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Accepted Insurance + Benefits

Does SGF Accept my Benefits?

A

pproximately 70 percent of our patients have some coverage for infertility treatment and 90 percent 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.

Florida


FLORIDA

  • Blue Cross Blue Shield Florida
  • Carrot
  • Cigna
  • Maven Clinic
  • Multiplan
  • Progyny*
  • United Healthcare

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

Georgia


Georgia

  • Aetna, SGF is designated an Aetna Institute of Excellence™
  • Blue Cross Blue Shield Georgia
  • Beechstreet
  • Carrot
  • Cigna
  • Coventry Healthcare of Georgia
  • First Health
  • Health Partners
  • Humana (excludes HMO)
  • Maven Clinic
  • Meritain Health
  • One Health
  • Piedmont Healthcare
  • Progyny*
  • Tricare/Humana Military
  • United Healthcare (excludes Navigate & Compass)
  • United Medical Resources
  • United Resource Network*

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

MD/DC/NOVA


Maryland, D.C., & Northern Virginia

  • Adventist Healthnet
  • Aetna, SGF is designated an Aetna Institute of Excellence™
  • Anthem Blue Cross Blue Shield (Some Maryland and D.C. providers may be out of range for this insurance plan. If you have this plan, confirm with your insurance provider or our New Patient Center about coverage.)
  • Anthem HealthKeepers*
  • Carefirst Administrators
  • CareFirst Blue Cross Blue Shield of D.C.
  • CareFirst Blue Cross Blue Shield of Maryland
  • CareFirst BlueChoice HMO*
  • Carefirst National Capital Area
  • Carrot
  • ChoiceCare Network/Humana
  • Cigna
  • Coventry Healthcare National Network (Formerly First Health)
  • Horizon Blue Cross Blue Shield of New Jersey
  • Johns Hopkins EHP
  • Kaiser*
  • Maven Clinic
  • Meritain Health
  • Medstar Health
  • MultiPlan Network
  • OneNet PPO
  • Optum Healthcare
  • Progyny*
  • Tricare/Humana Military*
  • United Healthcare
  • United Healthcare Oxford
  • United Healthcare MDIPA/Optimum Choice
  • United Resource Network*
  • Veterans Choice PCCC
  • *This insurance carrier requires authorization and/or a referral from your primary care physician prior to your new patient visit and pre-screening.

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). 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 2-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 six attempts of artificial insemination over the course of 2 years 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.

Effective January 1, 2021, Maryland’s infertility insurance law no longer has a marriage requirement, and the 2-year “waiting” period has been reduced to 1 year of unprotected sexual intercourse or three attempts of artificial insemination in the course of a year.

NEW YORK


NEW YORK

  • Aetna
  • Carrot
  • Choice Care/Humana
  • Cigna
  • Empire (excludes NYSHIP)
  • GHI/Emblem Health (excludes HIP)
  • Maven Clinic
  • Progyny
  • United Healthcare/Oxford (excludes NYSHIP)

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

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
  • Carrot
  • Cigna
  • Coventry Healthcare National Network (Formerly First Health)
  • Health America*
  • Highmark Blue Cross Blue Shield
  • Horizon Blue Cross Blue Shield of New Jersey
  • Independence Blue Cross Blue Shield
  • InterGroup
  • Johns Hopkins EHP
  • Keystone Healthplan East*
  • Keystone Healthplan Central*
  • Maven Clinic
  • Medstar Health
  • MultiPlan Network
  • OneNet PPO
  • Optum Healthcare
  • Progyny*
  • Tricare/Humana Military*
  • United Healthcare
  • United Resource Network*

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

Richmond


Richmond, VA

  • Aetna
  • Anthem Blue Cross Blue Shield of Virginia
  • Carrot
  • Cigna
  • Choice Care/Humana
  • Maven Clinic
  • Multiplan
  • Optima
  • Tricare/Humana Military*
  • United Healthcare

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

**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.

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.

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