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Understanding Your Insurance Benefits – Here’s What to Ask Your Insurance Provider

We want to empower you to be a part of your care! Here’s a guide to help you understand your fertility insurance benefits and questions to ask your insurance care team.

Step 1: Gather Your Information

  • Before you call your insurance provider, have the below information readily available to reference
    • Your Insurance Card with Member and Group Number
    • Your treatment plan and medication list from your clinic
    • Your cycle type and diagnosis (ie. IVF, IUI, Donor etc.)
  • Request a price quote from SMP Pharmacy
    • Using your treatment plan and medication list, get a free price quote from SMP so you can compare your insurance benefits with the cash-pay list from SMP

Step 2: Call your Insurance Provider

  • On your insurance card, a member services number should be listed. Give that number a call to request information about fertility benefits and covered medications

Step 3: Ask the Right Questions

Using the below template, these are important questions to ask your insurance provider to get a full understanding of your benefits.

  • Do my pharmacy benefits cover fertility medications?
    • If yes, does this include self-injectable medications?
    • If not, do I have any coverage for medications under my medical benefits?
  • Do I have an annual or lifetime dollar limit for fertility benefits?
    • How much has been used on my medical benefit?
    • How much has been used from my pharmacy benefit?
  • Do I have a deductible?
    • How much has been used of my current deductible?
    • When does my deductible restart?
    • When do I need to complete treatment in order to put money towards this years deductible?
  • Are there any specifications in order to receive fertility coverage (i.e. diagnosis, cycle type, etc.)?
    • If yes, is there limitations or specifications for medication specifically? What about for my cycle?
  • Which of my fertility medications, if any, require prior authorization?
    • Are there any preferred medications I should use?
    • What is my copay amount per medication? Is this applied to my deductible?
  • Do I have to use a specific fertility pharmacy to be covered?
  • Anything else that I need to know about my fertility benefit

Step 4: Review the information

Once you’ve spoken to your insurance company, review the information. You can always discuss with the financial coordinators at your fertility clinic to help you digest all the information you just received.

Step 5: SMP Pharmacy is here to support you.

Still need help? Give us a call at 855.255.5005 and we can assist in guiding you through the medication portion of your fertility journey.

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