I remember the day, not so long ago, when I took a look at my insurance health certificate and saw this statement under Non-Covered/Excluded Services "for testing or treatment related to fertilization or infertility such as diagnostic tests performed to determine the reason for infertility and any service billed with an infertility related diagnosis." It also stated it that it didn't cover infertility drugs under prescription drug benefits. My heart sank to the soles of my feet.
Recently, I've started facing the fact that I need to make 100% I know exactly what's covered and what's not. I hate to totally assume there is NO coverage, without asking them more specific questions. The trouble is, I am not even sure what to ask. Or, if I ask, can I be penalized in some way - like maybe they'll refuse future treatment of things related to PCOS.
Then I came across a resource that just might help make this a little easier.
Their website states that among the various things they offer, is free assistance with a benefits specialist who can help answer any insurance related questions you have, as well as actually call your insurance company (with your consent of course) and ask all the key questions pertaining to your infertility related insurance coverage and then report back to you on their findings. They'll even send you a write up with the collective info for your records. How awesome is that?! Right now it seems almost too good to be true, but I am having a wait and see attitude.
The woman I spoke at Fertility LifeLines, Julie & Bonnie, were VERY easy and pleasant to talk to. They made me feel exteremely comfortable in sharing my infertility woes - they didn't ask too many questions, but just enough to make sure they were directing me in the right manner. They said that I should hear back from them within 1-2 days to go over the information. At that point, depending on what they find and if I'm interested, they would share with me some other financial assistance options (also listed on their site), if I was interested.
At the very least, it's worth visiting their site just to utilize a few free downloadable resources they have available, one of which is a Word template letter you can use to request a predetermination of benefits (and another for drug coverage) through your insurance. They list a lot of specific questions that I would have never thought to ask.
Anyway, I'll be sure report back. I'm hopeful we'll have SOME infertility insurance coverage, but I'm not counting on it.