Insurance & benefits

Approximately 70% of our patients have some coverage for infertility treatment and 90% have coverage for their initial consultation. Below is a list of insurance networks accepted by Shady Grove Fertility as well as exclusive fertility benefits to make treatment more affordable. Please note that each state accepts different insurances and benefits.

Shady Grove Fertility participates with several insurance plans. Plans update and change routinely; please contact SGF to verify coverage prior to your scheduled appointment.

Some insurance plans will require a referral from your primary care provider (for example an OB/GYN) before receiving treatment for infertility services. It is your responsibility as the patient to provide SGF with a copy of the referral prior to your scheduled appointment.

Helpful info
State fertility insurance laws
Knowing your benefits
Fertility treatment discounts

Accepted insurance by region

  • Kaiser Permanente Colorado
  • Tricare Healthnet Federal Services
  • TriWest VA CCN Claims
  • Veteran Administrators
  • United Healthcare
  • Anthem BCBS
  • Cigna

  • Florida Blue
  • Cigna
  • GEHA
  • United Healthcare (excludes Navigate & Compass)

  • Aetna, SGF is designated an Aetna Institute of Excellence™
  • Anthem Blue Cross Blue Shield of Georgia
  • Cigna
  • Coventry Healthcare of Georgia
  • First Health
  • GEHA
  • Health Partners
  • Humana
  • Tricare/Humana Military
  • United Healthcare (excludes Navigate & Compass)
  • United Medical Resources

  • Aetna, SGF is designated an Aetna Institute of Excellence™
  • Carefirst Administrators
  • CareFirst Blue Cross Blue Shield
  • ChoiceCare Network/Humana
  • Cigna
  • Coventry Healthcare National Network (Formerly First Health)
  • GEHA
  • Johns Hopkins Healthplan
  • Kaiser*
  • Medstar Health
  • Tricare/Humana Military*
  • United Healthcare
  • Oxford
  • VA Community Care Network

*This insurance carrier requires authorization and/or a referral from your primary care physician prior to your new patient visit and pre-screening.

Maryland, Delaware, and West Virginia have state mandated fertility coverage. Learn more.

  • Aetna
  • Empire BCBS
  • Cigna
  • Emblem Health (GHI/HIP)
  • GEHA
  • United Healthcare (excludes Navigate & Compass)
  • United Medical Resources 
  • Oxford
New York, New Jersey, and Connecticut have state mandated fertility coverage. Learn more.

  • Aetna
  • Amerihealth HMO*
  • Capital Blue Cross Blue Shield
  • Cigna
  • Coventry Healthcare National Network (Formerly First Health)
  • GEHA
  • Health America*
  • Highmark Blue Cross Blue Shield
  • Independence Blue Cross Blue Shield
  • Keystone HMO
  • Tricare/Humana Military*
  • United Healthcare (excludes Navigate & Compass)
  • United Resource Network*
  • UPMC (Wexford office only)
  • VA Community Care Network
  • Vet Administrators (Wexford office only)

*This insurance carrier requires authorization and/or a referral from your primary care physician prior to your new patient visit and pre-screening.

New Jersey and Delaware have state mandated fertility coverage. Learn more.

  • Anthem Blue Cross Blue Shield of Virginia
  • Anthem Healthkeepers
  • Cigna
  • GEHA
  • Optima
  • Tricare/Humana Military
  • United Healthcare (excludes Navigate & Compass)
  • United Medical Resources
  • VA Community Care Network

*Our Richmond and SGF Jones Institute locations accept the insurance plans listed above for covered services, however, each office and lab differ in what services may be considered out of network. You may have benefits even for services that are considered out of network.We also offer a wide variety of innovative financial programs regardless of insurance coverage, including a refund guarantee program. Following your initial visit, our financial team will assist you in evaluating your benefits and our programs to find the best option for you.

Fertility benefits

SGF is proud to make fertility treatment more affordable by accepting exclusive fertility benefits provided by employers/companies as well as third-party administrators. SGF patients who choose to use their benefits from the below list of providers will enjoy negotiated preferred service rates and a streamlined claims process.

Some fertility benefit administrators may require employees to enroll directly with their organization in order to be eligible for fertility treatment benefits. Please connect with your employer’s HR department for more information about available fertility benefits, or your SGF Financial Counselor to get started.

  • Carrot
  • Maven Clinic
  • Progyny (excluding SGF Colorado)
  • Optum
  • Mantech
  • WINFertility

For more information on SGF’s third-party administrators, please contact your SGF financial counselor or ask your HR Department for the best way to contact.

Learn more about Carrot
Learn more about ManTech

FAQ

SGF will conduct an Insurance Benefit Verification (IBV), which will be presented to you. The IBV Summary will outline potential coverage for diagnostic testing, as well as fertility treatment coverage. The IBV Summary also outlines if you will require a referral, prior authorization, as well as the amount of your current deductible and/or co-insurance. Given each patient’s insurance plan is different, we highly recommend you research your own benefits to confirm that they are accurate, up to date, and represented accurately.

Based upon your insurance plan, you may be required to use a specialty pharmacy, and/or obtain prior authorization. It is essential for you to verify if medication coverage is under your fertility benefit rider, or, your major medical, and if you are required to use a specialty pharmacy. Once your treatment plan is known, someone on your clinical team can provide you with a list of medications, allowing you to confirm coverage with your insurance. SGF also works with a preferred pharmacy, which provides discounts for self-pay patients.

The IBV Summary will outline if you require a referral or prior authorization for services. Your Financial Counselor can review this information with you and your insurance benefits should outline when a referral and/or prior authorization are needed.

Referral: A process through which the patients primary care physician, or other specified physician, permits or allows the patient to obtain service and treatment from another physician, or provider type.  The patient is responsible for obtaining a Referral. In the absence of a Referral, the patient will need to sign a waiver and will be charged at time of service.

Prior Authorization: A process through which the physician or other health care provider is required to obtain advance approval from the plan for a service. Unless specified, SGF will obtain Prior Authorization for the patient.

Depending upon your insurance plan, you may have an individual or family deductible. The deductible is established prior to signing up for the plan, and typically must be met before covered expenses are covered in full, or through a co-pay.

If you have not met your deductible, SGF will collect a deductible deposit at the time of service. Once claims have been processed by insurance, the deposit will be used to cover any outstanding expense (deductible, co-pay, and/or co-insurance). Based upon your benefits, you may be balanced bill for any amount not covered by insurance and/or the deductible deposit.

The IBV Summary will outline if you have diagnostic coverage for testing and pre-screening. Your Financial Counselor will review this with you, and will outline if you have met your deductible, will need to pay a deductible deposit, or will owe a co-pay and/or co-insurance.

Once you know what treatment you will be undergoing, your financial counselor will provide you with information on the available financial options, estimated out of pocket expenses, prior authorization or deductible, and payment due date. Payment will be made in advance to the start of your treatment.

Based upon your insurance, you may have an annual or lifetime maximum benefit in which fertility services will be covered. Once you reach your maximum benefit, insurance will stop paying for fertility services, and you will be changed to a self-pay patient. SGF offers multiple self-pay financial programs.

It is important to know if your medication coverage is part of your annual or lifetime maximum, or your major medical. Insurance coverage tends to go further, when it comes to fertility services, than it does with medication coverage; i.e. paying out of pocket for medications, and using your annual or lifetime maximum benefit for fertility services tends to maximum your coverage, however this is a personal decision.

How to get started

Shady Grove Fertility has treatment options to help almost everyone build the family of their dreams. And it all starts with one call:

2022 Shady Grove Fertility