom you may send your “predetermination for benefits request.”
Be very specific in your letter, which should include your situation and the treatment program-specific CPT codes (billing codes). The codes are included on our cost estimates.
A copy of a cost estimate list is often sufficient information for the insurance carrier.
When You Contact Your Carrier
To get a good overall look at whether you have infertility treatment insurance, verify whether you have the following services covered:
- Diagnostic testing for infertility
- Injectable infertility drugs
- Artificial insemination
- In vitro fertilization (IVF)
- Surgeries to correct or restore fertility (depending on your situation)
Sometimes insurance companies will only cover medications and monitoring if they are not used in conjunction with “artificial means of conception.” It is also possible that the carrier will cover medications and monitoring but not the actual insemination.
If the carrier states that infertility drugs and monitoring are covered, verify that you still have the benefit if your treatment includes artificial insemination or IVF.
If you have coverage for artificial insemination or IVF, verify what the benefit includes. Always be very specific in your request.
Here are some questions to ask:
- Does my benefit include a lifetime maximum, and if so, what is that maximum?
- Does the maximum include past services rendered with previous insurance companies?
- Are drugs included in the benefit amount or if there is a separate benefit for drugs?
Verify whether there are certain criteria that need to be met before starting treatment. Often carriers require that one meet certain criteria such as:
- Providing a letter of medical necessity
- Verifying length of time attempting conception
- Verifying length of employment before the benefit is effective
Procedure and diagnosis coding for infertility treatment can easily be mistaken for diagnostic testing when the billing is filed. Please remember that your insurance company may request access to your medical records, and we are required to code according to the treatment you receive.
Insurance Errors
Many times insurance companies will pay in error for treatment-related office visits, labs, and ultrasounds. This could lead a patient to believe she has coverage even though her carrier does not provide those benefits for infertility.
If payments are made in error, the insurance company will usually correct the error within a few months and the payments will be returned. The patient will then be billed for these services.
Help Obtaining Information about Your Plan
IVF-PALS hotline is a free service offered by Organon Inc. that can assist you in obtaining information about your insurance plan. This information includes coverage and claims.
The hotline can be reached at 800-IVF-PALS.
Helping patients from Raleigh, Durham, Apex, Cary, Chapel Hill, Fayetteville, South Boston, VA, Danville, VA and nationwide realize their dream of having a family. Contact us online or at 919-572-HOPE (4673) to get started today.
