Funding Fertility Care

Understanding Insurance Benefits

Embarking on the fertility journey can evoke a range of emotions, and navigating insurance benefits, referrals, and authorizations can feel overwhelming. Our goal is to support you through this process and help maximize your insurance benefits. Every insurance plan is different and may cover all or just some of our services, so understanding your coverage is crucial.

Our staff is here to assist you, and we have created learning modules (Fertilitywise) to outline your options for funding your fertility care. After your initial consultation and the scheduling of your initial tests, we will contact your insurance company to verify your benefits, determine what services are covered, and find out if pre-authorization is required before your treatment can start. We recommend that all our patients confirm their benefits with both their primary and secondary insurance carriers to ensure we have accurate information. We also review if you are responsible for any co-pays, deductibles, co-insurance, lifetime maximums, and/or out-of-pocket maximums. It is your responsibility to understand your policy's benefits.

Insurance billing codes are based on the clinic’s documentation of the service provided, including medical decision-making, complexity, and diagnosis. Due to federal regulations, we cannot misrepresent services or diagnoses. Some insurance companies verify procedure codes but do not guarantee coverage or payment. Throughout your treatment, your insurance company will send you Explanation of Benefits (EOB) forms detailing covered services and amounts for which you are responsible.

Our goal is to maximize your benefits, but any services not covered by your plan become your financial responsibility, and current and past due balances must be settled before future services are provided

Preauthorization / precertification

Preauthorization or precertification does not guarantee payment. While an insurance company may preauthorize a service, they may later determine not to cover the service.
Delays in treatment can occur as the turnaround time for authorization response may be between 15-30 days depending on your insurance company’s responsiveness.

Want to know more about how fertility benefits work?

Call your insurance company and ask the following:

Do I have Fertility Benefits?

Financing Your Treatment

Building or expanding your family can be physically, emotionally, and financially challenging, especially with in vitro fertilization (IVF), which can cost around $25,000. We understand the toll that fertility treatments can take, and our goal is to minimize confusion and frustration by offering comprehensive information and support. Each treatment plan is customized to the patient to avoid unnecessary procedures or tests, helping to manage costs effectively.

Insurance Coverage

Reproductive Specialists of the Carolinas currently is contracted with the following insurances.

Financial Partners

For patients without full insurance coverage for fertility treatments, we have partnered with a select group of fertility financing partners with long-track records of helping individuals build families.

• ARC Fertility
  ARC is the nation’s largest network of fertility specialists. It is a patient-focused organization that has helped more than 80,000 patients over the last 2 decades. ARC and its member clinics are committed to making the cost of fertility treatments predictable and affordable.
• MyEggFund
  EggFund helps 1 in 8 Americans with infertility afford their dream of having a family. EggFund has the largest network of vetted fertility lenders, who provide you with pre-approved loan offers. EggFund gives you more choices, so you can find the best loan for you—all in one place. Loans can cover all aspects of the treatment process including testing and medication, agency, attorney and storage fees.
• Sunfish
  Sunfish offers low-interest fertility loans for IVF, surrogacy and egg freezing. They offer patients dedicated, one stop, full-service financial support. Sunifish makes parenthood attainable for all types of families through financial solutions, support, and guidance.
• Future Family
  FutureFamily's flexible financing plans can help cover IVF, egg freezing, and all your fertility related expenses. Their plans include expert support to answer all your questions.

Pharmacy Discounts

Our discounts are based off discounts received from pharmacy programs including:

• ReuniteRX
  Eligible Medications include: Follistim AQ Cartridge, Ganirelix Acetate Injection, Pregnyl
• Fertility Lifelines
  Eligible Medications include Gonal-F, Ovidrel, and Cetrotide

These will be discussed in the future once you receive a treatment plan. Please note that discounts will on be offered on self-pay items that have not already been discount by your insurance carrier or other discount program.

We are also proud to offer a 10% discount for healthcare workers, first responders, and teachers.

Glossary of Insurance Terms

Allowable services - Determined by your insurance to be the amount your provider is due for a particular service. This amount is usually less than the amount billed by the provider.

Center of Excellence - A center of excellence is a hospital or healthcare facility where patients continually return to receive primary care or treatment for acute conditions, separate from the place of diagnosis. Such facilities are often epicenters of care provision for large patient populations.

Coinsurance - The amount you must pay after your insurance has paid its portion. In many health plans, patients must pay a portion of the allowed amount. For example, if the plan pays 80% of the allowed amount, the patient pays the remaining 20%.

Covered Benefit - Services that your insurance company pays for in full or in part.

Deductible - The amount a patient pays before the insurance plan pays anything.

Diagnostic - method used when there is a suspicion of a disease condition to help diagnosis a new problem.
Explanation of Benefits - shows you the total charges for your visit. It helps you understand how much your health plan covers, and what you'll owe your healthcare office.

Fee-for-service - is a payment model where services are unbundled and paid for separately.

Health maintenance organization (HMO) - health insurance plans require enrolled patients to receive all their care from a specific group of providers. HMOs often provide integrated care and focus on prevention and wellness.

Lifetime Maximum - is the maximum dollar amount a health plan will pay in benefits to an insured individual during that individual's lifetime.

Non-covered Services - charges for medical services denied or excluded by your insurance. You may be billed for these charges as determined by your insurance carrier.

Out-of-pocket Maximum - The most money you will have to pay before your insurance company covers all costs. Once that limit is reached, the plan will pay 100% of the allowed amount for eligible charges for the rest of the calendar year based on insurance plan set-up. Some insurance companies do not include certain costs in this limit, such as fertility treatments or prescription drugs.

Preauthorization - A decision by your insurance carrier that a health care service or treatment plan is medically necessary. Sometimes called prior authorization, prior approval, or precertification. Your health insurance may require preauthorization for certain services before you receive them. Preauthorization isn’t a promise your health insurance or plan will cover the cost.

Treatment - is a medical intervention intended to remediate a health problem, such as a disease or disorder.