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Billing & Finance Insurance Coverage Health insurance can add to the complexities of the decisions you will have to make when choosing infertility treatment options. At RMA of Connecticut, our goal is to alleviate some of that stress and help you work with your insurance company to determine what your level of coverage is, what your out-of-pocket expenses will be (if applicable) and to help educate you on the specific details of your insurance plan. You can be your own best advocate by thoroughly understanding your benefits. It is important that you review your specific policy requirements and covered and non-covered services. In order to help you get started, we have included some insurance tips. It is also very important that both you and your partner provide us with your insurance information. Often times the male partner carries their own insurance which may have different requirements. Insurance Tips Establishing a point of contact with a representative at the insurance company is a good idea and may enhance follow-up. Be sure to document all phone conversations with your insurance company, including the date and time of the conversation, and with whom you speak. Here are some important questions to ask the insurance company:
Types of Plans HMO (Health Maintenance Organization)- these plans usually only offer in-network benefits and will normally require referrals or authorizations. Authorizations are usually required for all covered services. If your partner is covered under the same plan, he will need to have referrals and authorizations for services rendered to him as well. POS (Point of Service) - these plans usually offer both in and out of network benefits. Most POS plans do require referrals or authorizations for the maximum benefit and the least payment out of your pocket. If you chose to come without a referral, you will likely be subject to an out of network deductible and higher coinsurance. Authorizations are usually required for all covered services. If your partner us covered under the same plan, he will need to have referrals and authorizations for services rendered to him as well. PPO (Preferred Provider Organization) - these plans usually do not require referrals or authorizations, but you should check with your insurance company as some do require notification of services/cycles. If your plan covers IVF, you will need a pre-determination letter from your insurance company verifying benefits in order to avoid paying for your cycle up front. Common Terms Referral - an insurance authorization number initiated when a primary care physician or OB/Gyn refers a patient to a specialist. Obtaining referrals is the patient's responsibility. A specialist's name written on a prescription pad does not constitute a referral. Authorization - a number issued by an insurance company authorizing a specific service or medication. Some insurance companies require patients to obtain authorizations and some require the specialist to do so. Pre-certification - a number issued by an insurance company for a surgery or in-office procedure. Pre-determination letter - a written verification of benefits for your specific plan from your insurance company. Participating Insurances:
Please note that our participation with your insurance company does not guarantee coverage for infertility services. The extent of coverage, benefits and referral/authorization requirements vary from policy to policy. It is important that you understand what is covered and what is necessary to ensure the maximum coverage before you begin treatment. This can be done by speaking directly with your insurance company, or your Employer's Benefits or Human Resources Administrator.
Treatment Financing Programs In addition to providing financial counseling to our patients, we also offer a program that provides convenient, low-interest payment plans designed specifically for infertility-related diagnoses and treatments. Through Capital One Health Care Finance, a third-party finance company, this plan offers interest rates that are significantly lower than those of credit cards or other finance companies. Through this plan, it is possible for virtually all couples to receive the infertility treatments that they need, no matter what their financial status. The Patient Financing Program works to eliminate financial obstacles, allowing patients to budget wisely, avoid cash flow problems and hold on to their savings or investments. There are no pre-payment penalties, hidden fees, or down payment requirements. Payment plans are individually tailored with low fixed or variable interest rates and loans are available from $2,000 to $25,000, with other loans and terms available. To find out more about our Patient Financing, please visit the Family Fee Plan web site. If insurance coverage is a concern, The Center has collaborative efforts with a company to offer Financial Programs. Please call one of our Financial Counselors at 203-750-7400 to review the Loan Program or IntegraMed Shared Risk Refund Program to pay your medical expenses. While you are in our care at The Center, we want to provide you with the highest quality healthcare available in a comprehensive compassionate and cost-effective manner. For this reason, our fertility treatment programs are structured to encourage a high level of personal contact with your medical team and financial team. Shared Risk Refund Program One of the primary benefits of this program is that it maximizes the patient's chances of success with IVF by allowing them to attempt up to 3 fresh & 3 frozen IVF cycles for one fixed cost. Patients can determine the cost of their treatment plan up front, taking away the anxiety of having to revisit the financial concerns of IVF should the first attempt be unsuccessful. Click here to apply online. IntegraMed Financial Services RMA is the only practice in Connecticut credentialed and approved by IntegraMed to participate in their national network of fertility specialists.
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