Insurance Benefits

While medical recommendations are given by your physician based on what is medically most appropriate, we recognize that the type and amount of your insurance coverage may impact your decisions with respect to fertility treatment. We often hear, “I didn’t know that I had any fertility benefits.” So let’s first talk a bit about how reimbursements for medical care are made.

Medical reimbursements must conform to the rules determined by your specific carrier. Most carriers follow the structure set up by the Centers for Medicare and Medicaid Services (CMS). Under this system, the underlying disease is classified using the ICD-9 coding system, an abbreviation for International Statistical Classification of Diseases and Related Health Problems. The medical procedure is classified using the CPT (current procedural terminology) codes developed by The American Medical Association. Together, a CPT and an ICD-9 code determine what was done and for what purpose. Insurance carriers often categorize the purpose of the CPT-ICD-9 code set as either diagnostic or treatment. Your insurance coverage is often different for the same type of procedure, depending on whether it is categorized as diagnostic or treatment. Thus, you may be covered for procedures to diagnose infertility, but not for the same procedure to treat infertility.

As part of our new patient consultation, we verify your benefits with your insurance carrier. We review both your diagnostic and treatment benefits since we realize the importance of this distinction. We are familiar with pre-certifications, authorizations, co-pays, deductibles, participating laboratories for blood work, lifetime maximums, cycle maximums, and many other insurance terms used in fertility care. We will work with you and your insurance company to coordinate your care. To learn more about which insurance carriers and medical group affiliations we’ve worked with, click here.