WHAT DO I NEED TO KNOW?
First, check your wallet to determine if the “carrier” or insurance company responsible for your medical benefits is ALSO responsible for your pharmacy or drug coverage. How many cards do you have? It is not uncommon for your employer to have “unbundled” your health benefit from your drug benefit. This is extremely important since you will be prescribed medication during your treatment.
Prior to treatment, you will need to be familiar with how your medical AND pharmacy benefits are administered. This means you will need the following:
- Your medical and pharmacy benefit cards. These may be together on one card or separate, depending on your plan.
- The patient/member services contact information for BOTH.
Next, FIND OUT EVERYTHING YOU CAN ABOUT YOUR COVERAGE!
There is a great deal of information provided by most commercial health carriers regarding their medical and pharmacy policies. Your insurance company’s website is a vital part of your quest to understand your coverage and maximize any available benefit you may have. This a good place to start.
When visiting the website, search “medical policies” for “infertility” (some plans may refer to it as “ART”, Assisted Reproductive Technology or Family Planning). Next, determine what your specific plan benefits include. Remember, not all plans have the same benefits – your employer dictates what benefit package you have. If you are unable to find the information online (or in your employee handbook) it is best to call member services.
Keep in mind, many member services employees are highly unfamiliar with infertility treatment. If you get the feeling that the person you are speaking with does not understand your questions, it’s best to ask for a supervisor before you get too frustrated.
On the next page you will find specific questions to ask regarding your coverage. Have these questions handy when calling your carrier.