Fertility Insurance & Pre-Authorization
Many of you will have medical insurance coverage. It is your responsibility to be sure that your referral and authorization are up to date prior to your visit. We will be happy to assist you with your referral if you are having difficulty obtaining it from your primary care physician. Please call us at least two business days in advance of your appointment day. You will be responsible for all charges payable at the time of the visit if your referral or authorization is not current. If you prefer to reschedule your appointment for a later date, please do so at least 24 hours before your appointment or the cancellation fee will apply.
You will not be required to make advance payment for any services that will be paid in full by your insurance company. However, to avoid paying these fees in advance, we must have an unrestricted promissory note in writing from your insurance company or a contract to provide services. Payment is expected at the time of your visit. Payment for all ovulation induction/intrauterine insemination cycles and all assisted reproductive technologies (IVF, GIFT, ICSI, donor oocytes, FET) must be made in advance of cycle initiation, which is the first day of medication. We accept cash, checks and Visa/Mastercard/Discover. Questions may be addressed to our practice administrator.
Letter for Predetermination of Benefits
If your treatment includes any of the assisted reproductive techniques, we can assist you by filing a letter for predetermination of benefits. Please be advised that it may take four (4) weeks to get a response from your insurance company. If a non-restricted letter is received prior to the start of treatment, you will only be expected to pay the difference of those services that are not fully covered by your insurance. If services are not covered, you will be required to make full payment in advance for these procedures. If a credit balance remains, we will process your refund as quickly as possible.
We currently utilize the ICD.9.CM International Classification of Diseases and the latest CPT Current Procedural Terminology codes to classify your diagnosis and treatment. Many couples we see are referred because they desire to become pregnant and carry a child to full term. In the overwhelming majority of cases, this includes a diagnosis of infertility (exceptions would be recurrent pregnancy loss). We are required to code your visit with all applicable diagnoses. Failure to do so would constitute fraud.
We routinely must complete multiple forms mandated by your insurance carrier to obtain coverage and request laboratory tests. When indicated, we will provide you with written notices for leave of absence from work as follows: three days for laparoscopy or hysteroscopy; two days for IVF oocyte aspiration; three days for embryo or blastocyst transfer; and five weeks for laparotomy, myomectomy or tubal reversal. We will request your assistance in completing these multiple forms. Additional requests for leave of absence from work or disability not indicated by your treatment will be completed after receipt of a payment of $25. Similarly, requests for forms to be completed for non-formulary drugs and “letters of medical necessity” will be performed after receipt of a $25 fee for each.