Helping women touched by cancer become mothers.
California Appeals Process

The Department of Managed Healthcare regulates most of the insurance plans young cancer patients have. Please follow these steps when asking for your carrier to cover your fertility preservation services.

STEP 1

Have your reproductive specialist request an URGENT prior authorization through your insurance carrier. They should write the words URGENT at the top of the form and use CANCER as your primary diagnosis and these fertility preservation V-codes as your treatment codes:

  • V26.42 Encounter for fertility preservation counseling prior to cancer therapy
  • V26.82 Encounter for fertility preservation procedure prior to cancer therapy
  • Include a _Letter of Medical Necessity v 0.1 (written by the Reproductive Specialist or Your Oncologist)
  • Include a Physician Statement of Immediate Health Threat (written by your Oncologist)

STEP 2

If your prior-authorization is denied, immediately submit an appeal (also called consumer grievance or complaint) through your insurance plan. Use the expedited route since you have cancer. Most plans have an online method for this.

  • Include a _Letter of Medical Necessity v 0.1 (written by the Reproductive Specialist or Your Oncologist)
  • Include a Physician Statement of Immediate Health Threat (written by your Oncologist)

STEP 3 

If your appeal is denied by your insurance plan, you may request an EXPEDITED IMR from DMHC.

To learn more about the process, visit the DMHC website 

To request your IMR in English, visit here.

To request your IMR in Spanish, visit here.

Include your Letter of Medical Necessity and  Physician Statement of Immediate Health Threat in your IMR Request.

Resources:

CA State Webinar for provider’s and patients! CA Fertility Preservation

http://mypatientrights.org/