Insurance Tips:

RMA of NJ would like to emphasize the importance of reading and understanding your policy, its requirements and the covered and non-covered services.

Tips:

When pursuing insurance coverage, do not just handle it over the phone. If you simply call and ask about coverage for a certain procedure, the customer service representative may give you his or her interpretation of what he/she thinks the policy states.

You should contact your insurance company with a request that they provide you with a written pre-determination of your exact coverage, and any eligibility or requirements that must be met in order to get that service covered.  A sample letter along with a breakdown of our fees will be provided to you at the initial consultation visit.

It is also helpful to get any determination of benefits and coverage in writing from the insurance company.  If you receive a verbal verification of coverage, you will not have any written documentation.  Written verification of their intent to pay is a much more effective tool than verbal if you have a challenge.  

Establishing a point of contact with a representative at the insurance company is a good idea and may enhance follow-up. All phone conversations regarding coverage should also be backed up with a written record.

Here are important questions to ask the insurance company:

-What are the specific policy or procedures that I need to follow to get infertility treatment covered?  For example, do I need separate referrals or authorization for each office visit, blood work or office procedures?

-Is there a dollar maximum associated with infertility treatment?  If so what is that dollar amount? 

-Is there a maximum lifetime amount for Intrauterine Inseminations  (IUI)?

-How many cycles of Invitro Fertilization are covered?

-If my policy covers infertility as a result of the NJ state mandate, do I meet the criteria for coverage for Invitro Fertilization?  This is a very important question you may have the benefit for IVF but unless you meet the criteria set by your carrier they might not cover your benefit. 

Common Terms:

Referral - a form issued by a primary care physician or ob/gyn referring a patient to a specialist.  If applicable, all referrals are obtained by the patient

Authorization - a number issued by an insurance company authorizing a specific service or medication.  The doctor or the patient, depending on the insurance, can obtain authorizations.

Pre-certification - a number issued by insurance for a surgery or in office procedure.  

Pre-determination letter - a letter from an insurance quoting benefit coverage according to the specific patient policy.