On behalf of IVF NJ we would like to welcome you to our Financial Services Section. Our goal is to help you understand in advance what the approximate costs of treatment will be, whether or not your treatment is covered by insurance, and to assist you with the insurance process. This introduction to the program includes important information regarding our roles and the most effective ways of providing you with the information relevant to your particular situation.
- Prior to any appointment with us you will be asked to provide information about your insurance coverage. This will give us time to find out the extent and scope of your coverage.
- If preauthorization is required it could take as long as two (2) weeks. Your appointment will be adjusted accordingly.
- You may also be contacted by a member of our financial team for additional information if we are unable to get all relevant information from your insurance provider.
- A member of our financial team will always be available to answer your questions in detail regarding your cycle related costs once you have successfully completed prescreening.
Insurance Coverage for Infertility Treatment
Health insurance can add to the complexities of the decisions you will have to make when choosing infertility treatment options. At IVF NJ, our goal is to alleviate some of that stress and help you work with your insurance company to ensure that your out of pocket expenses are minimized. Under New Jersey’s Family Building Act, many residents may be eligible for coverage of infertility/in vitro fertilization treatment through their insurance provider.
For those who are not covered by the new law for their infertility treatment, IVF New Jersey offers financial assistance in the form of a discounted rate for in vitro fertilization treatment (see below). If you are uncertain about whether or not you can receive infertility coverage, contact our fertility center; we would be happy to answer any questions you may have.
New Jersey Family Building Act (S1076) —- (A.K.A. The State Mandate) Infertility Diagnosis and Treatment was signed into law by Acting Governor Donald DiFrancesco on August 31, 2001. To view the law online, visit http://www.state.nj.us/dobi/acrobat/pn02_260.pdf
Understanding Your Insurance Coverage
Please keep in mind that you do need to verify whether or not you have benefits for infertility treatment. We suggest that you verify, in advance, whether your policy provides benefits for in vitro fertilization. Once you have received verbal verification that your insurance company does provide in vitro fertilization benefits under your policy, you may wish to request in writing how much of the infertility treatment will be covered.
As a patient you can be your own best advocate by thoroughly understanding your benefits. It is important for you to review your specific benefits, your policy’s requirements and covered and non-covered services.
When obtaining information on insurance coverage, do not just handle it over the phone. If you simply call and ask about coverage for a certain procedure, you run the risk of getting incorrect information. We strongly suggest you request a written pre-determination of your exact coverage, and any requirements that must be met in order to ensure coverage. This is your most effective tool if you need to challenge a decision or file an appeal for payment with your insurance. A sample letter along with a breakdown of our fees is available to you in our office. With some participating insurances, IVF NJ will require these letters in order to avoid requiring payment in full prior to starting a cycle.
Establishing a point of contact with a representative at the insurance company is a good idea and may enhance follow-up. Be sure to document all phone conversations with your insurance company and get the names of the representatives with whom you speak.
Our insurance representatives can assist you with this process if necessary. By providing copies of your insurance card (front and back), our insurance counselors can optimize their assistance to you. Fax cards to (732) 545-1164. For insurance plans with which IVF New Jersey participates, we will bill your insurance company for covered infertility services. Any non-covered or denied infertility services remain your responsibility. It is also the IVF New Jersey patient’s responsibility to present the appropriate referrals to us prior to treatment.
Even though we may not participate with your carrier, you may still be eligible for reimbursement directly from your insurance company. Therefore, at each visit, you will be given a statement indicating the procedures performed with appropriate coding that you can submit to your insurance company for payment. In these cases, you will be responsible for payment up front. Our insurance counselors will be happy to help you with any concerns you may have in understanding your infertility coverage with IVF New Jersey.
Please contact our insurance department as soon as you know that you will be undergoing an in vitro fertilization/infertility treatment at IVF New Jersey to make sure that all arrangements, including all necessary insurance pre-authorizations, are completed in a timely fashion. Where applicable, deposit payments must be received in our office prior to your scheduled start date in order to insure that there will be no lapse or interruption in your treatment cycles.
Types of Plans:
1. HMO — these plans usually only offer in network benefits and will normally require referrals or authorizations.
2. POS — these plans usually offer both in and out of network benefits. Most POS plans do require referrals or authorizations for the maximum benefit and the least payment out of your pocket. If you choose to come without a referral, you will likely be subject to an out of network deductible and higher coinsurance.
3. PPO — these plans usually do not require referrals or authorizations, but you should check with your insurance as some do require notification of services/cycles.
Important Questions to Ask Your Insurance Company
- Are there any specific procedures that I need to follow to get infertility treatment covered? For example, do I need separate referrals or authorization for each office visit, blood work, ultrasound or procedure?
- Is there a dollar maximum associated with infertility treatment? If so what is that dollar amount and how much have I used to date?
- Is there a limit to the number of attempts allowed for intrauterine inseminations (IUI)?
- Is there a limit to the number of attempts allowed for in vitro fertilization (IVF)?
- Are charges related to egg donors covered?
- If my policy covers infertility as a result of the NJ state mandate, do I meet the medical criteria for coverage for in vitro fertilization? This question is especially important because while IVF may be covered, if you do not meet criteria, your insurance may not cover your cycle (see section on NJ State Mandate).
Participating Managed Care Plans:
- United Health Network (Oxford & United Healthcare)
- Health Net
- United Resource Network (URN)
- Integrated Health Plan
- Blue Cross/Blue Shield PPO
NOTE: Under no circumstances should this list be viewed as an endorsement or guarantee of coverage by IVF New Jersey. Ultimate responsibility (for coverage verification and services provided) lies with the patient/guarantor.
