The Bureau of Insurance regulates VA State insurance plans. Please follow these steps when asking for your carrier to cover your fertility preservation services.
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:
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.
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!
For more information about VA’s process: https://www.scc.virginia.gov/boi/omb/ext_review.aspx