How can I/we confirm my insurance coverage and benefits?
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 patients insurance plan is different, we high recommend you research your own benefits to confirm that they are accurate, up to date, and represented accurately.
You may use the Insurance Benefit Questionnaire as a tool to explore your insurance coverage and benefits. The questionnaire can be completed as you speak with a representative from your insurance provider.
How can I/we confirm my medication coverage?
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.
How will I/we know if I need a referral or prior authorization?
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 authorzation 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 physican 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.
What is an insurance deductible?
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.
Will insurance cover diagnostic testing and pre-screening?
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.
Will insurance cover fertility treatment?
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.
What if my insurance has an annual or lifetime maximum benefit?
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.
Does SGF offer discounts or financial assistance?
SGF offers various discounts and finacial programs to make fertility care more accessible. Patients with combined earnings of less than $90,000 per year, may be eligible for our Shared Help Discount Program. Learn more about Shared Help, military discount options, medication discounts, and other financial programs.
Is financing available?
While SGF does not offer financing, patients may finance their care using Fertility Finance. Fertility Finance offers loans specifically for fertility treatment, and provides financial solutions.
Can I pay my bills online?
Yes, SGF accepts online bill payments with the click of a button. Pay Online Now