In today’s world, health insurance is very complex and can add to the decisions you will have to make when selecting infertility treatment options.
At Fertility Specialists of Texas, our goal is to lessen some of that strain and help you work with your insurance carrier to make sure that you are reimbursed at the maximum amount that is available to you. We will review your specific benefits with you at your first visit so that you have an understanding of your benefits and treatment options available. All insurance claims are filed electronically by our office. Please call our office with any questions. You can also email us using the contact form on the web site.
It is important for you, as a patient, to be the best advocate for yourself by completely understanding your insurance policy. It is critical that you review your specific insurance policy and understand what will be paid by insurance and what will not be covered.
Getting the Information
Make sure that you contact your insurance company and request a written pre-determination of your specific coverage and any eligibility requirements that must be met in order to have that service covered. Do not handle this on the phone. You may get a customer service representative who will give you their interpretation of your policy and it may not be accurate.
A written verification of their intent to pay is much more effective than a verbal one if you have to challenge them. Make sure to request written documentation for all phone conversations concerning coverage.
Below are some critical questions to ask your insurance provider:
- What is the specific policy or procedures that I need to follow in order to get infertility treatment covered? For example, do I need separate referrals or authorization for each office visit, blood work or office procedures?
- Is there a dollar maximum associated with infertility treatment? If so, what is that dollar amount?
- Is there a maximum lifetime amount for intrauterine inseminations (IUI)?
- How many cycles of in vitro fertilization (IVF) are covered?
- Are fertility medications covered and if so, am I required to use a particular pharmacy?
- Referral: A form issued by a primary care physician or OB/GYN referring a patient to a specialist. If applicable, all referrals are obtained by the patient.
- Authorization: A number issued by an insurance company authorizing a specific procedure or medication. Depending on the insurance, the doctor or the patient can obtain authorizations.
- Pre-certification: A number issued by insurance for a surgery or in-office procedure.
- Pre-determination letter: A letter from an insurance quoting benefit coverage according to the specific patient policy.
Accepted Health Care Plans
Aetna all plans
Associated Administrators Group (AAGI)
BCBS PPO (Center of Excellence)
Beech St PPO
Cigna all plans (Center of Excellence)
Direct Care America
Evolutions Health Care Systems
First Health Network
FOCUS Health Care Management
Galaxy Healthcare Network
Genesis Medical Savings Plan
Great West Healthcare all plans
Healthcare Partners of East Texas
Healthsmart all plans
Humana all plans
Managed Care Strategies (MCS) PPO
NPPN (National Preferred Provider Network)
NTHN all plans
One Health Plan
PHCS (Private Healthcare Systems) all plans
Regional Healthcare Alliance PPO
Rockport Healthcare Group (RHG)
Texas True Choice PPO
Texas Integrated Health Network (TEXIHN)
Texas DirectCare, Inc (TDC)
TML Intergovernmental Employee Benefits Pool PPO
UHC (United Healthcare) all plans (Center of Excellence)
Unicare Performance and Classic all plans
USA ManagedCare Organization PPO
Establish a point of contact with a representative at your insurance company. It may improve any follow-ups that are required.