Financial Information / Insurance

It is important that you call your insurance company and/or Human Resources Coordinator to check on your infertility coverage. Specifically Ask:

• Does my policy include or exclude infertility coverage?

If infertility treatment is excluded from your policy, you will be entered into our billing system as a “Self Pay” patient. Self Pay patients are required to pay for all services in full at time the service are provided. An initial New Patient Consultation will be approximately $250.00.

If infertility treatment is included in your policy coverage, please ask the following questions:

• Is my policy diagnostic only?
• Do I have coverage for underlying conditions? This is for surgery benefits.
• Would CPT codes 58322 & 58323 with the diagnosis code of V26.1 be covered? This is for Intrauterine Insemination (IUI).
• Would Advanced Reproductive Technology – using the CPT codes 58970, 58974, 58976, 89258 and the diagnosis code of V26.81, be covered? This is for In Vitro Fertilization. (IVF)
• Is there a maternity exclusion on my policy?
• Is there a pre-existing clause on your policy in reference to infertility treatment or surgery procedures?
• Do you have any drug coverage for infertility treatment?
  • If yes, where? (mail order or local pharmacy)
  • What drugs are included as Tier 1?
    • (i.e. Follistim, Gonal F, Lupron)
• Do I need a referral and/or a prior authorization for any office visits or procedures? (If yes, please secure this prior to your visit – failure to follow the guidelines of your policy may result in denial of covered services.)
• Have I met my deductible?
• What is my co-pay or co-insurance that will be due?

We are Infertility Specialists. If you have a specialist co-pay/co-insurance or if the deductible has not been met on your policy, please be prepared to pay this amount forcovered expenses. Payment for non-covered services is due in full at the time of service.

• Aetna PPO
• Aetna POS, HMO, EPO, MC – Aetna REQUIRES you to call the “Infertility Line” at Aetna @ 1.800.575.5999 to enroll and obtain an authorization number. Please bring this authorization number with you, to your appointment. Failure to enroll with Aetna may result in a denial of coverage from Aetna. If Aetna were to deny the coverage, you would be responsible for payment in full at the time of visit.
• BC/BS (in and out of state) – We are out of network for ALL BC/BS policies and we are NOT HMO providers. Please refer to either your card or your benefits package to view your out of network benefits. It is usually a larger deductible and a larger co-insurance than you may be expected to pay at your in network specialists office. If the deductible has not been met or can not be verified as met, you will be expected to pay in full at the time of service. We will file the visit to BC/BS for reimbursement for all policies except for HMO, policies with infertility exclusion, and policies with NO out of network benefits.
• Kaiser - It is imperative that you call with the diagnosis and CPT codes for IUI (CPT Codes 58322/58323, Diagnosis Code V26.1). If you do not have coverage for IUI, you will be considered a self pay patient for ANY & ALL services in our office(this includes the first consult). All covered services require a valid referral. Please obtain this referral number from your Kaiser physician and bring it to your appointment. IVF is not covered with most Kaiser Policies. Once you are referred to RBA you are in treatment. All visits are for the benefit of your infertility treatment. Coin is usually 50% of contracted rate. If you have no treatment coverage you will be self pay for all care.
• First Health, South Care, and Coventry (not HMO) - Usually, there is an exclusion for infertility or they may cover the initial visit only.
• Multiplan - This is the out of network plan for Cigna and has limited benefits similar to the ones above.
• Private HealthCare Systems (PHCS) - Initial consult only and/or an exclusion for infertility.
• United Healthcare - All types, except for group numbers 228485 and 704077. Every plan is different and the covered benefits are mandated by the individual employers.

*****THIS LIST IS SUBJECT TO CHANGE******

We will verify benefits, as well, with your insurance company but it is important that you become acquainted with your coverage and any procedures that are required (such as referrals and prior authorizations). After you have spoken with your insurance company and/or your HR department, please feel free to call the business office if you have additional questions.

If you are in need of patient financing, RBA has contracted with several outside sources to facilitate cost effective financing alternatives with quick approval processes.

If you find that you must cancel your appointment based on your lack of coverage please call your doctors Administrative Assistant to cancel the appointment. Failure to cancel your appointment without a 24 hour notice will result in a missed appointment fee.

We have found that being well informed about your insurance coverage will empower you as you proceed through your treatment. We appreciate you as patients and we are here to help in any way we can.