Important information from Advanced Fertility Care regarding your insurance coverage.
Before your first visit:
It is important that you call your insurance company and/or Human Resources Coordinator to check on your infertility coverage. Specifically Ask:
Does my policy include or exclude infertility coverage?
If infertility diagnosis and treatment is excluded from your policy, you will be entered into our billing system as a “Self Pay” patient. Self Pay patients are required to pay for all services in full at time the service are provided. An initial New Patient Consultation is $300.00.
If you have an individual policy, please be advised that infertility is not covered at all, and that maternity may also not be covered.
If infertility treatment is included in your policy coverage, please ask the following questions:
Is my policy diagnostic only?
Do I have coverage for underlying conditions?
This is for surgery benefits.
Would CPT code 58322 with the diagnosis code of V26.1 be covered?
This is for Intrauterine Insemination (IUI).
Would Advanced Reproductive Technology – using the CPT codes 58970, 58974, and the diagnosis code of V26.81, be covered? This is for In Vitro Fertilization. (IVF)
Is there a maternity exclusion on my policy?
Is there a pre-existing clause on your policy in reference to infertility treatment or surgery procedures?
Do you have any drug coverage for infertility treatment?
If yes, where?
(mail order or local pharmacy)
What drugs are included?
(i.e. Follistim, Gonal F, Lupron)
Do I need a referral and/or a prior authorization for any office visits or procedures?
(If yes, please secure this prior to your visit – failure to follow the guidelines of your policy may result in denial of covered services.)
Have I met my deductible?
What is my co-pay or co-insurance that will be due?
If I or my partner has had a previous sterilization, regardless of current status, is infertility still a covered service?
The insurance must provide a letter detailing that coverage is still available and must state that the sterilization does not exclude coverage.
If you have a specialist co-pay/co-insurance or if the deductible has not been met on your policy, please be prepared to pay this amount for covered expenses. Payment for non-covered services is due in full at the time of service.