Insurance Policies - Part 2 (Overview)
You may need pre-certification or predetermination or preauthorization. At Pacific Fertility Center, we have financial consultants who will assist you by providing insurance-specific codes for the services to be rendered.
We recommend that you request predetermination in writing.
• Pre-certification: Your benefits will not be paid if you commence treatment before obtaining the pre-certification from the insurance company.
• Preauthorization: Referral from your Primary Care Physician or OB/GYN to a Reproductive Endocrinologist must be preauthorized by HMO/IPA.
• Investigate infertility riders, which are now being added to basic coverage by some insurance companies. You may be required to register as an infertility patient and meet criteria set by the insurance company.
Submitting your claims:
• If possible your Physician will process the claims directly, but if you must submit on your own, request documentation from your Physician and attach to your claim.
• Keep your explanation of benefits (EOB), all receipts and all documents from the insurance company. These will be invaluable in the event you receive denials and you need to appeal.
• Financial consultants can provide a valuable service to you and together with your input we can avoid loss of benefits due and maximize your reimbursement.
I hope you find this information useful. The information enclosed pertains to the issues we see at our clinic but it should help provide you a framework in order to go about maximizing your fertility benefits. If you have any questions on this issue, I’d love to hear from you!