13 June 2011

Pursuing Reimbursement for ART Procedures. Part 1

Posted by Jody under: Women's Health .

Navigating the healthcare system can be difficult and can be a very stressful part of the treatment process. Unfortunately, I must warn you to expect things to be even more difficult when the issue is fertility treatment. This is because there are no federal regulations mandating any form of fertility coverage, and as a result, there are no real standards for infertility coverage in the industry. Also, no two insurance policies are exactly alike and different insurers are likely to have different attitudes and policies for infertility. In general, the language in many insurance policies can be difficult to understand and may seem unclear but you can rely on a certain level of coverage for most treatments. Not so for infertility. This may make it difficult to determine what infertility treatments or procedures are covered. So baffling are the rules that most people simply take an initial claim denial for a fertility procedure as final.

Besides the differences among insurance plans and types of coverage, the subject of reimbursement for infertility treatment is open to a great deal of misinterpretation. It sometimes lacks logical sense and may even seem intentionally confusing. Sometimes, certain aspects of treatment may be covered while others are not. Other times, the insurance company will pay for diagnostic but not treatment procedures. Further confusion results when different practices code differently for the same procedure, which results in the insurance companies inability to accurately capture their costs for fertility treatment.

To make matters worse, insurers have not adopted a single definitive definition of infertility remedies or the procedures that are covered. Benefits vary considerably by plan as well as by employer. Frequently, what is not written into the plan is just as important as what is written.

You should expect your physician’s office to take a systematic approach in helping you determine what is covered by your current health insurance policy. But don’t always expect to get the answers your looking for. Many medical offices currently call insurance companies to obtain benefit information. Unfortunately, the information provided is often vague, or even inaccurate. I have even heard of occasions were a health insurance company will tell a medical office the patient is covered and then later inform the medical office no coverage is available. This confusion puts the medical office personnel in an awkward position, so it’s still a good idea to follow-up and advocate for yourself. Always ask for things in writing.

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