Affordable Infertility Treatment is Not a Myth
Infertility is stressful enough without the added concern of the cost. It‘s no secret that infertility treatment is often expensive, and insurance coverage is not always available. Our financial counselor will research your benefits and provide you with the information you need to make the best decision regarding your care. Having no insurance coverage does not have to mean the end of your journey to parenthood. Our goal is to do everything possible to assure that the cost of treatment does not become a factor in the decision. We do have options for patients without fertility coverage that can make treatment more affordable, and hopefully reduce stress.
A Fertility Specialists of Texas financial counselor will personally meet with you to explain your insurance coverage and benefits. During this meeting, we will review cost for medical treatments that you may be considering and review any responsibility for payment that you may have due to deductibles, co-insurance or co-payments. If you do not have insurance coverage for fertility treatment, we will discuss our programs to help make it more affordable.
Insurance
Health insurance can add to the complexities of the decisions you will have to make when choosing infertility treatment options.
At Fertility Specialists of Texas, our goal is to alleviate some of that stress and help you work with your insurance company to ensure that you are reimbursed at the maximum level that you are covered. We will review your specific benefits with you at your first visit so you have a understanding of your benefits and treatment options available to you. All insurance claims are filed electronically by our office. Please call our office for any questions or email us using the contact bar on the right side of the web site.
In addition, we have a prepared a document that answers key insurance questions.
Click to download: Insurance Information for Patients
Review your policy
As a patient you can be the best advocate for yourself by thoroughly understanding your policy. It is important that you review your specific policy and understand what will be paid and what will not.
When pursuing insurance coverage, do not just handle it over the phone. If you simply call and ask about coverage for a certain procedure, the customer service representative may give you his or her interpretation of what he/she thinks the policy states.
You should contact your insurance company and request a written pre-determination of your exact coverage and any eligibility requirements that must be met in order to have that service covered.
It is also helpful to get any determination of benefits and coverage in writing from the insurance company. If you receive a verbal verification of coverage, you will not have any written documentation. Written verification of their intent to pay is a much more effective tool than verbal if you have a challenge.
Establishing a point of contact with a representative at the insurance company is a good idea and may enhance follow-up. All phone conversations regarding coverage should also be backed up with a written record.
Here are important questions to ask the insurance company:
- What is the specific policy or procedures that I need to follow to get infertility treatment covered? For example, do I need separate referrals or authorization for each office visit, blood work or office procedures?
- Is there a dollar maximum associated with infertility treatment? If so what is that dollar amount?
- Is there a maximum lifetime amount for Intrauterine Inseminations (IUI)?
- How many cycles of In vitro Fertilization are covered?
- Are fertility medications covered and if so, am I required to use a particular pharmacy?
Common Terms
- Referral - A form issued by a primary care physician or ob/gyn referring a patient to a specialist. If applicable, all referrals are obtained by the patient
- Authorization - A number issued by an insurance company authorizing a specific service or medication. The doctor or the patient, depending on the insurance, can obtain authorizations
- Pre-certification - A number issued by insurance for a surgery or in office procedure
- Pre-determination letter - A letter from an insurance quoting benefit coverage according to the specific patient policy
We are affiliated with the following health care plans:
- Accountable PPO
- Aetna all plans
- Affiliated PPO
- Associated Administrators Group (AAGI)
- Blue Cross and Blue Shield all (BCBS) all plans
- Beech St PPO
- Cigna all plans
- Direct Care America
- Evolutions Health Care Systems
- First Health Network
- FOCUS Health Care Management
- Galaxy Healthcare Network
- Genesis Medical Savings Plan
- Great West Healthcare all plans
- Healthcare Partners of East Texas
- Healthsmart all plans
- Humana all plans
- IMS PPO
- Managed Care Strategies (MCS) PPO
- Multiplan PPO
- National ChoiceCare
- NHA PPO
- NPPN (National Preferred Provider Network)
- NTHN all plans
- One Health Plan
- PHCS (Private Healthcare Systems) all plans
- ppoNext PPO
- ProNet PPO
- Regional Healthcare Alliance PPO
- Rockport Healthcare Group (RHG)
- Texas True Choice PPO
- Texas Integrated Health Network (TEXIHN)
- Texas DirectCare, Inc (TDC)
- TML Intergovernmental Employee Benefits Pool PPO
- UHC (United Healthcare) all plans
- Unicare Performance and Classic all plans
- USA ManagedCare Organization PPO
