Even with these options, financing infertility treatment can still be worrisome for some patients.
Fortunately, more and more insurance providers are now offering coverage for the diagnosis and treatment of infertility. At CRM, we work with most major insurance companies to accept coverage for those patients who have it.
However, insurance policies can be confusing, and even those providers that offer infertility and IVF insurance 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 entering a treatment program.
Frequently Asked Infertility Insurance Coverage Questions
Questions and answers will be added periodically as they arise.
How do I know what my insurance will cover?
While it is ultimately the patient’s responsibility to know and understand the limits of the coverage offered by the insurance carrier, CRM financial staff will provide a benefits review at the time of the New Patient visit. This benefits review is not a guarantee of coverage and is subject to the policy provisions in place at the time the insurance is contacted.
What does it mean if my coverage says "diagnose and treat?"
It has been CRM’s experience that most insurances offer at least some coverage to diagnose an underlying condition (fibroids, blocked tubes, endometriosis, etc.). Diagnose and treat usually refers to correcting the underlying condition causing the infertility.
What do I have to pay for?
Regardless of the reason for your visits to CRM (or any other doctor), the patient is always responsible for deductible, copay, coinsurance and non-covered amounts. It is the policy at CRM to collect these responsible amounts at the time of service.
Can I pay my bill online?
YES! Please click here or go to the Pay Online button at the top right. Online payments are simple and quick.
My friend and I have the same insurance, but she has coverage and I don’t. Why not?
The coverage of infertility treatments is something that is chosen 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 through a smaller local employer and her friend has Cigna through a national employer (such as Disney), it is quite likely that the Disney employee has a much broader range of coverage.
Does CRM take my insurance?
CRM is contracted with nearly all of the insurance plans available to patients. It will be determined during the benefits review whether CRM is contracted with your particular insurance.
What does it mean for CRM to be contracted with my insurance?
When CRM agrees to take a particular insurance, for example United Healthcare, CRM agrees to a set fee schedule. This means that for a covered service, CRM cannot bill a patient the difference between the CRM charge amount and the contract amount. If a service is deemed to be non-covered by the insurance, the patient is responsible for the entire charge amount and CRM is not required to make any adjustments.
I have insurance through my employer and I am also on my partner’s insurance. How does that work?
CRM will file insurance to both carriers for appropriate charges, following the coverage and plan limitations with both.
My insurance doesn’t cover any infertility treatments, but my partner’s does. Does CRM file just my partner’s insurance?
The insurance claims must be filed "in order," that is yours – the primary - must be filed first (regardless of coverage) and then your partner’s – the secondary – can be billed. This is a requirement and can lead to many problems with the claims if you have insurance but don’t give it to CRM. You also have to be an active subscriber on your partner’s insurance to qualify for any benefits from the secondary insurance.
Does CRM offer financing?
While CRM does not currently offer in-house financing for fertility treatments, we do work with Lending Club, CapEx, and Health Credit Services for treatment loans. You are also welcome to visit your personal bank or seek out other avenues for securing the funds to pursue treatment.
What happens if my insurance denies my claims and I am not financially prepared to pay the entire balance in full?
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.
Can I prepay for my treatments?
Absolutely! Please work with one of the financial staff at CRM to determine what you will need to cover the cost of your treatment.
When is the diagnosis of infertility included on the claim?
Once all of the truly diagnostic tests have been completed and you have been set upon the path of either insemination cycles or IVF, the appropriate infertility diagnosis code will be included on your claims. Some carriers allow for some ultrasounds and blood tests to be covered with an infertility diagnosis and other carriers deny specific procedure codes, regardless of the diagnosis code. The appropriate diagnosis code for your visit will be included on your superbill.