Billing & Insurance


Insurance

Health insurance can add to the complexities of the decisions you will have to make when choosing infertility treatment options. At RMA, our goal is to alleviate some of that stress and help you work with your insurance company to ensure that you are reimbursed at the maximum level that you are covered.

As a patient, whether you are from Michigan, Ohio or elsewhere, you can be the best advocate for yourself by thoroughly understanding your policy. It is important that you review your specific policy and understand what will be paid and what will not.  In order to help you get started we have some insurance tips to help you look into your benefits.


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Insurance Tips

RMA of MI would like to emphasize the importance of reading and understanding your policy, its requirements and the covered and non-covered services.

Tips

When pursuing insurance coverage, do not just handle it over the phone. If you simply call and ask about coverage for a certain procedure, the customer service representative may give you his or her interpretation of what he/she thinks the policy states.

You should contact your insurance company with a request that they provide you with a written pre-determination of your exact coverage and any eligibility or requirements that must be met in order to get that service covered. You must call your insurance carrier to obtain the proper forms for pre-determination.

It is also helpful to get any determination of benefits and coverage in writing from the insurance company. This is something that they provide you with as a contract holder. If you receive a verbal verification of coverage, you will not have any written documentation. Written verification of their intent to pay is a much more effective tool than verbal if you have a challenge.

Establishing a point of contact with a representative at the insurance company is a good idea and may enhance follow-up. All phone conversations regarding coverage should also be backed up with a written record.

Here are important questions to ask the insurance company

  • What are the specific policies or procedures that I need to follow to get infertility treatment covered? For example, do I need authorization for office visits, 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 are covered?

Common Terms

Authorization

A number issued by an insurance company authorizing a specific service or medication. The doctor or the patient, depending on the insurance, 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. At RMA we want to help our patients from Michigan, Ohio, Ontario, etc. understand the cost of IVF, IUI and other treatments and testing. Learning and understanding these costs early on is important so patients know how much they will be responsible for.


Participating Insurances

The extent of coverage, benefits and authorization process vary from policy to policy. It is important that you understand what is covered before you begin treatment or what are the necessary requirements to get the maximum reimbursement. The finance department can provide some general guidelines on the most common policies within each plan.

Some plans require authorizations. We encourage all patients to check the infertility benefits under your specific plan. Our participation with their insurance does not guarantee coverage for our services.

RMA of Michigan currently participates with 7 major insurance companies

  • Blue Cross/Blue Shield - (Excluding Blue Choice Plan)
  • Aetna
  • Cofinity - *For Ohio patients we do participate with Medical Mutual of Ohio if your insurance card says Cofinity on the back of it.
  • United Healthcare
  • William Beaumont Hospitals Health Plan
  • HAP
  • Health Plus

Non-Participating Insurances

If you have a non-participating insurance company, RMA will require payment up front for all services. Payment will be expected at the time of service for all non-IVF services and 2 weeks prior to the start of your cycle for IVF. RMA accepts several forms of payment: credit card, check, cash or participating loan programs.
Most POS and PPO plans allow you the flexibility of seeking medical care out-of-network. If you have out of network benefits, you can use the following guidelines:

The following is an example of an Out of Network Plan. Please note this is only an example. For information specific to your plan, please call your insurance company.

Calendar Year Deductible

In Network

  • None

Out of Network - PPO Plan

  • $250.00 amount per individual
  • $500.00 amount per family

Calendar Year Out of Pocket Maximum

In Network

  • Dollar amount Deductible per individual

Out of Network - PPO Plan

  • $250.00 deductible 80% of Reasonable and Customary Charges up to $2,000.00 out of pocket then 100% for the remaining of the calendar year

Outpatient Doctor Visit

In network

  • 100% after $10 copay

Out of Network - PPO Plan

  • 80% of reasonable charges after deductible

Using the above example and applying to a typical IVF cycle the following is an approximate cost of IVF at RMA of Michigan:

  • Cost: $9,215.00
  • Deductible: $250.00
  • Coinsurance: $1,793.00

The estimated insurance reimbursement to you for cycle = $7,265.00

*Estimated IVF Cycle cost does not include ICSI, Assisted Hatching or medications.

