The scoop on Insurance, IVF and understanding your benefits

More and more insurance companies are offering coverage for infertility diagnosis and treatment. RPMG works with most major insurance providers and accepts coverage for patients whose insurance offers IVF benefits, of those which we are contracted. At RPMG our Patient Care Coordinators are dedicated to not only checking your insurance benefits but explaining what you can expect in terms of coverage and out-of-pocket expenses.

RPMG's ethical standards of practice include recommending IVF only when absolutely necessary and offering transparent pricing. Insurance policies can be confusing. While some patient's insurance programs have significant benefits, other patient's may have a limited lifetime maximum and scope. It's important our patient's get the most out of their benefits and are aware that sometimes out-of-pocket expense can cost more than RPMG's global pricing. Again, we encourage you to have our staff check your benefits so you can make informed decisions, prior to treatment.

Let's elaborate further to help you understand your insurance

What will my insurance cover and how do I get started?

When you're ready to schedule your initial consult, call 877-273-7763, our patient care coordinators can assist you in checking your benefit prior to your scheduled consultation visit. It is equally important that the patient assume responsibility in further understanding any non-covered concerns by contacting your insurance provider directly. RPMG staff will provide you with financial options that best suit your physician recommended course of treatment, your insurance coverage and your financial needs.

What is my financial responsibility?

Like most Doctor or Clinic visits, it's the patient's responsibility to pay for all fees not covered by insurance at the time of service. This includes deductible obligations and copays.

Can I pay by credit card or Online?

Sure! You can by credit card before or during the office visit, or by using our online payment form. Online payments are simple and quick.

Does RPMG take my insurance?

We are contracted with most major insurance companies and many insurance plans including, United Health Care, Blue Cross, Aetna, Cigna, Meritain, and First Health. Visit our website to view an abridged version of other Major PPO and select HMO plans not listed. RPMG is a “center of excellence” with United Health Care and Blue Cross is the largest insurance carrier in California.

Call our office to find out if your insurance company is contracted with RPMG. Even if your insurance company is not contracted with RPMG, they may still provide some benefits. You may also find that our Global Pricing may be lower than what some insurance companies charge in out-of-pocket expenses to include deductibles and copays. Some insurance plans are limited in terms of lifetime maximums and scope, and can be capped at $2000-$4000. When evaluating the costs of fertility treatment, particularly IVF treatment, RPMG could help you save money.

Why do people I know have the same insurance as I do and they have coverage and I don't. I don't understand?

Your employer chooses the coverage of infertility treatments. It's our experience that larger or publicly traded companies will offer coverage for procedures like insemination or IVF. For example, if your friend has United Healthcare and is employed by a company like Google or Disney, they may have a broader range of coverage than a United Healthcare policy offered through a small local employer.

I heard some insurance plans require you to do a series of insemination before they would pay for any IVF treatment, if needed. Is there any way to avoid doing the inseminations if my chances at success are extremely low and my doctor suggests IVF for better success?

We have not experienced a lot of insurance companies that require a series of insemination treatments prior to IVF although they do exist. We encourage you to learn as much as you can about your insurance benefits and we can help with the process. While your insurance may cover insemination treatments, it may not include, or limit, your IVF benefit, which is important to know before starting the process. We can help you weigh all of your available insurance coverage, financing options, and ultimate out of pocket expenses, so you can make an informed decision.

At RPMG we don't recommend any more than three insemination treatments as success is low compared to IVF. Some insurance companies recommend a series of six insemination treatments, which could potentially lead to high out-of-pocket expense and undo stress. You may find foregoing insemination insurance benefits and choosing to pay cash for IVF is a better option that offers higher success rates and lower stress.

What if I have insurance through my employer and I am also on my partner's insurance plan. How is that handled?

RPMG will file claims insurance to both contracted carriers for appropriate charges, following the coverage and plan limitations with both. We do gender neutral billing where allowed by carrier, which will help the maximum benefits you receive.

What if I don't have any fertility treatment coverage but my partner's plan does. Can RPMG file only my partner's insurance?

Regardless of the “patients” coverage, a claim must be filed first with the Patients insurance and then with the secondary “partners” insurance. This is to certify the patients insurance confirms they do not cover the treatment and allows the partners insurance to be billed. In the state of California you also have to be an active subscriber on your partner's insurance to qualify for any benefits from the secondary insurance.

What does it mean if RPMG is contracted with my insurance?

When RPMG contracts with particular insurance companies, like Blue Cross, it means we have an existing contract with a specified fee schedule for RPMG services. For any covered service, RPMG cannot bill a patient the difference between the RPMG amount and the contract amount. Disclaimer: A patient is responsible for any deductible, co-insurance fee, or any life time maximums that are exceeded.

Does RPMG offer financing?

RPMG doesn't currently offer payment plans or in-house financing for fertility treatments. To learn more about third party financing solutions visit our financing page, or ask our staff about CapexMD and LendingClub. Other options would be to consider your local bank for a personal loan, the possibility of a loan from your 401K program or other avenues for securing funds to pursue treatment.

When can I expect the diagnosis of infertility to be included on the claim?

Once all of your diagnostic tests have been completed, your physician will provide you with a treatment evaluation and plan, including insemination or IVF options if required. The appropriate diagnosis code will be noted in our system and included on your claims. Some insurance carriers allow for some ultrasounds and blood tests to be covered with an infertility diagnosis and other carriers deny specific procedure codes, regardless of the diagnosis code. The appropriate diagnosis code for your visit will be included on your superbill.

If you would like to discuss your financing options in person, please schedule a consultation in one of our offices where you will meet with a financial counselor and one of our highly trained fertility specialists.