Insurance 101 question

[Anonymous]

Sorry for the basic question. I find discussing insurance difficult with the provider.

If I have zero coverage for IVF through my insurance then am I paying out of pocket directly to a fertility clinic for all services I need (testing, IVF, transfers, etc)? Would the clinic still submit to my insurance even without any coverage? Might there be contracted rates which lower costs for me? I hope this makes sense. Beginning the process of figuring out the finances and I am confused.

[Anonymous]

I'm confused as to why your provider can't provide this info. I was with two different clinics and they were pretty clear on what the costs would be, except for meds. I think that most was out of pocket but some things, like bloodwork (maybe monitoring?) was covered by insurance.

At the time we were going through IVF, Aetna was the only federal benefit plan that paid for some of the IVF cost but it has since stopped this. I hope this helps.

[Anonymous]

My monitoring was covered, but the retrieval and transfer weren’t. They submitted for me.

[Anonymous]

Anonymous wrote:My monitoring was covered, but the retrieval and transfer weren’t. They submitted for me.

Thanks! This is helpful.

[Anonymous]

I just started my IVF cycle and went through all of this. I would recommend speaking with the financial counselor at your clinic, as they were very helpful for me at the beginning when I had a ton of questions.

What clinic are you with? SGF reached out to my insurance directly and provided me with what my insurance does and does not cover, but they also have a handy guide with questions to ask your insurance provider if you call yourself. I did also call my provider myself and asked them those exact questions on the sheet - I think this is available even for people not at SGF, just look it up on their website.

At SGF, once they found out what my insurance did and did not cover, they gave me a bill with my portion (the portion of the cost that insurance would not cover), which had to be paid in full before treatment could begin. In my case I have IVF coverage. Previously I had insurance that did not cover IVF but they still covered all of the testing. If your insurance does not cover treatment, then yes, you'll be paying the clinic directly and they would not submit to your insurance.

Good luck! It's complicated and overwhelming for sure, but your clinic should have someone who can help you navigate this.

[Anonymous]

Anonymous wrote:I'm confused as to why your provider can't provide this info. I was with two different clinics and they were pretty clear on what the costs would be, except for meds. I think that most was out of pocket but some things, like bloodwork (maybe monitoring?) was covered by insurance.

At the time we were going through IVF, Aetna was the only federal benefit plan that paid for some of the IVF cost but it has since stopped this. I hope this helps.

I meant my insurance provider. I haven’t had the financial consult with IVF clinic yet. I am asking here to understand what questions I should ask as I clearly have limited understanding of the process. Thanks, your answer is helpful!

[Anonymous]

Anonymous wrote:I just started my IVF cycle and went through all of this. I would recommend speaking with the financial counselor at your clinic, as they were very helpful for me at the beginning when I had a ton of questions.

What clinic are you with? SGF reached out to my insurance directly and provided me with what my insurance does and does not cover, but they also have a handy guide with questions to ask your insurance provider if you call yourself. I did also call my provider myself and asked them those exact questions on the sheet - I think this is available even for people not at SGF, just look it up on their website.

At SGF, once they found out what my insurance did and did not cover, they gave me a bill with my portion (the portion of the cost that insurance would not cover), which had to be paid in full before treatment could begin. In my case I have IVF coverage. Previously I had insurance that did not cover IVF but they still covered all of the testing. If your insurance does not cover treatment, then yes, you'll be paying the clinic directly and they would not submit to your insurance.

Good luck! It's complicated and overwhelming for sure, but your clinic should have someone who can help you navigate this.

Thank you! This is exactly what I am wondering. The guide of questions they provide will be so helpful to me, so thanks for letting me know about it. I am planning to use Shady Grove and consulting with them this week. Long story, but I previously did testing two years ago with a different clinic, did a second opinion of the results with Shady grove but did not do IVF at the time. I had different insurance at the time which had generous IVF coverage so I’m at new starting point financially.