Helping women touched by cancer become mothers.
Virginia Appeals Process

The Bureau of Insurance regulates VA State insurance plans. 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 review by the bureau.

Use this form to file your external review request:  https://www.scc.virginia.gov/boi/omb/files/216a.pdf 

Have your oncologist use this form to certify you need an expedited review: https://www.scc.virginia.gov/boi/omb/files/216c.pdf 

If you need to access an experimental procedure: have your oncologist use this form: https://www.scc.virginia.gov/boi/omb/files/216d.pdf

Include your Letter of Medical Necessity! 

Resources:

For more information about VA’s process: https://www.scc.virginia.gov/boi/omb/ext_review.aspx 

http://mypatientrights.org/