Medical necessity refers to a decision by your health insurance plan that your treatment, test, or procedure is necessary for your health or to treat a diagnosed medical problem.
It is not a guarantee of payment until your insurance carrier has received your claims and all medical records are reviewed by their medical review board.
If you are coming in for an egg retrieval and it is a covered benefit, this does not automatically mean your insurance carrier will pay for the procedure as soon as they receive the claim.
If claim is denied based on Medical Necessity, unfortunately, you will be responsible for the denied procedure. Patients do have the right to file an appeal themselves if the provider was unsuccessful with their appeal.
These are the steps taken:
It’s important to remember that what you or your doctor defines as medically necessary may not be consistent with your health plan’s coverage rules. Before you have any procedure, especially one that is potentially expensive, review your benefits handbook to make sure it is covered.
To Avoid Unwanted Healthcare Billing
Surprises, be sure to ALWAYS:
• Ask your insurance company what costs you
must pay out of pocket for your doctor visit,
test, procedure, or surgery.
• Bring your most up-to-date insurance
card(s) to every doctor appointment
and health care visit.
Generation Next Fertility
115 East 57th St, Floor 11
Manhattan, NY 10022
280 North Central Ave, Suite 303
Hartsdale, NY 10530
7:00am – 5:00pm
8:30am – 3:00pm
Sundays & Holiday Hours
By Appointment only
(By Appointment Only)
6:45am – 12:00pm
7:30am – 11:30am
Sundays & Holidays – By Appt
MWF: 7:00am – 9:00am