Ask Your Insurance Company

My name is Irene Laschuk. As manager of Patient Financial Services, I work closely with insurance companies and know how important it is to have a full understanding of the specifics of your policy as they relate to your infertility coverage. This is why we've scripted a list of questions to ask your insurance company in order to help you fully understand the extent of your coverage.

1. Who is the network that administers the plan? Are my physicians in network? If not, are there out-of-network benefits?
2. What type of plan is it (PPO, POS, HMO, Indemnity)? Am I required to notify you that I am seeking infertility treatments? If so, how?
3. When will coverage become effective?
4. Who is covered on the policy?
5. What is the copay for a visit to a specialist?
6. Are phone consults covered? If so, does the copay apply?
7. Are radiology and laboratory services performed in the doctor's office covered? Are they subject to my deductible? Does a copay or coinsurance apply?
8. Are there well-care benefits? Are labs to screen for infectious diseases covered if I present with no symptoms?
9. Does the policy carry infertility benefits? Does the benefit level change for these services?
10. Does the policy cover the diagnostic testing to determine the cause of infertility (diagnosis codes – V26.21, 628.8, 628.9)?
11. Once given a diagnosis of infertility, are there benefits?
12. Does the plan include coverage for semen analysis or other infertility testing?
13. Is karyotyping or other genetic testing covered? (CPT codes for karyotyping 88230, 88262, 88291).
14. Is screening for “carrier status” of genetic conditions covered?
15. Does the policy cover the treatment of infertility, or any services related in assisting in the attempt to gain a pregnancy; example: intrauterine insemination and in vitro fertilization (diagnosis codes – V26.1, V26.8)?
16. Are any services excluded from the plan?
17. Are pregnancy tests covered?
18. Does the plan include maternity benefits at a specialist's office?
19. Are infertility medications covered? Must they be purchased through a specialty pharmacy?
20. Are there any limits to the number of attempts, annual or lifetime?
21. Is authorization required? On what procedures?
22. What are the deductibles and maximums? Are the maximums annual or lifetime?
23. What is the name of the associate at the insurance company with whom you spoke? Ask for a call reference number (if available).