Medical Insurance and Fertility Treatments
By Julie Hughes and Erica Jack, Bay IVF
It is unfortunate that not all insurance companies provide infertility benefits, but we will do our best to help you utilize whatever benefits you may have.
Understanding your insurance coverage can be a challenging process. In some states, including California, employers are only required to offer medical insurance, not to provide it.
It is important to contact your insurance provider to confirm that your plan includes infertility coverage.
Your medical insurance will be either an HMO (Health Maintenance Organization) or PPO (Preferred Provider Organization) plan.
With HMO insurance plans it is expected that patients will have their provider in an approved network. Patients can be treated by an out of network provider, but the reimbursement will be at a lower rate.
PPO insurance plans allow the patient to choose a physician outside of their employer’s chosen network. PPO insurance allows the flexibility of seeing any provider, but the reimbursement rate is lower with higher out of pocket fees and a higher premium.
Kaiser HMO differs from an insurance HMO. Kaiser has its own network of providers, and there is no option of coverage with a physician outside of Kaiser.
Most insurance plans have an annual deductible and or out of pocket expenses that have to be met before you will receive reimbursement for any covered services.
It is also very important to know if a prior authorization is required for any given treatment. Such prior authorization should be initiated by the facility where you will have your treatment. Obtaining a prior authorization before treatment begins is always recommended because you are more likely to receive the maximum reimbursement.
Bay IVF is an out of network provider, but we will prepare the necessary physician’s statements that have the current procedure codes and the medically necessary diagnosis codes. We are here to help and will assist you in submitting your insurance claim for reimbursement.