Helping Yourself Understand Infertility Cost And Coverage
Helping yourself understand infertility cost and coverage is crucial before moving forward with the process Determining which infertility treatments your policy covers can be tricky. On one hand, you want accurate information. On the other hand, you risk alerting your insurer to the fact that you are about to undergo infertility treatment. If you are covered by a group plan, you cannot be dis-enrolled for medical reasons. But if you have individual coverage, there is always the possibility that the insurer will try to cancel your policy if it anticipates costly claims on the horizon. There are ways, however, to make inquiries about coverage without jeopardizing your policy.
The first step is to read your claims booklet carefully. This booklet may contain statements like “the treatment of infertility is not provided through the general policy, but may be part of a rider clause negotiated by a specific group”. Your personnel manager should be able to give you a copy of the rider. Even though infertility treatment (particularly in vitro procedures or even insemination) may not be covered, try to find out if diagnostic blood tests and ultrasound procedures are, and, if so, how many are covered. From the booklet you may be able to deduce which diagnoses are more likely than others to be reimbursable.
You also will want to know what percentage of treatment costs are typically covered by the policy. Sometimes, instead of paying a percentage of a medical bill, some companies offer a flat fee. They may, for example, pay up to $ 45 for any blood analysis, even if your analysis costs $ 100. Try to find out what the general fee schedule is, particularly if you have ever seen the following explanation (or one like it) from the insurer when it only partially reimbursed you: “This charge has been declared over and above the customary fee charged by medical professionals in your area”. Finally, try to find out about deductibles and at what ceiling your coverage changes. Many companies begin to offer a higher percentage of coverage when your co-payment ceiling is reached. Also try to find out which drugs may be covered.
Injectable fertility medications are all costly. Some insurers cover them, others do not. Some policies have an annual dollar limit for prescriptions. If you are lucky, your policy includes a liberal prescription plan that covers almost all prescription medications (except birth-control pills), with a small co-pay by you. If your claim booklet fails to answer all your questions about covered medications, your pharmacist, who deals with numerous insurance carriers every day, may be able to answer some of your questions.
Another good source of information is a co-worker or friend who has had the same policy you do and has undergone infertility diagnosis and treatment. This individual should be able to give you the “lowdown” on the insurer’s payment record and can alert you to any land mines. Even if this person is only an acquaintance, remember that there is an allegiance of sorts among infertile people. Having suffered and survived the experience, most are eager to help and comfort others in any way they can.
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