Fertility Insurance

& Estimates

How to Determine Your Insurance Coverage

& Treatment Costs

Insurance coverage and reimbursement for the testing and treatment of infertility is complex. Once you have become a patient with us we will be happy to assist you by completing an in depth insurance benefit determination. Our medical billing and insurance specialists are available to answer any insurance-related questions you may have.

You can contact our Billing Office with any questions you may have regarding your coverage.

  • Review

    Review your insurance policy. Contact them to help understand your benefits & ask detailed questions about fertility coverage.

  • Schedule

    Schedule a New Patient Appointment & provide us with your insurance information.

  • Verify

    Our billing team will contact your insurance company to verify your level of coverage.

  • Ask

    We’ll answer any questions you have regarding your coverage.

Prior to treatment, we encourage you to take the lead in contacting your insurance company to better understand your plan benefits. To help you start with this we have summarized key points about insurance coverage below. The first question to ask with regard to our clinic’s services is if the specific plan you have offers infertility coverage, or coverage for fertility testing.

The vast majority of plans fall into
1 of 3 categories
when it comes
to infertility coverage.
The plan provides no coverage whatsoever for infertility services.

Unfortunately this is often the case and means that you will be expected to pay at the time of service for any non-covered services.

The plan provides coverage for the diagnostic phase of infertility testing only.

In this scenario, the insurance plan will usually offer some coverage for a new patient consultation and generally offers some coverage for fertility testing. The treatment phase is not covered.

The plan provides coverage for the diagnostic testing phase and coverage for infertility treatment.

In these circumstances, coverage is provided for diagnostic testing and for some methods of infertility treatment. Understanding your individual coverage will help you anticipate whether or not a particular service with us is covered.

Please be aware that the Reproductive Medicine Laboratory (RML) does not participate with insurance plans. RML provides Embryology and Andrology laboratory services for testing and treatment. All services provided by RML will be on a self-pay basis, and payment is expected at the time of service. As a courtesy, claim forms will be filed to your insurance company for covered services with a request to reimburse the insured directly.

Additional Important Insurance Information:

Medicaid/Medicare:
Oregon Reproductive Medicine does not accept Medicaid or Medicare insurance plans. We will not bill Medicaid/Medicare for any services provided by ORM or RML as we are not participating providers. You will be financially responsible for all services and payment will be due at the conclusion of each office visit.
Out of Network:
If Oregon Reproductive Medicine is out of network with your insurance plan you may have limited coverage through an out of network benefit. We will check for out of network coverage as part of the insurance benefit determination process. The Reproductive Medicine Laboratory does not participate with insurances companies
Prior Authorization:
If a prior authorization is required for your services, it is your responsibility to determine if an authorization is on file before beginning your treatment cycle. If you wish to proceed with treatment prior to obtaining authorization you be expected to pay out of pocket.
Medical Coding (Diagnosis):
Our physicians are specialists in Reproductive Endocrinology. If you are seeking care in order to achieve a pregnancy you can expect that most, if not all, of your visits will be coded (diagnosed) as infertility or infertility related.

*Please note, most insurances exclude any infertility services when infertility is a result of a tubal ligation or vasectomy.

Review of Claims:
Insurance companies have the right to review claims for proper reimbursement for up to three years after the claim is made. This means that reimbursements that were made in the past can be reversed. When this occurs, the insurance company can demand refund reimbursement from you or from our practice. Should an insurance company in the future deny benefits for services rendered in the past and thus request refund of payment to them, payment for the services becomes the responsibility of the patient.

It is your responsibility to:

Bring

Bring your insurance card and identification to every visit.

Obtain

Obtain any necessary physician referral or pay at the time of service.

Remit

Remit payment for services not covered by insurance.**

We will not become involved in disputes between you and your insurance company regarding eligibility, deductibles, co-payments, secondary coverage, non-covered services, etc., other than to provide factual information regarding medical services provided.

**Co-payments, deductibles, non-covered services, etc. are due at time of service with the exception of IVF Treatment Deposits which are due in full at the beginning of your treatment cycle.

Contact Oregon Reproductive Medicine for more information today.

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