Financial Information for Fertility Treatment
As part of our commitment to helping our patients throughout their treatment, we have dedicated friendly resources to help you understand and manage the financial aspects of your care.
- PAMF Fertility Financial Counselors
Experts Ready to Help You
- Financial Options
- Prompt Pay Option
- List of Contracted Insurance Carriers
- Know Your Insurance Coverage
- Insurance Questions to Consider Before Treatment
Expert Assistance to Help You Understand Costs and Coverage
Our PAMF Fertility benefits advisors and fertility financial counselors will be pleased to address your questions on insurance coverage, obtaining maximum benefits, treatment fees and out of pocket expenses. While it is the patient’s responsibility to fully understand their insurance coverage, we will do our best to provide you with accurate, timely information.
Our benefit advisors can provide you with specific information about your coverage, and help you understand any requirements you may have in order to maximize your insurance benefits. Our fertility financial counselors can explain the fees related to your treatment plan and provide estimates of what you may expect to pay out-of-pocket. They can also help you identify alternatives for making treatment as affordable as possible and for managing treatment costs.
Our Benefit Advisors are available over the phone Monday through Friday 8 a.m. to 5 p.m. Call (800) 597-2234, Option #5 followed by Option #2.
Fertility Financial Counselors are available by appointment—please call (800) 597-2234.
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If you have insurance, there is a good possibility you will have coverage for at least some portion of your fertility treatment or diagnostics, whether "in-network" or "out of network." For patients that do not wish to use insurance to pay for their treatment, there are treatment packages for many of our services. These packages include a discount on the bundled services.
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Advanced Reproductive Care (ARC)
PAMF Fertility Physicians of Northern California has partnered with Advanced Reproductive Care, Inc., (ARC), the nation's largest network of fertility physicians. ARC is committed to helping people at all income levels realize their dreams of conceiving. Through this partnership with ARC, we are able to offer several flexible plans for you to finance state-of-the-art care, helping divide treatment costs into predictable payments. In addition, ARC offers a partial refund if treatment is not successful and an optional pharmacy plan so you can pay for your medication more easily.
ARC's patient services team is available to help process your application, free-of-charge, and to answer any questions you may have at any point during your treatment. For more information about these patient options—and to help you maximize your opportunity to have a baby with minimal financial risk—please call ARC's toll free number at (888) 990-2727 to speak with a patient services specialist or visit ARC Fertility.
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Your treatment may qualify for the PAMF Prompt Pay option. PAMF offers a 30 percent prompt-pay discount for many Reproductive Endocrinology and Fertility (REF) services. This can significantly lower the cost for you if your health insurance does not cover infertility services. There are some conditions that apply.
What is eligible for prompt pay?
- Discount only applies to services that are not covered by insurance.
- Payment must be made in full at the time of service when the discount is applied.
The following are not eligible for prompt pay:
- Deductibles, co-payments or co-insurance amounts
- ARC and PAMF Self Pay Packages
- Donor Compensation, Donor Insurance or Storage Fees
- Payment arrangements
- In the event payment cannot be made at the time of service, prompt pay must be arranged within 20 days of the statement date by calling Fertility Financial Services at (800) 597-2234, Option #5, Option #2
- Remaining balances must be paid in full at the time the discount is applied
- Balances paid by phone may be paid by debit or credit card
Contracted Insurance Carriers and Medical Group Affiliations
PAMF Fertility is contracted with a wide variety of insurance providers. Please visit our Health Plans page to see the latest list of insurance plans accepted by PAMF Fertility Physicians of Northern California.
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Many insurance companies now require patients to register with their Fertility program in order to qualify for their fertility benefits. Check with your health insurer to see if registration in a special fertility program is required.
Members of HMO plans must obtain prior authorization for fertility services in order for those services to be considered for reimbursement by your insurance plan. Without prior authorization, your HMO may hold you financially responsible.
To obtain prior authorization follow these steps:
- Contact the primary care doctor (PCP) or Ob/Gyn listed on your insurance and request an authorization.
- The doctor will review your chart and contact the medical group to request a letter of authorization on your behalf.
- The letter is typically mailed to the patient (sometimes a fax or email is possible).
- Please note it can take up to 72 hours to get approval.
Know Your Insurance Coverage
Each insurance company covers infertility differently. Some insurance companies do not cover all fertility services or have requirements that must be met before benefits are eligible. For example, your insurer may consider infertility to be 12 months of attempted conception.
It is recommended you contact your insurance company to learn about your fertility benefits.
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Insurance Questions to Consider Before Treatment
Before visiting a fertility specialist or having a treatment cycle, please have the following information:
- The name of your insurer
- Your policy identification number; your group number
- The insurance company phone and fax numbers
- The insurance company e-mail address and web site
NOTE: Communicate with your insurance company in writing so you have documentation if any claim disputes arise. You should contact your insurer in writing and request a written determination of your exact coverage amount prior to receiving any procedure. Your insurer may require you to obtain commitment of coverage for a specific medical service before you start treatment, called preauthorization or predetermination. When writing a letter to your insurer, it is helpful to include the following:
- Group and ID numbers (patient insurance identification number)
- Name of treatment(s) and/or medication(s)
- Reason for needing the procedure/treatment/medication
Below are insurance questions that you should consider before seeking treatment.
- What type of coverage is listed?
- Which procedures require preauthorization? Does preauthorization need to be done for each cycle of treatment and how long does it take to get?
- Will the treatment/procedure be covered under my current coverage or under my major medical portion?
- Are there any limitations to my fertility coverage?
- What is my maximum benefit? Is the maximum dollar benefit lifetime or annual? Some policies have limits on the age of the female patient or the number of months of treatment.
- Are any portions of my charges covered for prescription medication, laboratory tests or ultrasounds leading up to the intrauterine insemination?
- Are there restrictions on the type of healthcare provider who can perform infertility services?
- Is there a co-payment for medical services?
You should also examine your insurer's prescription drug plan as fertility medications are often costly. It is important to understand your drug benefits prior to starting any treatment. First, you should find out if you have drug coverage. Next, determine if fertility drugs are covered under your prescription plan. You may want to consider the questions below before starting fertility treatment.
- Is there a co-payment for drug coverage?
- Is prior authorization needed for these medications?
- Does my plan cover self-administered subcutaneous (under the skin) or oral medications?
- Are there discounts for mail-order medications?
- Are any of the drugs on the prescription formulary and therefore covered?