Fertility Financing and Insurance Information
Financing Overview:
We understand that infertility treatment can be physically and emotionally stressful and that often times the financial component adds another level of stress. We are aware of this and try to minimize as much of the stress as possible by making our highly trained and qualified business office staff available to answer your questions and guide you through the financial process before, during and after treatment.
We offer assistance with understanding your insurance benefits and provide financial options to assist you in seeking treatment. All patients considering fertility treatment at Troché Fertility Centers are offered a financial consultation. When you enter our program and a treatment plan has been selected, we work with you to provide a complete financial consult. This financial consult consist of an assessment of your insurance coverage (benefits check) as well as an explanation of what our understanding is of your covered benefits. We will inform you of what your potential patient responsibility may be because of your deductible and / or percentage of co-insurance for which you may be responsible. In case your infertility treatment is not a covered benefit or if you don’t have health insurance, we will help you determine the best financial alternative for your treatment plan. Also, we will provide a financial worksheet detailing the services that are included in your treatment as well as the total cost. Any additional costs, such as anesthesia services and medications, will also be explained to you. Our goal is for you to have a clear and comprehensive idea of the cost of your treatment. We encourage you to contact your insurance company and confirm that the information you have been provided by us is correct.
Insurance Coverage
Troché Fertility Centers is contracted with most insurance companies and we are happy to submit claims on your behalf for covered services. However, since insurance coverage varies greatly from carrier to carrier and policy to policy, we strongly encourage you to call and get specific information in writing about your insurance coverage before you begin fertility treatment. Since most patients have no experience in dealing with their insurance carrier and infertility coverage does not usually fall under standard care guidelines, we have listed below standard questions that will help you when talking with your insurance company's member services representative. We strongly encourage you to obtain written confirmation of predetermination of benefits for your records. (Note: Your member service representative's number should be listed on your insurance card.)
Insurance Company Questions
- Is the diagnostic evaluation for infertility covered (i.e. lab work, ultrasound, hysterosalpingogram, andrology services)? Does my insurance cover physician, hospital and lab charges?
- Are infertility treatments such as artificial insemination or in-vitro fertilization (IVF) covered under my plan? Are the hospital, physician and lab charges covered for these procedures?
- Is there a co-payment to an infertility specialist? How much?
(Note, this is usually provided by a sub-specialist and can be different from your regular co-payment amounts.) - What is my co-payment/deductible for infertility related hospital charges?
- Are oral or injectable medications covered?
(e.g. Clomid, Gonal-F, Follistim, Menopur, Repronex, Luveris, Ganarelix, Lupron) - Does my insurance require use of a specific contracted pharmacy?
- Am I required to use a specific contracted laboratory for insurance coverage?
- Do I have a lifetime maximum benefit for treatment? How much? Does it includes medications?
- Do I have an age cap restriction for my infertility benefits? What is the age maximum?
- Do my IVF benefits cover donor and / or gestational carrier services? How much?
Your involvement and assistance in coordination of authorizations, etc. is vital in the process when working with your insurance company. This protects you from the surprise of becoming financially responsible if they will not pay. You have more influence with your insurance provider than your physician or surgery center so be sure you have the appropriate authorizations before you begin any treatment plan. Insurance authorizations can take up to 6 weeks, so be careful not to rush into a treatment without an authorization number.
Last updated:
January 31, 2012
Reviewed by Dr. Vladimir Troché and his medical staff