Does Your Insurance Cover Infertility Costs

You should start by reading your claims booklet (some of them are notoriously vague and confusing). If you are still baffled after reading the booklet, schedule an interview with the benefits representatives or personnel managers at your and your husband's workplaces. Begin at the workplace that provides your primary coverage, and then move to the workplace that provides your secondary coverage. Even if you've chosen to keep your fertility problem a secret from your boss and co-workers, you are encouraged to level with your benefits representative, urging him or her to maintain your confidentiality. By giving the representative specifics about your condition, you are apt to walk out of the meeting knowing exactly how-if any-money you will personally have to fork over for your treatment. Also, knowing exactly how many of those treatments are covered can help you Make A Plan.

You may have no choice but to call your insurance company, which probably provides a toll-free number for its beneficiaries. If the insurance representative tells you something is covered either by the general policy or under a rider to that policy, write down the representative's name, exactly what he or she told you, and the date and time of your call. If possible, have the representative confirm your conversation in writing. This letter can become invaluable should you need to appeal a claim denial in the future. Some insurers require a letter from your doctor estimating the cost of an ART treatment prior to considering any claims related to that treatment. The request for such a letter doesn't necessarily mean your claim will be turned down. It's a tool insurance carriers use to budget for their future outlays. You are also encouraged to read the detailed question and answer section

Many infertility doctors and programs are willing to "work" with insurance companies and couples to help obtain the maximum infertility insurance coverage to which their patients are entitled. Toward this end, many doctor's offices and clinics employ a benefits counselor to help patients navigate the insurance maze. Be sure to discuss your ideas and concerns with this individual before your bills are prepared.

Here are some tips:

Don't list "infertility" as a diagnosis. Instead use the cause of your infertility, such as endometriosis, endocrine dysfunction, ovarian failure, tubal occlusion, fibroids, polycystic ovaries, or low sperm count. The reason is that insurers are more apt to cover treatment for precise diagnoses than they are a treatment for infertility.

Break down a particular procedure into its smallest components. Always use as many treatment codes as possible.

Don't overlook the potential of being reimbursed for office visits. If you are seeing your doctor frequently, ask the billing manager to vary the CPT code number of the office visits.

If you are undergoing various procedures over a two- or three week period, submit claims on different forms in separate envelopes.