Understanding
Coverage

At Reproductive Associates of Delaware we recognize that a primary obstacle to pursuing fertility treatment is affording care. As part of your comprehensive treatment we have a financial team who can help you through this process and offer a variety of financial options.

Understanding
Coverage

At Reproductive Associates of Delaware we recognize that a primary obstacle to pursuing fertility treatment is affording care. As part of your comprehensive treatment we have a financial team who can help you through this process and offer a variety of financial options.

Understanding Your Insurance Coverage

 

It is important that you know what your benefits cover to ensure you understand your potential out-of-pocket costs. Your member services number is listed on the back of your card. Listed below are some questions you may want to review with your insurance carrier.

 

Types Of Insurance Coverage

 

  • HMO – These plans usually only offer in-network benefits. In addition, you will usually have to provide a referral for any visit.
  • POS – These plans usually offer in and out-of-network benefits. However, you may still need a referral in order to maximize coverage.
  • PPO – These plans offer both in and out-of-network coverage. You usually do not need a referral or authorization for these services either, but should always verify this with your insurance carrier.

 

Questions To Ask Your Insurance About Benefits

 

  • Does my plan cover testing for infertility?
  • Does my plan cover assisted reproductive treatment?
  • What procedures require preauthorization?
  • Are there restrictions on the type of healthcare provider who can perform infertility services?
  • What limits, if any, apply to your coverage? (# of treatment cycles, procedures, months of therapy, embryo transfers, & age of patient)
  • What is the maximum dollar limit on my benefits? Does this maximum include prescriptions? If so, what portion is allocated to prescriptions, and what is allocated for treatment?
  • Is the maximum dollar benefit lifetime or annual?
  • What is the coinsurance or copayment for medical services?
  • What is my out-of-pocket maximum and does it include my deductible?
  • When does my plan year begin and end?
  • What procedures are listed in the exclusions section?
  • Does voluntary sterilization affect my benefits?

 

Questions To Ask Your Insurance About Pharmacy Benefits

 

  • Is there drug coverage?
  • Are infertility drugs covered under the pharmacy benefit or medical benefit?
  • What is the coinsurance or copayment for drug coverage?
  • What prior authorization policies are in effect for medications?
  • Are there 30-day drug prescription limits for infertility medications?
  • Does the plan pay for self administered subcutaneous, under the skin injection (SQ) and/or oral (PO) medications?
  • Does the plan pay for intramuscular (IM) medications?
  • Are there discounts for mail order medications?
  • Are infertility specialists encouraged to prescribe one drug over another?
  • Can I get a medication that is not a preferred drug or formulary? Can I get a medication that is not covered?If so, am I expected to pay a higher copayment or coinsurance or pay for it completely? And what is that amount compared to the preferred drug copayment or coinsurance?

Always record when and who you spoke with, as well as the reason and the outcome. It is also suggested that you obtain a written pre-determination of your benefits. This is your most effective tool if you need to challenge a future decision made by your insurance company.


Free 2nd Opinion Consult

Call (302) 602-8822 to speak to one of our RADvocates and schedule your free second opinion consult. Please mention this offer when you call.


Request An Appointment

If you would like to schedule an appointment, please let us know which dates and times work for you. A RADvocate will contact you to confirm your appointment.


Take Our Fertility Assessment

Answer a few brief questions and receive a personal response. Every submission is reviewed by a fertility expert. Get the answers you are looking for today!

Newark Office

4735 Ogletown-Stanton Road
M.A.P. 2, Suite #3217
Newark, DE 19713
Phone: (302) 602-8822
Fax: (302) 623-4241

 

Wilmington Office

Silverside Medical Center
2700 Silverside Road, Suite 2A
Wilmington, DE 19810
Phone: (302) 602-8822
Fax: (302) 623-4241

 

Dover Office

Eden Hill Medical Center
200 Banning Street, Suite 240
Dover, DE 19904
Phone: (302) 602-8822
Fax: (302) 623-4241

 

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