Billing & Insurance


Insurance Coverage

Health insurance coverage for infertility and IVF treatment overview

Health insurance can add to the complexities of the decisions you will have to make when choosing infertility treatment options. At RMA of Michigan, 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.

Insurance coverage for infertility treatment including artificial insemination and in vitro fertilization varies greatly. Some insurance plans will cover nothing related to infertility services, some may pay for all of it and many are somewhere in between.

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.

Treatment for infertility is covered by insurance much less commonly than testing is. When there is coverage for infertility treatment, it is fairly common to exclude IVF or to have a lifetime maximum benefit. We commonly see health insurance plans that have between $10,000 and $25,000 as a lifetime maximum. This caps the potential costs for the insurance carrier. In other cases, insurance will cover testing and treatment up to and including intrauterine inseminations - but they will not cover IVF - in vitro fertilization services. Sometimes the "monitoring" of the IVF ovarian stimulation (blood and ultrasound tests) are covered, but all of the more expensive IVF codes are not covered.


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 the necessary requirements are 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.

We are "in network" with several leading insurance plans including:

*For Ohio patients, we do participate with Medical Mutual of Ohio if your insurance card says Cofinity on the back of it.

Non-Participating Insurances

When a doctor is out of network it does not mean that the insurance company will not pay for the services. If we are out of network with the plan, then the patient will usually have a higher amount of coinsurance (what they are expected to pay) as compared to if they went to a doctor that is in network. We have many patients that see us out of network. They have decided to come to us out of network because of our superior success rates, our personalized care, recommendations from friends or their doctor, or for other reasons.

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.

Insurance Tips

RMA of Michigan would like to emphasize the importance of reading and understanding your insurance policy, its requirements and the covered and non-covered services. Infertility benefits vary from patient to patient. We’ve put together a few key points about insurance coverage by major plans to help you manage expectations of coverage. The information provided is for informational purposes only and is not a commitment of coverage.

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.

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?

Additional Insurance Information

Waiting time for authorizations:

  • Approximately 15 business days from submission of your paperwork.

Basic requirements for ART/IVF coverage:

  • Most plans require clinical history including physician notes, blood work, Day-3 FSH, semen analysis, saline sonogram or HSG reports before authorization is issued.
  • Requires new authorization if treatment plan converted (example IUI to IVF or vice versa).
  • Plan may require patients meet “lesser before greater” treatment criteria for medications, even if procedures have already been approved.

Genetic Testing (PGD) / Comprehensive Chromosome Screening (CCS):

  • Coverage is rarely provided. Patient is responsible for confirming coverage for PGD/CCS.

No Benefits

If insurance coverage doesn’t exist, RMA offers a multi cycle discount plan and a refund program that allows patients to pay a discounted rate for multiple IVF cycles. We also work with financing companies that can provide medical loans to help patients pay for treatment. Please call a RMA of Michigan Financial Counselor at 248-619-3100 for more information regarding these programs.


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 20-35% 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.

The multi cycle program is ideal for patients who are paying out of pocket with no insurance coverage, or for those who have waived or exhausted their insurance benefits. Patients may be able to use their insurance benefits for pre-screening tests and medications.

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
  • If the patient has frozen embryos, they must use their frozen embryos 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 the first 2 years; Annual storage of $500 will be billed after initial 48 months.
  • Monitoring labs, ultrasounds & office visits during cycles. We do offer a lower priced package when monitoring labs, ultrasounds and office visits during cycles are a covered benefit.

What’s Not Included:

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

If patient becomes pregnant and delivers a child prior to completing all cycles, program is complete. This is not a refund program.


RMA’s Refund Program

RMA’s 100% IVF Refund Program is a program that offers multiple IVF cycles for a single-package price. If after all attempts have been exhausted and there is no live birth, you will receive a 100% refund of your program fee.

The refund program is ideal for patients who are paying out of pocket with no insurance coverage, or for those who have waived or exhausted their insurance benefits. Patients may be able to use their insurance benefits for pre-screening tests and medications.

Requirements:

  • The program is available to patients age 39 and younger who are IVF appropriate and meet the Program criteria.
  • Couple must complete the three fresh and three frozen cycles within a 24 month time limit.
  • ICSI is required.
  • Must not require Preimplantation Genetic Diagnosis (PGD) or Comprehensive Chromosome Screening (CCS).
  • If the patient has frozen embryos, they must use their frozen embryos prior to proceeding with a fresh cycle.

What’s Included:

  • Up to three fresh and three frozen IVF cycles.
  • Assisted Hatching
  • ICSI
  • Monitoring labs, ultrasounds & office visits during cycles. We do offer a lower priced package when monitoring labs, ultrasounds and office visits during cycles are a covered benefit under your insurance plan.

What’s Not Included:

  • Initial Consultation
  • Pre-screening & Testing
  • Complications
  • Donor Sperm
  • Pregnancy Monitoring
  • Semen Analysis
  • Medications
  • Anesthesia Fees
  • Cryopreservation & storage of embryos or sperm

If after completing the allotted cycles there has not been a successful birth, or if the patient is withdrawn from the program for clinical reasons, the patient will receive a refund of 100% of the program fee.


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

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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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