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FINANCIAL INFORMATION

INSURANCE QUESTIONS

Currently we participate with:  Aetna, Anthem, Blue Cross and Blue Shield, Cigna, Community Health/Optima, First Health, Mamsi/MDIPA, Optimum Choice, Sentara, Coventry, United Healthcare, Tricare and VHN (subject to change without notification).

We understand contacting your insurance company regarding your fertility benefits may be a hassle but we highly recommend obtaining these benefits prior to receiving services so you are aware of potential out of pocket costs and non-covered services.  They are obligated to provide this information to you and is often delivered only in response to your specific questions.  Any time you can receive your benefits in writing, it is highly recommended.  You can also review your benefits summary/booklet provided by your employer’s human resource department.

To verify your benefits, please refer to the customer service phone number on your insurance card.  For this call you should obtain the representatives name, document the date and time of the call, and request a reference number.  Please be aware that if treatment is not covered by your insurance company, payment in full is due at the time of the service.

Fertility Insurance Questions:

  1. Does my policy cover diagnostic infertility services?
  2. Do I need to register for infertility benefits?
  3. Is diagnostic code N97.9 covered?
  4. Do I have coverage for the treatment of underlying conditions that may be the cause of my infertility?
  5. Would CPT codes 58322 & 58323, for IUI, with diagnosis code Z31.89 be covered?
  6. Would Advanced Reproductive Technology or In Vitro Fertilization – using CPT codes 58970, 58974, for egg retrieval and embryo transfer, 89250 through 89280 for embryology labs, and the diagnosis code Z31.83 be covered?
  7. Do I have any drug coverage for infertility treatment? If yes, where? (specialty mail order) What drugs? (i.e. Bravelle, Follistim, Gonal F, Lupron, Menopur, Clomid, hCG).
  8. Do I need a referral and/or prior authorization for any office visits or procedures? (If yes, please obtain a referral before your visit with us. If you do not, your visit/services may not be covered)
  9. Have I met my deductible?
  10. What is my co-pay or co-insurance that will be due?

It is important that you understand our physicians offer their medical recommendations and treatments based on your history, physical exam, and test results and not what your insurance company will/will not cover.  However, if you have restraints within your insurance coverage that you are trying to meet, please inform your physician so that together you and he/she can make the best and most cost-effective plan of treatment for you.