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What You Need to Know: Insurance Coverage for Fertility Treatment

Angela Tablada - Financial Services
Angela Tablada, Patient Financial Services Manager

Understanding insurance coverage for fertility treatment can be tricky. Every patient at Shady Grove Fertility has a devoted financial counselor to help guide them through each step of the process; which makes the transition into treatment as smooth as possible. We sat down with Angela Tablada, Patient Financial Services Manager, to learn about the most frequent questions patients have about insurance coverage for fertility treatment.

Do you work with my insurance provider?

“It’s likely,” explains Tablada. “Shady Grove Fertility works with over 30 insurance providers across the Washington, Baltimore, Philadelphia, and Atlanta metropolitan areas. We find that 90 percent of our patients have insurance coverage for the initial consultation and 70 percent have at least some form of insurance for testing and treatment.”

Once I am a patient, how will I know if I have insurance coverage for fertility treatment?

Upon scheduling a new patient appointment, current insurance information will be collected and our financial team will check your insurance policy for coverage. “For the majority of patients, our prescreening insurance benefits team will be able to verify your benefit coverage prior to your new patient consultation. After meeting with your medical team, you will speak with your dedicated financial counselor either in the office or via phone to review your benefits, insurance requirements, and any Shady Grove Fertility financial programs you may qualify for,” explains Tablada.

To ensure you are getting the most out of your insurance coverage, Shady Grove Fertility diligently re-verifies benefits at the beginning of your coverage year. We want to confirm that we are fully maximizing your insurance for both testing and treatment. In order to obtain the needed verification of benefits and authorizations, this process can take between 2 to 4 weeks.

  • Benefit Re-verification: This step generally takes our team 2 weeks to complete. While our team works directly with your insurance provider, we find that when patients are proactive and verify their coverage as well, we are able to confirm the accuracy of insurance plan details and catch any possible misinformation provided by the insurance company.
  • Prior Authorizations: Authorizations generally take about 4 weeks to obtain from your insurance provider. In addition, you should call your financial counselor to confirm authorization is on file before your first visit. Without authorization, you will be billed directly.

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What are my options if I don’t have insurance coverage?

Although insurance coverage can help ease the cost of fertility treatment, it is not the only option when it comes to growing your family.

“The most popular financial program we offer is our Shared Risk 100% Refund Guarantee Program. This option allows patients up to six fresh IVF or donor egg cycles and unlimited frozen embryo transfers (FETs) for one cost. The result of this program is the same for each participant – either take home a baby or receive a 100% refund,” says Tablada.

Along with unique financial programs we also offer a variety of discount programs for eligible patients. Through these programs such as Shared Help and the military discount qualified patients will receive a discount off the cost of their treatment. Once your discount is determined it can be combined with many of our other financial programs like Shared Risk and the Multi-Cycle Program.

In addition, Shady Grove Fertility has an exclusive partnership with Fertility Finance, a finance company that offers a wide variety of loan options, allowing patients to attain the necessary financing required to make treatment affordable. Each loan program is designed to fit the individual’s circumstances. Once approved, their Fertility Loan Specialists will work closely with Shady Grove Fertility to ensure the funds are secured prior to the start of your treatment.

What is the difference between participating with an insurance plan and having coverage for treatment?

“Nearly all insurance plans have the ability to cover infertility treatment. In order to access those services your employer must opt-in to infertility coverage for their plan members,” explains Tablada. “These decisions are usually made by the Human Resources Department before the open enrollment period every year. If your insurance plan doesn’t have fertility coverage speak with your HR department about getting the coverage added to your company’s insurance policy for the next plan year.”

Editor’s Note: This post was originally published in June 2013 and has been updated for accuracy and comprehensiveness as of January 2018.

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To learn more about affording fertility treatment or to 
schedule an appointment, please speak with our New Patient Center by calling 877-971-7755.

1 Comment

  1. Kevin H @ Growing Family Benefits

    July 2, 2013 - 7:53 pm
    Reply

    Thank you for pointing out that the employer headquarter state is most important when looking at the mandates. Most people assume the laws apply where they live. The in addition to MD the other local states with mandates are NJ, NY, and CT.

    Couple considering the shared risk option should understand the tax advantages of purchasing six cycles altogether. By bunching your un-reimbursed medical expenses into a single tax year you get maximum tax savings. There is a 10% adjusted gross income threshold before expenses are deductible. No sense in having to overcome this hurdle more than once.

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