Navigating Fertility Benefits
Navigating your insurance benefits at RMA of New York is an important step in your fertility journey. Understanding your coverage can help minimize out-of-pocket expenses and streamline your treatment process. This guide provides an overview of how to effectively navigate your insurance benefits.
1. Understanding your coverage
- Initial consultation and treatment coverage: Approximately 80% of RMA of New York patients have insurance coverage for their initial consultation, and about 70% have some coverage for infertility treatment.
- Review your benefits summary: Obtain a copy of your benefits summary from your employer to understand what is covered under your plan. Be aware that benefits and out-of-pocket expenses can change annually.
- Flexible spending accounts (FSA): Consider utilizing an FSA or Health Savings Account (HSA) to cover medical expenses not paid by insurance, such as deductibles, co-pays, and treatments not covered.
2. Verifying your benefits
- Contact your HR department: If infertility coverage isn't listed in your benefits summary, reach out to your Human Resources department or benefits coordinator for clarification. They can provide detailed information about your specific plan.
- Consult SGF Financial Educators: RMA of New York’s Financial Coordinators are available to explain treatment costs and help maximize your insurance benefits before starting treatment.
3. Gaining coverage
- State fertility insurance laws: Some states have laws requiring health insurance coverage for infertility diagnosis and/or treatment. Check if your state has such mandates, as this can impact your coverage.
- Employer-sponsored plans: Even in states without mandates, employers may offer plans that include infertility benefits. Discuss available options with your HR department.
4. Additional tips
- Pre-authorization: Some insurance plans require pre-authorization for certain fertility treatments. Ensure all necessary approvals are obtained before starting treatment to avoid unexpected expenses.
- Keep detailed records: Maintain copies of all communications with your insurance company, including pre-authorizations, denials, and appeals.
- Appeals process: If a claim is denied, don't hesitate to appeal. Provide additional documentation and work closely with your healthcare provider to support your case.
By proactively managing your insurance benefits and understanding the associated codes, you can navigate the financial aspects of your fertility treatment more effectively. For personalized assistance, contact RMA of New York’s Financial Coordinators who are ready to help you through this process!