Affording Care

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.

• 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? 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.
• We are Infertility Specialists. If you have a specialist co-pay or 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.