RE Consultation

Re: RE Consultation

• ceclarlinetlo member

  September 2015

  My RE gave me a list of questions to ask my insurance company - they said they will walk through my insurance benefits with me at my appointment but it's best if Patients have some understanding of coverage when they come. These are the questions I was given:
  
  If infertility treatment is included in your policy coverage, please ask the following questions:
  
  Is my policy diagnostic only?
  
  Do I have coverage for underlying conditions? This is for surgery benefits.
  
  Would CPT codes 58322 & 58323 with the diagnosis code of V26.1 be covered? This is for Intrauterine Insemination (IUI).
  
  Would Advanced Reproductive Technology – using the CPT codes 58970, 58974, 58976, 89258 and the diagnosis code of V26.81, be covered? This is for In Vitro Fertilization. (IVF)
  
  Is there a maternity exclusion on my policy?
  
  Is there a pre-existing clause on your policy in reference to infertility treatment or surgery procedures?
  
  Do you have any drug coverage for infertility treatment?
  If yes, where? (mail order or local pharmacy)
  What drugs are included as Tier 1?
  (i.e. Follistim, Gonal F, Lupron)
  
  Do I need a referral and/or a prior authorization for any office visits or procedures? (If yes, please secure this prior to your visit – failure to follow the guidelines of your policy may result in denial of covered services.)
  
  Have I met my deductible?
  
  What is my co-pay or co-insurance that will be due?

  TW: MMC
  BFP1 12/24/14 - EDD 09/07/15 (D/C 8w1d)
  BFP2 6/12/15 - EDD 2/22/16 (D/C 10w3d)
  ———
  Diagnoses and Treatments
  PCOS (myo-inositol, excercize)
  Indeterminant levels of APS IgM antibodies (baby aspirin)
  Sub-septate uterus (hysteroscopic septoplasty 12/18/15)
  ———
  BFP3 05/02/16 EDD 01/09/17 DS born 01/05/17
  BFP4 01/28/19 EDD 10/?/19 🤞🙏

  
  

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