Finances are a major consideration for those undergoing infertility treatments or preparing for treatment. We pride ourselves on being health insurance experts, advocating on behalf of our patients with their insurers to gain the maximum coverage.
Our physicians also promote the extension of healthcare insurance to cover more infertility treatments and costs by negotiating with individual insurance plans and engaging in the discussion of adopting mandated coverage at the state and federal levels.
Assessing health insurance benefits for fertility treatment coverage
Many infertility diagnostic and treatment expenses are not covered by healthcare insurance. The cause of infertility and the treatment recommended can have a significant impact on how much a patient may have to pay out-of-pocket.
How FSMG health insurance experts help our patients
We believe in educating our patients from the very beginning of our relationship about the cost of their diagnosis and treatment options and the available insurance coverage. We want to ensure our patients have a clear picture of what they can expect from a financial standpoint.
Fertility Specialists Medical Group’s insurance experts are well versed in dealing with infertility treatment coverage. We have extensive experience with:
- Lifetime and cycle maximums
- Limitations (age, duration of infertility, diagnosis, etc)
Meet Billing Manager Denise Maestas
Denise has worked in healthcare insurance and financing for nearly 20 years and supports FSMG’s mission of financial transparency by helping patients understand and navigate fertility treatment costs and payment.
Initial consultation: health insurance fertility coverage
Patients often have insurance benefits that cover diagnostic testing and some patients even have coverage for fertility treatments. Our physicians provide medical recommendations based solely on what is most appropriate. But we realize your insurance coverage may affect your treatment decisions, and we will work with you and your insurer to coordinate the best care.
During your new patient consultation:
- Our staff will verify your benefits with your insurance provider.
- We will review both your diagnostic and treatment benefits and help explain the important distinction between the two.
- Together, we will explore other options that may be open to you.
Tips on checking your infertility health insurance coverage
Our insurance experts will work with you on every aspect of your coverage.
Following are some general guidelines on how you can best prepare to manage your insurance benefits.
- In advance of your visit, review the coverage provisions for your health insurance plan, often called a Summary Plan Description, and seek clarification from the insurer if you have any questions.
- Call your insurer and ask specifically what infertility treatments are covered and what are excluded in your policy.
- Always make notes of any conversation with your insurer, listing what was said, the agent’s name, and the date and time of the discussion.
- Make sure to find out about coverage of fertility medications; they may contribute to your maximum benefit or may be separate. Some plans do not cover infertility medications at all.
- See if the insurer will give you a letter of predetermination of infertility benefits.
- If in vitro fertilization (IVF) is covered in your plan, make sure to determine any restrictions, such as number of cycles covered and age limits for coverage.
- Ask your human resources manager if you can buy a policy rider that includes IVF.
- If your insurance is through your employer, ask if they offer a policy that covers infertility treatment. More and more companies are doing this, often after an employee asks.
Healthcare insurance plans accepted by FSMG
Fertility Specialists Medical Group accepts most commercial insurance carriers, including, but not limited to, the following.
- Blue Cross
- Blue Shield
- First Health
- Scripps Health EPO HealthComp
- Beech Street
- ChoiceCare Network
FSMG medical group affiliations
OB/GYN referrals are typically required for you to use your benefits from a medical group affiliation (typically an HMO). Fertility Specialists Medical Group is affiliated with the following groups: