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
- 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
The plan provides coverage only for the diagnostic phase of infertility service. In this scenario, the insurance plan will typically cover services rendered
- 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.