Insurance Reauthorization for Fertility Coverage
The end of the year may seem like it’s full of lists: to-do lists, shopping lists, and New Year’s Resolution lists. However, when it comes to fertility coverage, we offer a simple checklist that will help you avoid unnecessary treatment delays because of a change in your insurance plan.
- Get to know your 2016 policy.
Check with your employer to discuss any policy/coverage changes. Some policies may look the same from year to year but, upon closer review, the limits, requirements, and fertility coverage details have changed. For example, if Kaiser is your new plan, it’s important to make an appointment with a Kasier OB/GYN in order to get a referral back to Shady Grove Fertility. If your new plan is Aetna, you may be required to enroll with the hotline. Call 800-575-5999 to enroll. Bottom line: the same policy does not mean the same coverage. In some cases, you may have additional benefits you didn’t have before; in other cases you may have fewer benefits. Avoid surprises; ask your HR/benefits advisor questions to get to know your new policy.
- Notify your SGF Financial Counselor of any changes or a new policy.
If your policy has changed, call SGF and notify your Financial Counselor right away. The start of the new plan year requires patients across the United States—no matter what type of medical care they are receiving—to have their benefits re-verified to continue medical care. For this reason, authorization requests to insurance companies may create a delay in their ability to provide updated authorizations. Since we must work with–and through–your insurance plan to obtain benefits and authorizations, that delay may impact our ability to receive your 2016 authorization. Since our insurance verification benefit team cannot necessarily influence the amount of time required by the insurance company to process and provide the authorization, we ask all patients to provide their insurance documentation in a timely manner to ensure the fastest authorizations possible to avoid planned treatment start dates.
- Check the expiration on your referral.
If you have an HMO that requires a referral to a specialist, confirm that your referral (from your OB/GYN or primary care provider) is current. If not, you can obtain a new referral by contacting your referring physician’s office directly.
- Plan ahead and allow adequate time for fertility coverage reauthorization.
Even if you’ve been a patient of Shady Grove Fertility prior to the start of 2016 and you didn’t change insurance companies, all patients with an insurance plan starting in January 2016 may need reauthorization prior to initiating treatment. Patients considering starting a treatment cycle in 2015 and completing it in 2016 will still be required to have their benefits re-verified at the beginning of 2016 to guarantee coverage. Please speak directly with your Financial Counselor to determine if this makes the most sense for you, as some patients may choose to delay the start of their treatment cycle until 2016 to ensure that they will have coverage under their new plan.
- Bring your insurance card to your first 2016 appointment.
All patients, whether they are a new or current patient will need to provide their insurance card at their first appointment in 2016. This will give our insurance verification benefit team the most accurate insurance information to reduce any benefit verification delays that could be caused by incorrect insurance information.
What if I don’t have fertility coverage under my current insurance plan?
For those patients who do not have fertility coverage/insurance benefits, Shady Grove Fertility offers a variety of exclusive financial programs that make fertility treatment affordable and accessible, including our:
Shared Risk 100% Refund Program for IVF or Donor Egg
Multi-Cycle Discount Program for IVF patients
Shared Donor Egg Program for donor egg recipients
If you would like to learn more about fertility coverage or our exclusive programs for affording care, please call our New Patient Liaisons at 877-971-7755 or click to schedule an appointment.