Ask Your Insurance Company
Irene Laschuk, Manager, Patient Financial Services, ACRM
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.
- Who is the network that administers the plan? Are my physicians in network?
If not, are there out-of-network benefits?
- 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?
- When will coverage become effective?
- Who is covered on the policy?
- What is the copay for a visit to a specialist?
- Are phone consults covered? If so, does the copay apply?
- Are radiology and laboratory services performed in the doctor's office
covered? Are they subject to my deductible? Does a copay or coinsurance apply?
- Are there well-care benefits? Are labs to screen for infectious diseases
covered if I present with no symptoms?
- Does the policy carry infertility benefits? Does the benefit level change
for these services?
- Does the policy cover the diagnostic testing to determine the cause of
infertility (diagnosis codes – V26.21, 628.8, 628.9)?
- Once given a diagnosis of infertility, are there benefits?
- Does the plan include coverage for semen analysis or other infertility testing?
- Is karyotyping or other genetic testing covered? (CPT codes for karyotyping
88230, 88262, 88291).
- Is screening for “carrier status” of genetic conditions covered?
- 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)?
- Are any services excluded from the plan?
- Are pregnancy tests covered?
- Does the plan include maternity benefits at a specialist's office?
- Are infertility medications covered? Must they be purchased through a specialty pharmacy?
- Are there any limits to the number of attempts, annual or lifetime?
- Is authorization required? On what procedures?
- What are the deductibles and maximums? Are the maximums annual or lifetime?
- What is the name of the associate at the insurance company with whom you
spoke? Ask for a call reference number (if available).