What steps must I follow to get coverage for fertility preservation services before starting medical treatment like chemotherapy, as required by California law?

To get coverage for fertility preservation in California before starting treatment, you must obtain a formal recommendation from your doctor and immediately file an urgent prior authorization request with your health plan. Here are the steps you must follow: Step 1: Obtain a Written Recommendation from Your Physician You must get a letter from your physician (e.g., your oncologist). This letter is the most critical document. It must state that your planned medical treatment, like chemotherapy or radiation, is medically necessary and is "expected to cause iatrogenic infertility," which means infertility caused by medical care. Step 2: Immediately Contact Your Health Plan Call the member services phone number on your insurance card without delay. Inform them that you need to start a time-sensitive medical treatment that will affect your fertility and you are requesting "prior authorization" for "standard fertility preservation services" as mandated by California law. Get a reference number for your call. Step 3: Formally Submit Your Request for Authorization Your health plan will require you to submit the physician's letter and a prior authorization form. Submit these documents immediately. Ensure the physician’s letter clearly outlines your diagnosis, the required medical treatment, and the risk of iatrogenic infertility. Keep copies of everything you submit. Step 4: Request an Expedited Grievance Review if Delayed or Denied Due to the urgent nature of your medical treatment, you are entitled to an expedited review if your health plan denies your request or fails to respond quickly. Contact your health plan and state that you are requesting an "expedited grievance review" because a delay would pose a serious threat to your health. Under California law, the plan must resolve an expedited review within 72 hours. Important Details and Nuances: - The law requires coverage for "standard fertility preservation services," which typically includes services like sperm banking and egg or embryo freezing (cryopreservation). - The law does not typically cover long-term storage costs for the frozen materials, so you should clarify this with your plan. - Keep detailed records of every phone call, including the date, time, name of the person you spoke with, and a reference number for the conversation. Warnings and Limitations: This mandate applies to most California-based health insurance plans and HMOs. However, it may not apply to certain types of plans, such as self-funded employer plans (ERISA plans), which are governed by federal law. Check your plan documents or ask your employer’s HR department to confirm what type of plan you have. This is general information and does not constitute legal advice. For complex situations or if your plan refuses to comply, consult with a qualified California attorney specializing in health insurance law.