understanding the connecticut fertility mandate questions for insurance companies & employers...
TRANSCRIPT
![Page 1: Understanding the Connecticut Fertility Mandate Questions for Insurance Companies & Employers May 8, 2006 Financial Services Representatives The Center](https://reader036.vdocuments.us/reader036/viewer/2022082817/56649daa5503460f94a97b30/html5/thumbnails/1.jpg)
Understanding the Connecticut Understanding the Connecticut Fertility MandateFertility Mandate
Questions for Insurance Companies & Questions for Insurance Companies & EmployersEmployers
May 8, 2006May 8, 2006
Financial Services RepresentativesFinancial Services Representatives
The Center for Advanced The Center for Advanced Reproductive ServicesReproductive Services
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The Center for Advanced The Center for Advanced Reproductive ServicesReproductive Services
About the Mandate About the Mandate
Mandate requires an infertility diagnosisMandate requires an infertility diagnosis Some of what the mandate says is open to the Some of what the mandate says is open to the
interpretation of individual insurance plans interpretation of individual insurance plans Definition of ovulation induction (clomid vs. injectiblesDefinition of ovulation induction (clomid vs. injectibles Definition of IVF cycleDefinition of IVF cycle
Mandate requires that covered treatments are Mandate requires that covered treatments are clinically indicatedclinically indicated Exhausting covered benefits does not mean one will be moved on Exhausting covered benefits does not mean one will be moved on
to the next level of treatmentto the next level of treatment
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Mandate Related QuestionsMandate Related Questions
Am I covered under the CT mandate passed on 10/1/05?Am I covered under the CT mandate passed on 10/1/05? Is my policy self funded or fully insured?Is my policy self funded or fully insured? When am I eligible to access my infertility benefit under the When am I eligible to access my infertility benefit under the
mandate?mandate? Do I need to complete the Disclosure Form (individual plan Do I need to complete the Disclosure Form (individual plan
holders)?holders)? If so, where do I send it?If so, where do I send it? Does my partner need to complete one?Does my partner need to complete one?
Is there a fertility look back clause associated with my Is there a fertility look back clause associated with my policy?policy?
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The Center for Advanced The Center for Advanced Reproductive ServicesReproductive Services
Mandate Related QuestionsMandate Related Questions
Confirm eligibility for:Confirm eligibility for: 4 ovulation inductions (how is your plan defining ovulation 4 ovulation inductions (how is your plan defining ovulation
induction; clomid, injectibles?)induction; clomid, injectibles?)
3 intrauterine inseminations3 intrauterine inseminations
2 IVF cycles (How is your plan defining an IVF cycle?)2 IVF cycles (How is your plan defining an IVF cycle?)– Do FET cycles count toward the 2?Do FET cycles count toward the 2?– When does the clock start ticking (what constitutes When does the clock start ticking (what constitutes
one cycle)?one cycle)?» Start of medsStart of meds» Completed retrievalCompleted retrieval» Completed transferCompleted transfer
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The Center for Advanced The Center for Advanced Reproductive ServicesReproductive Services
General Questions for your insurance companyGeneral Questions for your insurance company(mandate and non-mandate)(mandate and non-mandate)
Do I have infertility benefitsDo I have infertility benefits Do I need a referral?Do I need a referral? What is my co-pay for a specialist office visit?What is my co-pay for a specialist office visit? Effective date of my policyEffective date of my policy Renewal date of my policyRenewal date of my policy Is there a deductible or co-insurance?Is there a deductible or co-insurance?
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The Center for Advanced The Center for Advanced Reproductive ServicesReproductive Services
Questions about blood workQuestions about blood work
Is diagnostic blood work covered?Is diagnostic blood work covered? Estradiol, FSH, LH, Hep B&C, HIVEstradiol, FSH, LH, Hep B&C, HIV
Is monitoring blood work covered?Is monitoring blood work covered? Estradiol, FSH, LH, ProgesteroneEstradiol, FSH, LH, Progesterone
Is blood work for genetic testing covered?Is blood work for genetic testing covered? Chromosomes; Cystic Fibrosis, Tay SachsChromosomes; Cystic Fibrosis, Tay Sachs
Am I required to use specific labs?Am I required to use specific labs?
