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Accepted Insurance + Benefits

Does SGF Accept my INSURANCE?

A

pproximately 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 and fertility benefits accepted by Shady Grove Fertility. 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.

Colorado


Colorado

Approximately 70% of SGF patients have some coverage for infertility treatment and 90% have coverage for their initial consultation.

Please note each state accepts different insurances. We are in the process of transitioning insurances and becoming credentialed with all payers in the Colorado market.

If you receive an out of network denial, please contact your SGF Financial Counselor. We are happy to work with you and the payer on your behalf during this transition.


SGF’s Accepted Fertility Networks
SGF also partners with several fertility networks, or third-party administrators—companies/employers who offer additional fertility benefits, negotiate preferred service rates, and process claims on behalf of their employees as an employee benefit.

Some infertility networks may require patients to enroll directly with their organization before seeking treatment as a condition of eligibility. 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.

Florida


FLORIDA

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


SGF’s Accepted Fertility Networks

SGF also partners with several fertility networks, or third-party administratorscompanies/employers who offer additional fertility benefits, negotiate preferred service rates, and process claims on behalf of their employees as an employee benefit.

To determine your eligibility, please review our network participation list below. Some infertility networks may require patients to enroll directly with their organization before seeking treatment as a condition of eligibility. 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.

  • Carrot
  • Maven Clinic
  • Progyny
  • Optum
  • Mantech

We 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.

Schedule an Appointment

Georgia


Georgia

  • 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

SGF’s Accepted Fertility Networks

SGF also partners with several fertility networks, or third-party administratorscompanies/employers who offer additional fertility benefits, negotiate preferred service rates, and process claims on behalf of their employees as an employee benefit.

To determine your eligibility, please review our network participation list below. Some infertility networks may require patients to enroll directly with their organization before seeking treatment as a condition of eligibility. 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.

  • Carrot
  • Maven Clinic
  • Progyny
  • Optum
  • Mantech

We 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.

Schedule an Appointment

MD/DC/NOVA


Maryland, D.C., & Northern Virginia

  • 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.

    SGF’s Accepted Fertility Networks

    SGF also partners with several fertility networks, or third-party administratorscompanies/employers who offer additional fertility benefits, negotiate preferred service rates, and process claims on behalf of their employees as an employee benefit.

    To determine your eligibility, please review our network participation list below. Some infertility networks may require patients to enroll directly with their organization before seeking treatment as a condition of eligibility. 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.

    • Carrot
    • Maven Clinic
    • Progyny
    • Optum
    • Mantech

    We 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.

    Schedule an Appointment



    Maryland Mandate

    The Maryland Insurance Article Section 15-810, "Benefits for In Vitro Fertilization," requires health and hospital insurance policies issued within the state that provide pregnancy benefits to also cover the cost of in vitro fertilization (IVF). Effective January 1, 2021, Maryland’s Mandated Benefits no longer has a marriage requirement for patients to receive benefits for IVF treatment. There is a limit of three IVF attempts per live birth; not to exceed a maximum lifetime benefit of $100,000.
    CRITERIA
    For contracts that follow the Maryland mandate, benefits are provided when all of the following criteria are met:
    • The patient must be a policyholder or subscriber, or a covered spouse of the policyholder or subscriber.
    • The patient is unable to get pregnant through less-expensive covered treatments.
    • For patients whose spouse is of the opposite sex, the patient and her spouse must have at least a 1-year history of involuntary infertility or infertility must be associated with one or more of the following conditions
      • Endometriosis
      • Fetal exposure to diethylstilbestrol, also known as DES
      • Blocked or surgically removed Fallopian tubes
      • Abnormal male factors, including oligospermia, contributing to the infertility
    • For patients whose spouse is of the opposite sex, the patient’s eggs must be fertilized with the patient’s spouse’s sperm.
    • For patients whose spouse is of the same sex, there must be three attempts of artificial insemination over the course of 1 year failing to result in pregnancy.
    • IVF must be performed at a facility that conforms to the standards set by the American Fertility Society and the American Congress of Obstetricians and Gynecologists.
    EXEMPTIONS
    • Regulations that took effect in 1994 exempt businesses with 50 or fewer employees from having to provide IVF coverage. [Code of Maryland Regulations (COMAR) 31.11.06.06 (B) (11).]
    • Religious organizations offering health benefits to their employees may request that carriers exclude IVF benefits; there must be bona fide religious beliefs and practices that prohibit IVF.
NEW YORK


NEW YORK

  • Aetna
  • Anthem Empire
  • Cigna
  • Emblem Health (GHI)
  • GEHA
  • United Healthcare (excludes Navigate & Compass)
  • United Medical Resources
  • Oxford


SGF’s Accepted Fertility Networks

SGF also partners with several fertility networks, or third-party administratorscompanies/employers who offer additional fertility benefits, negotiate preferred service rates, and process claims on behalf of their employees as an employee benefit.

