Infertility Insurance Coverage in Atlanta

Our Current Fertility Insurance Plan Networks

ACRM is contracted with various insurance networks. CCRM Atlanta is contracted with most, but not all of the same networks. Contact your carrier to confirm that both ACRM and CCRM Atlanta are considered in-network for your specific plan. If either are considered out of network, inquire if you have out of network benefits. Listed below are the vast number of plans with which we are currently in network (We are not contracted with any discount cards.)

Insurance for Infertility:

• Aetna - PPO, POS, EPO, MC, HMO and Indemnity
  - Institute of Excellence" designation by Aetna since 2008.
• Beechstreet PPO
• Blue Cross Blue Shield of GA (PPO, POS, HMO & Indemnity)
  - We are not in network with the BCBS "Pathway" Network; patients with these plans will be self-pay.
• Choice Care PPO
• Cigna PPO, POS and HMO
  - We are not in network with the Cigna LocalPlus Network; patients with these plans will be self-pay.
• Coventry PPO, POS and HMO (includes networks formerly known as First Health and Southcare)
• Humana with Choice Care PPO
• Humana National POS
• Kaiser with Multiplan/PHCS
• MDI Healthcare Solutions PPO - MAG Mutual Employee insurance plan only
• Multiplan PPO (includes the network formerly known as PHCS)
• PPO Next/HealthStar PPO
• Unicare PPO
• United Healthcare PPO, POS, HMO, EPO, and Indemnity
  - "Center of Excellence” designation by Optum Health, a United Health Care Company, since 2007.

Fertility Treatment Insurance Coverage

Insurance coverage and reimbursement issues for the treatment of infertility are complex. There are many variables that come into play in determining how much support, if any, these companies will provide.

The first question we are typically asked by a prospective patient is "Are you in my network?" The truth is that this is not a simple “yes or no” question for a fertility clinic. In assisting our patients we have seen that the vast majority of insurance plans fall into one of three categories when it comes to infertility coverage.

• The plan provides no coverage whatsoever for infertility services. Thus, it really does not matter whether you see an infertility specialist in or out-of-network, because no infertility services are covered. This means that even if you go to an in-network physician who provides infertility services to you, you will still be self-pay, because the service itself is not a "covered benefit." In this circumstance, even though a practice may be in-network to you, you will be responsible for payment in full, since your insurance company will not reimburse for the services themselves.
• The plan provides coverage only for the diagnostic phase of infertility service. In this scenario, the insurance plan will typically cover services rendered to determine:
• That infertility does in fact exist, and that if it does,
• The nature or cause of the infertility.

The plan provides coverage for the diagnostic phase and for some infertility treatment services, but not all treatment services. In these circumstances, coverage is provided for some methods of infertility treatment, but not others. For example, IUI may be a covered service, but not IVF.

For fertility services, you need to determine whether your plan covers diagnostic infertility services and infertility treatment services. If it covers infertility treatment services, it is important to know which services are specifically covered and which are excluded from being covered.

Other Infertility Insurance Scenarios

There are as many combinations of possibilities with these insurance scenarios as there are companies for whom the insurance plans are developed. Listed below are additional circumstances that we have seen with the various plans with which we have had contact.

• Although a plan may cover a particular treatment service, there is a limit as to the number of services, e.g. not more than 3 IUI treatment attempts, not more than 2 lifetime IVF cycles, etc.
• Oral medications may be covered while injectable medications may not be covered.
• There may be a maximum dollar amount stated in the policy that can be paid for infertility services, such as a $25,000 lifetime cap.

Keep in mind that there are no two insurance plans that are necessarily alike. The degree to which diagnostic services or treatment services are covered or not covered is strictly dependent on what your employer has purchased as coverage in the policy they obtained for your company. Even if someone you know is in the same network or has the same insurance company, your two plans may be totally different.

What does this mean for you as an infertility patient?

• Know your insurance plan. Know which infertility services (both in terms of diagnosis and in terms of procedures rendered) are covered and which are not. Understand whether these services are covered in-network only, or whether you have out-of-network benefits for these services. These are such complex issues that we feel it is important that patients take the step of finding out the extent of their coverage before treatment is even initiated.
• Do not let the physician's status as being an "in-network" provider be the determining factor for selecting an infertility center. As you can see from above, there is no simple answer when it comes to insurance and infertility.

Understand your plan - what it covers and what it does not. We strongly encourage all new patients to call their insurance company to ask about the coverages that are and are not provided for infertility care. We have provided a list of suggested questions to ask your insurance company to assist you in determining your coverage.

You should speak with your insurance provider about coverage for intertitle services. If you have further questions for us, feel free to contact us.