Source: New York Times– February 7, 2015
As many Americans are using their insurance policies purchased from the Health Insurance Marketplace under the Affordable Care Act, they are finding that those policies come with high deductibles and increasing out-of-pocket coinsurance fees while also offering less coverage than ever before, according to a recent article in The New York Times.
The Affordable Care Act (ACA) has improved insurance in some respects. The law states insurance companies cannot deny coverage for pre-existing conditions, and new policies limit out-of-pocket spending for care under those policies. However, many people are encountering out-of-pocket costs they traditionally weren’t responsible for in previous private or company-sponsored policies. This is because, in an effort to reduce their own financial risk, insurance companies are creating policies to meet the minimum criteria of the law.
In this new insurance landscape, patients will need to become better-informed health care consumers and learn how to interpret their new plans to avoid unexpected costs of care.
New ACA policies are unfamiliar to patients and providers, and interpreting these policies has become problematic for everyone involved. In this new insurance landscape, patients will need to become better-informed health care consumers and learn how to interpret their new plans to avoid unexpected costs of care.
From Our Expert, Eileen Ramos
“RADfertility is here to help patients understand their insurance benefits.”
Many policies are costing more money for less coverage, but this is not limited to only Marketplace Plans. One of the biggest changes patients will find with these new plans is that deductible and co-insurances may be much higher. The policies themselves have quickly become very complicated, and a lot of it doesn’t seem logical.
To meet their deductible or co-insurance, patients with infertility coverage are also increasingly putting more money up front to pay for procedures that diagnose infertility. Another challenge is that in some cases, where patients have no infertility coverage, their annual out-of-pocket maximums in their plans are so high that they have essentially become self-pay.
At RADfertility, we try to do our best to make sure you understand your insurance benefits. We call your insurance companies and get as much information as possible about your benefits and whether you have any benefits specifically related to diagnosing and treating infertility. We also try to find out your estimated out-of-pocket cost at each visit based on this information.
At your new patient visit, you will sit with a member of our financial team and review your benefits in a one-on-one session. However, it’s important to know that we are just as subject to what your insurance company says as you are. Unfortunately, we cannot offer any guarantees about your insurance coverage because companies only offer a statement of your benefits, and not a guarantee that your insurance will cover certain services.
The best way to understand what your insurance policy covers is to become an advocate for your own care. We have created several handouts outlining how to understand your insurance benefits, how to contact your insurance company yourself, and what questions to ask them. My advice to our patients is to ask questions, stay informed, and don’t lose hope! Between 10% and 15% of the population will experience fertility challenges at some point in their lifetimes. It’s important to know you are not alone on your journey.
I’ve seen patients become disheartened after learning their insurance coverage wouldn’t cover their treatment. But it doesn’t mean you can’t have that baby. We have financial options to help you through this difficult time. We want you to be informed so you know the potential benefits and limits of your coverage ahead of time. Know we are here, you’re not alone, and we’ll do our best to help you through it.
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"I feel so lucky to have found RADfertility. I tried two other clinics before I expanded my search and found RADfertility. I drive an hour each way to go to them but I don’t regret a thing. They are so caring and so professional. Every time I message them they respond quickly. Every time I see them they have a friendly smile and warm welcome. They explain everything so well and I never feel lost in the process as I did elsewhere. They also took the time to figure out what was wrong. Other clinics threw up their hands, said 'I don’t know' and pushed me to try IVF."
"Dr. Feinberg and the entire staff at RADfertility are absolutely amazing. The receptionists, coordinators, nurses, and lab staff are compassionate, caring, and straight forward. I’ve had a 12-year infertility journey and I’ve tried other clinics but RADfertility was the only one I felt at ease with. They answered any questions that I had and were there any time I needed them. My coordinator, Amy, was the absolute best and always had my back. Dr. Feinberg’s dedication to his patients is incredible. You are not just a number there, you are a person with individualized needs and care."
"My journey with RADfertility and Dr. McGuirk started when my husband and I were trying to conceive and were having difficulty. We went to RADfertility, where we met Dr. McGuirk. I always say she changed my life and 'fixed' me. Dr. McGuirk is always learning more about endometriosis and how to help her patients. She’s brilliant and truly cares for you! I’m eternally grateful to her and everyone at RADfertility for their unwavering support, love, and care."
"Every step of our journey was tailored to us. We were treated so respectfully. Every detail was clearly explained and we felt so comfortable. Rhonda Wright was a Godsend and inspiring. I highly recommend this place! I cried when my weekly appointments were done and I 'graduated.'"
"The day I met Dr. Neithardt I knew she was the perfect doctor for me. Dr. Neithardt was so compassionate every step of the way. She held my hand, she hugged away tears, and continued to give me hope. There are not enough 'thank you's' in the world for Dr. Neithardt and the whole RADfertility team who will forever have a special place in my heart."
"RADfertility's staff has heart and provided me with exceptional health care. I knew I was in good hands and felt like we were in this together. The doctors and nursing staff always answered all of my questions and provided thorough information about all of my options. I am so fortunate and appreciative of the care that I received at RADfertility. They go above and beyond."
"I cannot begin to explain how wonderful RADfertility is. We were frustrated with trying to start a family and it not working for us. The entire team of doctors and nurses made us feel comfortable and hopeful that we would be parents. We experienced so many ups and downs but we never felt like we were on our IVF journey alone, we had our RADfertility team every step of the way. If you're looking for a supportive team on the IVF journey, look no further. RADfertility is the absolute best."
"Dr. Schillings always kept us informed and never gave up on us. She always explained our options and risks with each procedure. She called us personally when there were any issues or sensitive subjects to cover. Dr. Schillings was the first doctor that had answers for us and wanted to help us have our miracle baby!"
4735 Ogletown-Stanton Road
Medical Arts Pavilion 2
Newark, DE 19713
Silverside Medical Center
2700 Silverside Road, Suite 2A
Wilmington, DE 19810
Eden Hill Medical Center
200 Banning Street, Suite 240
Dover, DE 19904
Phone: (302) 602-8822
Fax: (302) 602-8832