The Importance of Prior Authorization

Learn how prior authorization works and how it can help you determine what expenses are covered for fertility treatment.

Hearing a diagnosis of infertility can be devastating. So if you’ve decided to take next steps toward undergoing fertility treatment, the last thing you want to worry about are unforeseen costs. If you have decided to pursue a fertility treatment, it’s important that you get prior authorization. This is to help to determine what expenses are covered.

How prior authorization works

Sometimes called predetermination, prenotification or precertification, prior authorization is approval from your health insurer that treatment may be delivered. Here’s what you can expect:

1. You and your provider agree on a treatment plan.
2. Your provider submits that treatment plan to your health insurer.
3. Your health insurer determines what’s covered based on your health plan.
4. The cost typically doesn’t include estimates for patient responsibility, such as deductibles and co-insurance.
5. Prior authorization isn’t a promise that your health plan will cover the cost.

When does a prior authorization need to be requested?

Your provider needs to submit the treatment plan after you’ve agreed to treatment, but before you start that treatment. This may take a few days. During a visit with your reproductive endocrinologist (RE) or their billing office, it’s important to verify that they have submitted the treatment plan before you to start your cycle.

How do I know what’s covered?

Refer to your health plan documents for details.

By Kristin Nelson, Contributing Writer

Last Updated: May 8, 2020