To determine your eligibility, please review our network participation list below. Some infertility networks may require patients to enroll directly with their organization before seeking treatment as a condition of eligibility. 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.

  • Carrot
  • Maven Clinic
  • Progyny
  • Optum
  • Mantech

We 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.

Schedule an Appointment

NEW YORK Mandate

The New York Insurance Law Sections 3216 (13), 3221, requires all employers within large group health insurance markets (100 employees or more), issued or delivered within the state of New York providing coverage for hospital care or surgical and medical care, to provide coverage for the diagnosis and treatment of infertility. There is a limit of three cycles of in vitro fertilization (IVF) for people who have been diagnosed with infertility.

Patient Criteria:
  • The patient must be between the ages of 21 and 44, and covered under the policy for at least 12 months.
  • Prohibits the exclusion of coverage for the diagnosis and treatment of a correctable medical condition, solely because the condition results in infertility.
  • Infertility means a disease or condition characterized by the incapacity to impregnate another person or to conceive, defined by the failure to establish a clinical pregnancy after 12 months of regular, unprotected sexual intercourse or therapeutic donor insemination, or after 6 months of regular, unprotected sexual intercourse or therapeutic donor insemination for a female 35 years of age or older. Earlier evaluation and treatment may be warranted based on an individual’s medical history or physical findings.
  • Standard fertility preservation procedures are covered but not defined by law.
coverage:
  • Provides up to three in vitro fertilization (IVF) cycles (fresh embryo transfer or frozen embryo transfer) to patients in the large group insurance market (100 or more employees) who have been diagnosed with infertility.
  • Provides medically necessary fertility preservation medical treatments for people facing iatrogenic infertility caused by a medical intervention, such as radiation, medication, or surgery, in all commercial markets (individual, small and large groups).
  • Every policy that provides coverage for prescription drugs will also include drugs (approved by the FDA) for use in the diagnosis and treatment of infertility.
  • Prohibits delivery of insurance coverage from discriminating based on age, sex, sexual orientation, marital status, or gender identity.
  • Group policies must provide diagnostic tests and procedures that include:
    • Hysterosalpingogram
    • Hysteroscopy
    • Endometrial biopsy
    • Laparoscopy
    • Sono-hysterogram
    • Post coital tests
    • Testis biopsy
    • Semen analysis
    • Blood tests
    • Ultrasound
Exceptions:
  • Excludes GIFT, and ZIFT; reversal of elective sterilizations; sex change procedures; cloning or experimental medical or surgical procedures.
  • Excludes coverage for IVF in the individual and small group markets.
  • Employers who self-insure are exempt from the requirements of the law.
Pennsylvania


Pennsylvania

  • 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*
  • 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.

SGF’s Accepted Fertility Networks

SGF also partners with several fertility networks, or third-party administratorscompanies/employers who offer additional fertility benefits, negotiate preferred service rates, and process claims on behalf of their employees as an employee benefit.

To determine your eligibility, please review our network participation list below. Some infertility networks may require patients to enroll directly with their organization before seeking treatment as a condition of eligibility. 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.

  • Carrot
  • Maven Clinic
  • Progyny
  • Optum
  • Mantech

We 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.

Schedule an Appointment

Richmond


Richmond, VA

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

*Our Richmond locations accept the insurance plans listed here for covered services, however, each office and lab differs in what services may be considered out of network. You may have benefits even for services that are considered out of network.

SGF’s Accepted Fertility Networks

SGF also partners with several fertility networks, or third-party administratorscompanies/employers who offer additional fertility benefits, negotiate preferred service rates, and process claims on behalf of their employees as an employee benefit.

To determine your eligibility, please review our network participation list below. Some infertility networks may require patients to enroll directly with their organization before seeking treatment as a condition of eligibility. 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.

  • Carrot
  • Maven Clinic
  • Progyny
  • Optum
  • Mantech

We 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.

Schedule an Appointment

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