MD IPA authorization

[Anonymous]

I was told that you need to have authorization before certain fertility testing if you have MDIPA. Is this correct? If so, what type of testing will require authorization and it is a pain to get it if you work with Shady Grove? I have no problem getting a referral from my family doctor.

Thanks.

[Anonymous]

Call MD IPA and ask once you know what tests you need.
Shady Grove will handle the authorization for you. They are quite efficient, but tend to be very busy in January and February.

[Anonymous]

Can't speak to SG specifically, but yes you do need both a referral to your RE from your PCP (even if you are already a patient of RE) and pre-authorization for some fertility tests. If you are switching to MDIPA in January, you can still get the referrals now and have SG submit them at the start of the year.

You RE's office should handle requesting preauthorization for testing as appropriate on their own, though it never hurts to call MDIPA on your own (I always found them extermely helpful on getting me the right IF-related coverage information). Remember that it's often a combination of the specific test and the diagnosis code that determines what's covered, so you have to make sure your RE's office does both correctly. When I was at CFA, they were terrible about it. When I switch to GW, they were awesome (though now Brian is gone, so I have no idea about the new billing folks). I don't know about SG.