Financial Information for Fertility Treatment

As part of our commitment to help you throughout your fertility treatment, our dedicated, friendly financial and insurance specialists provide you with pertinent information and support.

Expert Assistance to Help You Understand Costs and Coverage

At PAMF Fertility, you will have a personal financial navigator who will be pleased to address your questions on insurance coverage, obtaining maximum benefits, treatment fees, and out-of-pocket expenses. While it’s your responsibility to fully understand your insurance coverage, we will do our best to provide you with accurate, timely information.

Your financial navigator will give you specific information about your coverage, help you understand any requirements you may have in order to maximize your insurance benefits, explain the fees related to your treatment plan, and provide estimates of what you may expect to pay out-of-pocket. Your navigator can also help you identify alternatives for making treatment as affordable as possible and for managing treatment costs.

Call (800) 597-2234 to connect with a fertility financial navigator Monday through Friday, 8:00 am to 5:00 pm, option 5 followed by option 1.

For billing inquiries, call (800) 597-2234, option 5 followed by option 2.

Financial Options

If you have insurance, there is a good possibility you’ll have coverage for at least some portion of your fertility treatment or diagnostics, whether in-network or out of network. If you do not wish to use insurance to pay for treatment, there are treatment packages for many of our services that include a discount on the bundled services.

Uninsured Payment Option

Lack of insurance coverage should not be a barrier to fertility care. PAMF offers a 20 percent uninsured self-pay discount. This can significantly lower your cost if you do not have insurance, or, if your health insurance does not cover infertility services. Some conditions apply.

Discount applies to all services that are not covered by insurance. Payment must be made in full at the time of service when the discount is applied.

Contracted Insurance Carriers and Medical Group Affiliations

PAMF Fertility is contracted with a wide variety of insurance providers. Please visit our Health Plans page to see the latest list of insurance plans accepted by PAMF Fertility Physicians of Northern California.

Pre-Authorizations

Many insurance companies now require patients to register with their fertility program in order to qualify for fertility benefits. Check with your health insurer to see if it requires registration in a special fertility program.

Members of HMO plans must obtain prior authorization for fertility services in order for those services to be considered for reimbursement by your insurance plan. Without prior authorization, your HMO may hold you financially responsible. ,

To obtain prior authorization follow these steps:

• Contact the primary care doctor (PCP) or ob/gyn listed on your insurance and request an authorization.
• The doctor will review your chart and contact the medical group to request a letter of authorization on your behalf.
• The letter is typically mailed to you (sometimes a fax or email is possible).
• Please note it can take up to 72 hours to get approval.

Know Your Insurance Coverage

Each insurance company covers infertility differently. Some insurance companies do not cover all fertility services or have requirements that must be met before benefits are eligible. For example, your insurer may consider infertility to be 12 months of attempted conception.

Contact your insurance company to learn about your fertility benefits.

Insurance Questions to Consider Before Treatment

Before visiting a fertility specialist or having a treatment cycle, please have the following information:

• The name of your insurer.
• Your policy identification number and your group number.
• The insurance company’s phone and fax numbers.
• The insurance company’s e-mail address and website.

NOTE: Communicate with your insurance company in writing so you have documentation if any claim disputes arise. You should contact your insurer in writing and request a written determination of your exact coverage amount prior to receiving any procedure. Your insurer may require you to obtain commitment of coverage for a specific medical service before you start treatment, called preauthorization or predetermination. When writing a letter to your insurer, include the following:

• Group and ID numbers (patient insurance identification number).
• Name of treatment(s) and/or medication(s).
• Reason for needing the procedure/treatment/medication.

Below are insurance questions that you should consider before seeking treatment.

• What type of coverage is listed?
• Which procedures require preauthorization? Does preauthorization need to be done for each cycle of treatment and how long does it take to get?
• Will the treatment or procedure be covered under my current coverage or under my major medical portion?
• Are there any limitations to my fertility coverage?
• What is my maximum benefit? Is the maximum dollar benefit lifetime or annual? Some policies have limits on the age of the female patient or the number of months of treatment.
• Are any portions of my charges covered for prescription medication, laboratory tests or ultrasounds leading up to the intrauterine insemination?
• Are there restrictions on the type of healthcare provider who can perform infertility services?
• Is there a co-payment for medical services?

Also examine your insurer’s prescription drug plan because fertility medications are often costly. It is important to understand your drug benefits prior to starting any treatment. First, you should find out if you have drug coverage. Next, determine if fertility drugs are covered under your prescription plan. You may want to consider the questions below before starting fertility treatment.

• Is there a co-payment for drug coverage?
• Is prior authorization needed for these medications?
• Does my plan cover self-administered subcutaneous (under the skin) or oral medications?
• Are there discounts for mail-order medications?
• Are any of the drugs on the prescription formulary and therefore covered?

Here is a Sample Letter to Request Insurance Coverage Information for an IUI procedure.