**Remember that your insurance company will reimburse you using their reasonable and customary rates. For example, if your insurance pays 80% for out of network services and we charge $50 but the insurance r&c rate is $40, they will reimburse you at 80% of the $40 amount, not our full fee.

Prices are subject to change without notice.


No Benefits

If insurance coverage is a concern, RMA offers a multi cycle discount program that allows patients to pay a discounted rate for two fresh and two frozen IVF cycles. We also work with financing companies that can provide medical loans to help patients pay for treatment. Please call a RMA Financial Counselor at 248-619-3100 for more information regarding these programs.

While you are in our care, we want to provide you with the highest quality healthcare available in a comprehensive, compassionate and cost-effective manner. For this reason, our fertility treatment programs are structured to encourage a high level of personal contact with your medical team and financial team.


RMA Multi Cycle Discount Plan

RMA’s multi cycle discount plan allows patients to pay one discounted fee for two fresh and two frozen IVF cycles. By paying for the four IVF cycles as a package you receive a significant discount ranging from 8%-35% depending on your age and whether or not ICSI is required. This plan makes it more financially affordable and predictable for patients who plan to do multiple IVF cycles if the first one is not successful. This gives peace of mind that if the first IVF cycle is not a success, there are up to three more chances to achieve a pregnancy.

Requirements

  • Female must have a normal uterine cavity
  • Male sperm morphology must be normal or ICSI will be required
  • Couple must complete the two fresh and two frozen cycles within a 12 month time limit
  • Must not require Preimplantation Genetic Diagnosis (PGD)
  • If the patient has frozen embryos, they must use their frozen prior to proceeding with a fresh cycle

What’s Included

  • Up to two fresh and two frozen IVF cycles
  • Assisted Hatching
  • Cryopreservation & storage of embryos for one year
  • Monitoring labs, ultrasounds & office visits during cycles.
  • We offer a lower priced package when monitoring labs, ultrasounds and office visits during cycles are a covered benefit.

What’s Not Included

  • Pre-screening
  • Complications
  • Pregnancy Monitoring
  • Male Services (i.e Biopsy & semen analysis)
  • Medications
  • Anesthesia
  • ICSI unless ICSI package is purchased
  • IMSI

If patient becomes pregnant and delivers a child prior to completing all cycles, contract is complete. This is not a refund program. Please contact our office at (248) 619-3100 for more information.


Financing

Prosper Healthcare Lending

RMA of Michigan has partnered with Prosper Healthcare Lending to make the treatment process more affordable. Prosper Healthcare Lending provides loans up to $100,000 with terms out to 84 months. No collateral required. Low monthly payments. Can be used for a variety of fertility treatment options.

Prosper Healthcare Lending is the premier financing company in the fertility industry.  With over 1,500 fertility patients empowered by over $21,000,000 in funded loans, this is a name and financing program you can trust.

Here are some of the benefits you’ll receive with a loan from Prosper Healthcare Lending:

  • Financing ANY fertility or surrogacy treatment related expenses, including medication
  • Loan amounts go up to $100,000 and terms out to 84 months
  • Instant decision without affecting your credit on loans under $35,000*
  • Anyone can submit- family members or friends can inquire about a loan on your behalf
  • Convenient- you can apply through your provider’s website in less than 2 minutes

Apply through the provider link above, or find us at www.patientfinancing.com

Reproductive Medicine Associates of Michigan - Provider #003572

*Only for loan inquiries submitted through the Standard Credit Program.


Lending Club Patient Solutions

Lending Club

 


Grants

The Tinina Q. Cade Foundation’s Family BuildingTM Grant

Applying For The 2015 and 2016 Family Building Grant

The Tinina Q. Cade Foundation’s Family BuildingTM Grant provides up to $10,000 per funded family to help with costs of domestic adoption and medical fertility treatment. The only restrictions for applying are:

  1. You must have a diagnosis of infertility from your doctor
  2. You must be a legal permanent US resident

There are no age limitations or other restrictions currently. The grant is offered twice per year, and the number of applications funded as well as the amount of funding depends on the success of the Cade Foundation’s fundraising activities (i.e. the more we raise, the more we can give away). To date, 46 families have been funded. For more information please visit www.cadefoundation.org

Apply for the Family Building Grant

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