Researching Coverage

Researching coverage can be confusing and time-consuming. Nevertheless, it is important to understand your coverage before beginning treatment.

Some insurance plans do not consider fertility treatment medically necessary, and therefore do not provide coverage. Couples must be their own advocates when trying to get full or partial coverage for treatment.

Some health plans offer coverage up to a specific dollar amount while others cover only a certain number of cycles.

Check your policy to determine the maximum timeframe allowed between treatment and submission of receipts for reimbursement.

It’s important to attend to this matter early on, so you don’t have to contend with expensive surprises at a time when your physical and emotional energies are directed elsewhere.

Steps to Take

Here are some steps couples can take when researching insurance coverage:

  • Get a copy of the plan’s contract, not just the plan summary. Read the list of exclusions very carefully. The employer’s personnel department can provide a copy of the contract.
  • Find out who to contact about coverage at the insurance company.
  • Get a written pre-determination of coverage before any procedures. Follow-up with the contact person to check on the status of the request. If the policy holder does not receive a written response promptly, then the request should be sent again to the appropriate contact person via registered mail.
  • Determine how much the plan will pay. Take into account the deductible, co-payments, maximum payment provisions or payment caps.
  • Try not to be discouraged if you are initially denied coverage for treatment. Be persistent about resubmitting coverage requests and asking questions.

Remember that you are responsible for any amount that the insurance company will not cover, so be prepared for that expense.

Here are a few ways to help defer some of the costs not covered by insurance:

  • Flex spending accounts: Many organizations have Flex plans that allow employees to set aside pre-tax dollars for health care expenses that are not covered by their insurance plan. Check with your employer’s benefits office to determine if the money must be used in that calendar year or else forfeited.
  • Credit cards: Most fertility clinics accept payment by credit card. If a couple knows that they may not be able to quickly pay off credit card debt, it may be appropriate to take out a personal loan instead.
  • Personal loans: Some clinics have teamed up with a major bank to create a loan program for their patients. Couples must qualify as with any other loan, but favourable interest rates can be helpful. For many couples no sacrifice is too small or too great in the quest to have a baby. Counseling can help couples define limits, set boundaries and keep the lines of communication open.

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