Financing and insurance coverage
At the Center for Reproductive Medicine, we believe that our fees should not stand in the way of our patients' desire to expand their families.
Fortunately, more and more insurance providers are now offering coverage for the diagnosis and treatment of infertility. We work with most major insurance companies to accept coverage for infertility programs.
However, insurance policies can be confusing, and even those providers that offer infertility and IVF insurance coverage usually have restrictions. We highly recommend that you contact your insurance company or employer to investigate exactly what your policy will and will not cover prior to beginning an infertility treatment program.
Frequently Asked Questions
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The Center for Reproductive Medicine is contracted with nearly all of the insurance plans available to patients. Our financial team will review your benefits at the time of your new patient visit to determine whether CRM is contracted with your particular insurance provider.
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When the Center for Reproductive Medicine agrees to take a particular insurance (for example, United Healthcare), we agree with the insurer to a set fee schedule. This means that for a covered service, CRM cannot bill you the difference between the amount we charge and the contract amount. If a service is deemed to be non-covered by your insurance provider, you are responsible for the entire charge amount and CRM is not required to make any adjustments.
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While it is ultimately your responsibility to understand the limits of the coverage offered by your insurance carrier, the Center for Reproductive Medicine’s financial staff will provide a benefits review at the time of your new patient visit. This benefits review is not a guarantee of coverage and is subject to the policy provisions in place at the time your insurance provider is contacted.
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In our experience, most insurance providers offer at least some coverage to diagnose an underlying condition, such as fibroids, blocked tubes, endometriosis, etc. The phrase “diagnose and treat” usually refers to correcting the underlying condition causing the infertility.
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We will file insurance claims with both carriers for the appropriate charges, following the coverage and plan limitations with both insurance companies.
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The insurance claims must be filed "in order." That means that your insurance claim (the primary) must be filed first (regardless of coverage) before your partner’s insurance (the secondary) can be billed. This is a requirement. (You have to be an active subscriber on your partner’s insurance to qualify for any benefits from the secondary insurance.) It can lead to many problems with the claims if you have insurance but don’t inform the team at CRM.
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The coverage of infertility treatments is something that is decided on by the employer. It is more common for larger, national companies to offer coverage for procedures like insemination or IVF. For example, if a patient has Cigna coverage through a smaller, local employer and her friend has Cigna coverage through a national employer (such as Disney), it is quite likely that the Disney employee has a much broader range of coverage.
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Regardless of the reason for your visits to the Center for Reproductive Medicine (or any other doctor), the patient is always responsible for paying the deductible, copay, coinsurance and non-covered amounts. It is our policy to collect these responsible amounts at the time of service.
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While we do not currently offer in-house financing for fertility treatments, we do work with Lending Club, CapEx and Future Family for treatment loans.
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CRM does offer short-term payment plans (no longer than three to four months). A credit card will be required to set up any payment plan for an outstanding balance. This is also a scenario where Springstone Financial can be helpful.
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Once we have completed all of your diagnostic tests and you elect to pursue either insemination cycles or IVF, the appropriate infertility diagnosis code for your visit will be included on your superbill. Some insurance carriers cover some ultrasounds and blood tests once an infertility diagnosis is made, while other carriers deny specific procedure codes, regardless of the diagnosis.
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Absolutely. Please work with one of the financial staff members at CRM to determine what you will need to cover the total cost of your treatment.
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Yes. Please click here to login to your Prelude Connect portal to make a payment.