Leaders in Fertility Research and Care
Timothy N. Hickman, M.D. | Laurie J. McKenzie, M.D. | Katherine K. McKnight, M.D. | James L. Nodler, M.D.
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Sample Letter Forms

These are sample form letters you can use to request information regarding your fertility coverage from your insurance company. The information (in parentheses) should be completed by filling in the boxes with information specific to your case. We have listed the relevant questions you need to ask to confirm all aspects of your fertility coverage.

If this request is sent as a letter via certified mail, the receipt will confirm your insurance company received your request. You may elect to call your insurance company. It is a good idea to get the name of the person with whom you are speaking and jot down the date and time of your conversation.



Click to create your own...Letter Requesting Predetermination Benefits

This form will help you determine what coverage you have for fertility treatment, excluding drugs. Unfortunately, there is very little standardization in terms of treatment plans. For example, some plans will cover new consultations, a certain number or type of exams, specific procedures, or a fixed dollar amount while other plans will not. Click the Get Started Button to access the printable form. Get Started Button



Click to create your own...Letter Requesting Predetermination of Drug Coverage

Coverage for fertility treatment medication can be a separate issue from coverage for medical procedures. Having coverage for fertility treatment does not guarantee fertility medications are covered, even if you have prescription coverage. The attached printable form will allow you to understand the limits and the scope of your prescription coverage. Click the Get Started Button to begin to fill out the form. Get Started Button