Insurance coverage for the diagnosis and treatment of infertility can be arbitrary and inconsistent. Coverage varies widely from state to state and from policy to policy. To help our patients, we have a program that sorts through all of the insurance information and helps couples take advantage of any and all coverage they may have available.
Understanding your insurance
Your insurance policy is a contract between you and your insurance company. The Center is NOT a party to that contract. All contracts have limits and/or various levels of co-payments, co-insurance, and deductibles. Please make yourself aware of your specific plan design. In most cases you can discuss this with your human resources department or call the number on your insurance card for details. The treatment recommended by our office(s) is never based on what your insurance(s) will pay; it is based upon our dedication to giving our patients the highest quality of care. IT IS THE PATIENTS RESPONSIBILITY TO INFORM THE OFFICE OF ANY INSURANCE CHANGES.
We have a team of Financial Service Representatives [FSRs] to assist you in understanding your insurance benefits. We will do our best to assess your fertility benefit and estimate what your patient portion will be. The FSRs will work with you and your health plan to provide information and any documentation that may be required. We are not responsible for misinformation provided to us by your insurance company. Therefore, we strongly recommend you call your insurance company to confirm any information The Center provides you about your fertility benefit. All estimated patient responsible amounts are due up front when allowed and should NEVER be considered a guarantee insurance will cover the remainder. The balance is ultimately your responsibility whether your insurance company pays or not.
If you start your treatment cycle before you receive financial clearance, you may jeopardize the insurance coverage that you may be entitled to or have patient balance(s) you were not expecting. If you have no coverage, you want to be prepared for the expenses you will incur. Financial clearance is confirmed by your FSR. Please make note that some insurance companies may require up to 15 business days to approve a cycle.
If during treatment, you are given a new “treatment plan” to begin a subsequent cycle, you must again be financially cleared. You must speak to your FSR before beginning another cycle.
In the event an account is turned over to a collection agency or an attorney, patient will be responsible and hereby agree to be responsible for all associated fees, including attorney’s fees.
Medicare, Medicaid, and Tricare
The Center for Advanced Reproductive Services (CARS) does not participate in the federal Medicare, Medicaid and Tricare programs and state Medicaid programs.
Medicare, Tricare, and Medicaid will not directly reimburse patients for any services received from CARS and that CARS will not accept reimbursement from Medicare, Tricare or Medicaid for any services rendered. Patients may not independently seek reimbursement for expenses from services received at CARS by directly submitting to the Medicare, Tricare, or Medicaid programs for reimbursement.
Medicare, Medicaid and Tricare recipients may choose to waive this coverage and become self-pay for services at The Center. You will be asked to sign a waiver and given the opportunity to participate in one of our Possibility Program Packages. The Center also accepts CASH, CHECK, DISCOVER, MASTERCARD AND VISA.
Connecticut Fertility Mandate
In October 2005, legislation was passed in Connecticut requiring employer groups and health plans to cover medically necessary costs of diagnosing and treating infertility. In the initial law, the state only required the coverage for people under 40. However, for insurance policies sold or renewed after January 1, 2016, the age limit has been revoked. This mandate applies to health insurance plans subject to state regulation.
However, the law has many limitations and exemptions. Because of these variables, costs for infertility diagnosis and treatment for couples in Connecticut can be minimal or substantial. For more details about the Connecticut Insurance Mandate go to the State of Connecticut website at https://portal.ct.gov/
As of January 2018 Connecticut passed legislation (HB 7124) to require insurance coverage of fertility preservation for insured individuals diagnosed with cancer, or whenever this treatment is medically necessary. Specifically, the new law amends the existing insurance requirement for infertility coverage in the state by changing the definition of infertility. Previously, it was defined as “the condition of a presumably healthy individual, who is unable to conceive or produce conception or sustain a successful pregnancy during a one-year period.” The new law removes the words “presumably healthy” from the definition, and extends it to include those for whom fertility services are “medically necessary.” The new definition means the condition of an individual who is unable to conceive or produce conception or sustain a successful pregnancy during a one-year period or such treatment is medically necessary. The changes apply to individual health insurance policies providing coverage delivered, issued for delivery, amended, renewed or continued on or after January 1, 2018.
The only way to determine your particular coverage is to work closely with your particular insurance carrier and examine all angles of your plan. At The Center for Advanced Reproductive Services, we have a trained staff dedicated to help. Our Insurance Program Coordinators will help couples determine what their insurance plan covers and what you can expect to spend as a result. Click here to learn more about the insurance plans in which we participate.
To find out more about our Insurance services, please contact us.