Questions For Insurer

The answers to the questions listed below can help couples understand which procedures will be covered and reimbursed during the course of fertility therapy. The information obtained will also be useful to the insurance counselor at the doctor’s office. If the answers received are unsatisfactory, couples should ask to speak to a supervisor or to another representative who is more familiar with the infertility benefits.

Several pieces of personal information should be within reach before calling to inquire about benefits. They include:

  • Name of the insured individual
  • Employee/Patient ID number or Social Insurance Number
  • Name of employer
  • Name of plan
  • Group code/number
  • Patient’s name and date of birth
Questions to ask the insurance company
  • What are this plan’s fertility benefits?
  • What is excluded?
  • What do the benefits cover?
    • Do they cover drug therapy?
    • Do they cover any other aspect of fertility treatment, such as diagnostics or treatment procedures?
  • Which drugs are reimbursable? (Be sure to have the Drug Identification Number or DIN for specific drugs, in order to expedite the process.)
  • Which diagnostic or treatment procedures are covered?
  • Is predetermination or special authorization required?
    • What does it cover?
    • How do I get it?
    • For how long is it valid?
  • Does this plan include a lifetime maximum benefit?
    • If so, what is the limit?
    • Is there a calendar year maximum benefit?
    • If so, what is the limit?
  • Is infertility therapy included in the lifetime maximum benefit?
    • Is infertility therapy included in the calendar year maximum benefit?
  • Is there a maximum number of attempts allowed for different ART procedures?
    • If so, what is it, and are all attempts covered equally?

It is best to get the insurance company’s reply in writing.


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