Tips for Insurance Open Enrollment

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This is often the time of year when your employer’s insurance plan has open enrollment.  It’s a good time to examine your insurance coverage for fertility treatment, a time to make a change if another plan suits you better and a time to get familiar with the details of your policy.   Ask questions regarding coverage options specific to your needs and use available company resources to help you choose the best plan for your family.

Where to Start

Health insurance companies typically have several optional policies, each of which may vary in what fertility treatments are covered.  At Utah Fertility Center, we do our best to verify coverage for our patients prior to their consultation appointment, but because most insurance companies have many different policies and varying degrees of coverage, it can get complicated.  You are your best advocate and knowing exactly what your specific insurance policy covers can help avoid unnecessary issues.   The following steps may be beneficial as you review your covered benefits and gather information:

  • Get to know your policy inside and out.
  • Reach out to your health insurance company to determine which fertility treatments they cover, and which they don’t.
  • Each time you call your health insurance company, write down detailed notes just in case you need to refer back to them later. It’s also a good idea to jot down the date and name of the representative you speak with.
  • Ask for details on which procedures and drugs are covered.
  • Check to see if there is an age restriction or maximum lifetime benefit.
  • Ask if you need a referral, and how to get one.
  • Find out if you need to use a specific clinic to get coverage.

Ask questions and document the answers you receive.  That will make any disputes that arise easier to handle

What’s Typically Covered?
Two people may have the same health insurance company, but find out their coverage is different depending on a number of variables. Many insurance carriers cover diagnostic testing until an infertility diagnosis is confirmed. The most common diagnostic testing procedures include consultation, initial ultrasound, initial blood work, semen analysis, and Hysterosalpingogram (HSG). Certain carriers may also provide some level of coverage for infertility treatment.

Some employers offer multiple insurance carriers. If this is the case at your work, you may want to consider exhausting your infertility coverage with one health insurance company and then switching to another carrier’s plan. Before you do so, check to see if previous infertility treatments will affect your new coverage in any way.

Also, some plans allow for out-of-network coverage. So, even if Utah Fertility Center isn’t a contracted provider for your insurance, you may have some level of coverage.  Again ask questions.

How We Can Help
Our dedicated financial counselors are here to help you maximize your insurance coverage. We are available to answer your questions, coach you on the best way to work with your carrier, and provide guidance throughout the process.  We want to help you make the most of every opportunity and advantage available to you.   If you’d like more information, or have specific questions for our financial team, please call us at 801-785-5100.