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The Center for Advanced The Center for Advanced Reproductive ServicesReproductive Services
Questions about diagnostic testing proceduresQuestions about diagnostic testing procedures
Will my new patient visit be covered?Will my new patient visit be covered? Will any of the following be covered?:Will any of the following be covered?:
Semen analysisSemen analysis Hysterosalpingogram or SonohysterogramHysterosalpingogram or Sonohysterogram Endometrial biopsyEndometrial biopsy Transvaginal ultrasoundsTransvaginal ultrasounds
– DiagnosticDiagnostic– Monitoring as part of cycleMonitoring as part of cycle
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Questions about IUI treatmentQuestions about IUI treatment
Do I have coverage for intrauterine inseminations aka Do I have coverage for intrauterine inseminations aka artificial inseminations?artificial inseminations?
Is prior authorization required?Is prior authorization required? Is there:Is there:
A maximum number of cycles? Does the maximum include A maximum number of cycles? Does the maximum include all treatment cycles?all treatment cycles?
A dollar amount maximum?A dollar amount maximum? Coverage for sperm washing?Coverage for sperm washing?
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The Center for Advanced The Center for Advanced Reproductive ServicesReproductive Services
Questions about IVF TreatmentQuestions about IVF Treatment
Do I have coverage for In Vitro Fertilization?Do I have coverage for In Vitro Fertilization?
Is prior authorization required?Is prior authorization required?
Is there:Is there: A maximum number of cycles? Does this maximum A maximum number of cycles? Does this maximum
include all treatment cycles?include all treatment cycles? A dollar amount maximum per year or lifetime?A dollar amount maximum per year or lifetime?
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The Center for Advanced The Center for Advanced Reproductive ServicesReproductive Services
Questions about Embryology Lab ProceduresQuestions about Embryology Lab Procedures
Is there coverage for Intracytoplasmic Sperm Injection Is there coverage for Intracytoplasmic Sperm Injection (ICSI)? CPT codes 89280 or 89281(ICSI)? CPT codes 89280 or 89281
Is there coverage for Assisted Hatching? Is there coverage for Assisted Hatching?
CPT code 89253CPT code 89253 Is there coverage for Cryopreservation of embryo(s)? Is there coverage for Cryopreservation of embryo(s)?
CPT code 89258CPT code 89258 Is there coverage for Cryopreservation of sperm? Is there coverage for Cryopreservation of sperm?
CPT code 89259CPT code 89259
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The Center for Advanced The Center for Advanced Reproductive ServicesReproductive Services
Questions about MedicationsQuestions about Medications
Do I have a separate pharmacy carrier?Do I have a separate pharmacy carrier? Do I have coverage for oral medications (ie, clomid)?Do I have coverage for oral medications (ie, clomid)? Do I have coverage for injectible medications?Do I have coverage for injectible medications?
Bravelle, Follistim, Gonal FBravelle, Follistim, Gonal F
Is prior authorization required for my medications?Is prior authorization required for my medications? Do I need to utilize a specific pharmacy?Do I need to utilize a specific pharmacy?
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In ClosingIn Closing
If unable to access this information from your insurance If unable to access this information from your insurance company contact your benefits administrator thru your company contact your benefits administrator thru your employeremployer
Don’t take “no” for an answer or a first response as the final Don’t take “no” for an answer or a first response as the final word. Request to speak to a supervisorword. Request to speak to a supervisor
Your doctors office has experienced people to help you Your doctors office has experienced people to help you obtain information and help you understand it. However, obtain information and help you understand it. However, ultimately we cannot guarantee benefits. Benefits are ultimately we cannot guarantee benefits. Benefits are between patients and their insurance company.between patients and their insurance company.
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Questions and AnswersQuestions and Answers
Thank you!Thank you!