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Help Avoid Treatment Delays: Learn How Insurance Changes May Affect You in the New Plan Year

When coming for your new patient consultation or continuing treatment, you want to make sure that you won’t experience any delays in care because of a change in insurance. Some patients will have a new insurance plan, but for others, they may have the same exact plan from 2014, but coverage for diagnostic or treatment may have changed for 2015. Here are tips from our financial counselors on how to educate yourself about potential changes in your insurance:

Notify SGF as Soon as Your Coverage Changes

woman on phoneIt is important to notify your financial counselor as soon as your insurance information changes, in order to prevent delays in treatment. It can take time to verify benefits–sometimes several weeks–and we do not want your treatment to be delayed. Before you come to see us, get to know your new plan and learn what questions to ask of your insurance provider.

The Same Plan Does Not Always Mean the Same Coverage

Even if your insurance plan appears to be identical to the previous year, your employer may have changed the level of benefits that you will receive. For patients, this can be a positive or a negative – sometimes you may have previously unavailable coverage for treatment, but other times you may discover that your employer decreased certain coverage. This is why it is always very important to contact your insurance provider and research your plan at the start of a new plan year.

Confirm that Your Referral is Current

The majority of HMO plans require a current referral from your primary care physician (PCP) before covering any visits. Patients can obtain a new referral by contacting the PCP’s office directly.

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Consider How Long it May Take to Obtain Authorizations

Before patients can start any course of testing or treatment, their insurance plans will require providers of care to obtain referrals and authorizations. Even if a patient did not change insurance plans/providers, reauthorization is still necessary at the start of the plan year.

These authorizations in some cases can take up to a month to receive and can delay treatment start dates for patients. Two major variables determine the length of the potential delay: the availability of documentation provided by the patient and the time required by the insurance company to process and provide the authorization. If you wish to start a treatment cycle soon with your insurance benefits, our financial team will need to obtain the necessary prior authorizations before you can begin your cycle. Please keep in mind that we must work with–and through–your insurance plan to obtain benefits and authorizations and there may be delays on their part in processing insurance changes and registering new enrollees.

Available Options for Patients without Insurance

For those patients who do not have insurance benefits, Shady Grove Fertility has several affordable treatment plans, including the Shared Risk 100% Refund Guarantee program, the Multi-Cycle Discount program for IVF patients, the Shared Donor Egg program for our donor egg recipients, the Shared Help program, and more. Learn more about these options.

The best thing you can do when determining your insurance plan is to be prepared. Speak with your insurance provider about your benefits and what options may be available to you. Our financial counselors will work with you and your provider to determine how your changed benefits will affect your treatment costs. It may take some time, but by working together, we can obtain the most current and reliable information regarding your coverage and help support you on your path to parenthood.

If you would like to find out more information about what questions to ask your insurance provider, please call our new patient liaisons at 877-971-7755 or click to schedule an appointment.


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