Insurance Coverage

INSURANCE AND BILLING ISSUES

Fertility insurance coverage and treatment of infertility is complex. Once you have become a patient with us our medical billing and insurance specialists will be happy to provide you with an estimation of benefits based upon the information that is obtained by your insurance carrier. However, it is your responsibility to know your insurance benefits, coverage, and limitations as we cannot guarantee which procedures and services will be covered by your insurance carrier. Our staff is available to answer any insurance-related questions you may have either by email or phone.

Prior to treatment, we encourage you to take the lead in contacting your insurance company to better understand your fertility insurance plan benefits. To help you start with this we have summarized key points about fertility and infertility insurance coverage below. The first question to ask with regard to our clinic’s services is if the specific plan you have offers infertility coverage, or coverage for fertility testing. The vast majority of plans fall into one of three categories when it comes to infertility coverage.

  1. The plan provides no coverage whatsoever for infertility services.Unfortunately this is often the case and means that you will be expected to pay at the time of service for any non-covered services.
  2. The plan provides coverage for the diagnostic phase of infertility testing only.In this scenario, the insurance plan will usually offer some fertility insurance coverage for a new patient consultation and generally offers some coverage for fertility testing. The treatment phase is not covered.
  3. The plan provides coverage for the diagnostic testing phase and coverage for infertility treatment.In these circumstances, coverage is provided for diagnostic testing and for some methods of infertility treatment. Understanding your individual coverage will help you anticipate whether or not a particular service with us is covered.

Additional Important Insurance Information

Medical Coding (Diagnosis):

Our physicians are specialists in Reproductive Endocrinology. If you are seeking care in order to achieve a pregnancy you can expect that most, if not all, of your visits will be coded (diagnosed) as infertility or infertility related.

It is your responsibility to:

  • Bring your insurance card and identification to every visit.
  • Please check with your insurance carrier to determine whether or not your policy requires you to have a written referral from your referring physician or an authorization number directly from your insurance carrier. Failure to acquire referrals could result in unpaid claims and would then become your financial responsibility.
  • Remit payment for services not covered by insurance (co-payments, deductibles, non-covered services, etc.) at time of service.
  • All self-pay fees will be collected at time of service unless a treatment deposit has been paid in advance.