Are all benefit plans the same?
No, employers drive what specific benefits and services they offer their employees, so it’s best to start with your HR team or employee benefits coordinator.
I need to choose a new plan? How should I decide?
Although we cannot verify benefits until the policy is in effect, we’re happy to provide general information about an insurance carrier.
We suggest comparing premium cost, deductible, copay, co-insurance, maximum out-of-pocket expenses, and covered services. Also, check your pharmacy benefits to see if the plan covers fertility drugs.
Open enrollment is a good time to consider adding a flexible spending account (FSA) for costs not covered by insurance like deductibles, co-pays and treatments that are not covered.
However, your FSA may limit how or when you use your funds. Always check with your employer benefit coordinator to make sure you understand the terms of your particular FSA.
What if I’m on the same plan as last year?
Not all authorizations extend to the new year, so check if you need a new one. Let us know if you are of pocket maximum or deductible is changing, so we can calculate with the assumption those amounts reset with the new year.
If you reached your out-of-pocket maximum in 2021 and have not been paying copays, we will reset your account and begin collecting copays again in 2022.
Anything else I should know?
Some insurers determine coverage based on specific medical criteria, including a history of infertility. They may also require you to do a certain number of intrauterine inseminations (IUI) before approving in vitro fertilization (IVF), so be sure to read the details of the policy.
You may inquire by the treatment-specific codes: Intrauterine Insemination (IUI) is 58322, necessary egg retrieval for IVF is 58970, and intracytoplasmic sperm injection (ICSI) is 89280.
Insurance Information if you're currently in treatment?
My insurance plan is changing on 1/1/22. What should I do?
Unfortunately, insurance carriers will not quote any benefit information or provide authorizations before the plan is in effect. If you anticipate this being an issue, please talk to your nurse about adjusting your start date (the date you start injectable medication or Estrace).
Keep in mind that billing dates are always determined by the date of service. If you start your medication before 1/1/22, the bill will reflect the date the services were rendered.
If your retrieval, transfer or insemination occurs after the new year, it will be billed with the date the services were rendered, NOT with the date you started your cycle.
Any services, including any bloodwork, will be billed with the date the services were rendered.