Any changes in coverage or misstatements of benefits by the Insurance Company are the patient’s responsibility.
Refund and Multi-Cycle Programs
We have a great financial solution for our IVF patients who do not have full insurance coverage. Attain® IVF offers multiple cycle treatment plans for a single, discounted fee that increase your chance of success. There are two programs available, click here to learn more.
Egg Donor Sharing
Our patients have the option of sharing donor eggs, which greatly decreases the cost of egg donation. Because of our recruitment efforts, there are a large number of egg donors who are available right away.
If you want to learn more, contact IVF New Jersey about the financing plans and insurance coverage available for in vitro fertilization and infertility treatment. Our insurance department will be happy to answer any questions or concerns you may have.
An estimate payment for egg retrieval, embryo lab, and embryo transfer will be due prior to the start of your in vitro fertilization/infertility treatment cycle at IVF New Jersey. All other infertility cycle monitoring costs must be paid to IVF New Jersey on the day of each visit. Medication is not included in these payments and, based on your insurance benefits, remains your responsibility.
IVF New Jersey accepts most major credit cards. In vitro fertilization/infertility cycle deposits can also be made by cash, bank/certified check, or money order.
Discounted Rate for In Vitro Fertilization
IVF New Jersey has discounted rate treatment plans for patients who have no insurance coverage, patients whose plan does not cover IVF, and those whose insurance companies are not included in the Family Building Act. This allows those interested in in vitro fertilization in Bucks County, New Jersey, and beyond to have access to the infertility procedures we offer at IVF New Jersey.
Successive Cycle Discounts
Nothing is more disappointing than an Egg Donor Cycle that is unsuccessful. We at IVF NJ are sensitive to the emotional and financial burden that this can cause. We are prepared to offer our patients a 20% off the Donor Cycle fees if they have had a prior unsuccessful Donor Cycle with us. The discount excludes donor compensation, cycle management fees, anesthesia, cryopreservation, etc.
In addition, if the patient has 2 failed cycles with us we will discount the 3rd cycle by 25%. The 25% is calculated on the original cycle fees. Contact us for more information about our discount programs.
To help our patients with the cost of fertility treatment when they do not have insurance coverage or have exhausted their coverage, IVFNJ has made available the services of Springstone Credit. Springstone Credit specializes in providing patients financing services for all fertility treatment options. Their easy, convenient loan process and competitive rates ensures the financial aspects of treatment are not an obstacle to achieving your dream of a family. Springstone Credit offers a wide variety of loan options allowing you to obtain the necessary financing required to make treatment affordable. Each loan program is tailored to fit your individual circumstances. Loans are available from $1,500 to $50,000 relative individual financial standing. To learn more please contact one or of billing associates or Springstone Credit directly (1-800-630-1663).
If you are seeking in vitro fertilization or other infertility treatment in Bucks County, New Jersey, or anywhere in the world, IVF New Jersey can help you understand the financial aspects of treatment, including insurance coverage.
Prescription (Rx.) Help Options
Prescription Plan discount programs
IVF New Jersey is aware that costs for medication for your fertility cycle can really add up. Some insurance plans do not provide coverage for medications that are for you or for your donor. In those cases our local pharmacies participate in medication discount programs to offer our patients the best prices. Examples of some of these programs are:
The Smart Rx program makes infertility medications affordable for our patients. Our consistently low prices have made treatment possible for thousands of couples so that they could build their families. Let us help you build yours! For more information about the Smart Rx Program please call 877-252-0553 or visit www.mandellspharmacy.com
Freedom Fertility Pharmacy carries the nation’s largest stock of infertility medications, including all those required for a typical treatment cycle. They accept most insurance and offer low discount prices for cash-paying patients. For more information contact Freedom Fertility.com™ or call 800-660-4283 www.freedomfertility.com
DesignRx® has partnered with Schering Plough and offers patients discounts on medications ranging anywhere from 15% to 30%, depending on which specialty pharmacy they choose. DesignRx® negotiates drug discounts on behalf of its members and enforces its formulary through a carefully selected pharmacy network. To receive these discount benefits, patients are required to enroll for their free membership with DesignRx®. To learn more, or to enroll in the program, please visit www.designrx.net or call 1-877-416-6600.
Ferring Pharmaceuticals’ h.e.a.r.t.+ Pharmacy Savings Program, offers significant savings on prescriptions for BRAVELLE®, MENOPUR®, ENDOMETRIN®, and NOVAREL®.† Cash-paying patients pay no more than $56 per vial of BRAVELLE® (over 35% off the wholesale price). Cash Patients also pay the lowest available cash price for MENOPUR®, ENDOMETRIN®, and NOVAREL®. Insured patients can save up to $500 on each prescription for BRAVELLE. For more information on the h.e.a.r.t.+ program please visit www.ferringfertility.com/heart.
For eligible patients with insurance, Gonal-f® Cares has conceived a new way to save money by reducing out-of-pocket costs with the Gonal-f® Co-Pay Savings Card. Now patients can save up to $200 per prescription every 21 days for Gonal-f® medications. For more information about this program, or to get your Co-Pay Savings enrollment card, please visit www.fertilitylifelines.com/index.jsp
Now, eligible self-pay patients can save approximately 10% on Gonal-f® medication on every cycle. With EMD Serono’s new GO – Direct To Savings program, the more medication needed, throughout a patient’s treatment, the more they will save. For more information about this program, or to get your Go Direct to Savings enrollment card, please speak with one of our nurses by calling 800-483-6544 or www.freedomfertility.com