Accepted insurance

Approximately 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 accepted by Shady Grove Fertility. Please note that each state accepts different insurances.

• 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 administrators—companies/employers who offer additional fertility benefits, negotiate preferred service rates, andprocess 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

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.