Your Financial FAQ
- How much does IVF cost?
- How much do the medications for IVF cost?
- How much does an IUI cost?
- Do you have package pricing?
- Do you take my insurance?
- Will my insurance cover my treatment?
- Will my insurance cover my medications?
- Fertility Treatment Insurance Coverage
- I have Medicare or Medicaid. How much will these plans cover?
- How much does a Tubal Reversal cost?
- Does insurance cover Tubal Reversal?
- Do you have financing available?
- What is WinFertility?
1. How much does IVF cost?
A typical IVF cycle costs approximately $12,000, plus the cost of medications.
2. How much do the medications for IVF cost?
Medication costs vary depending on the specific treatment plan, but the average is less than $3,000.
3. How much does an IUI cost?
We charge $385 for an IUI, $410 if it is performed on a weekend.
4. Do you have package pricing?
Not at this time, but we are in the process of developing some package pricing. Check back with us.
5. Do you take my insurance?
We participate with most insurance plans, but we don't contract with any HMO plans, including Medicare HMOs.
6. Will my insurance cover my treatment?
While we participate with most insurance plans, many do not cover infertility. We will check your specific insurance policy if you believe you have coverage.
Often there is an underlying or associated medical condition that can be medically corrected, giving you a better chance to become pregnant. Insurance may cover the medical treatment, even if it will not cover infertility treatment.
7. Will my insurance cover my medications?
We will send your prescriptions to a pharmacy that can file claims to your insurance. Some plans cover some medications, but there is no simple answer. The pharmacy will tell you what your specific plan allows.
8. Fertility Treatment Insurance Coverage
Insurance coverage and reimbursement issues for the treatment of infertility are complex. There are many variables that come into play in determining how much support, if any, these companies will provide.
The first question we are typically asked by a prospective patient is "Are you in my network?" Unfortunately, the answer is not as simple as "yes" or "no".
In assisting our patients we have seen that the vast majority of insurance plans fall into one of three categories when it comes to infertility coverage.
The plan provides no coverage whatsoever for infertility services. Thus, it really does not matter whether you see an infertility specialist in or out of network, because no infertility services are covered. This means that even if you go to an in-network physician who provides infertility services to you, you will still be self-pay, because the service itself is not a "covered benefit." In this circumstance, you will be responsible for payment in full, since your insurance company will not reimburse for the services themselves.
The plan provides coverage only for the diagnosis of infertility. In this scenario, the insurance plan will typically cover services rendered to determine:
- That infertility does in fact exist, and that if it does,
- The nature or cause of the infertility.
Once the above questions have been answered, which is when the patient is given an infertility diagnosis by the physician, the diagnostic phase has come to an end.
If there is an "underlying cause of infertility" that can be medically corrected, the plan may cover that medical treatment, but it won't pay to assist you in becoming pregnant.
During the diagnostic phase, we will bill your insurance for services. When coverage is limited to diagnosis, then no future infertility services are covered by the insurance plan in these cases. Thus, when the treatment phase begins, you will be expected to pay for all services when rendered.
The plan provides coverage for the diagnostic phase and for some infertility treatment services, but not all treatment services. In these circumstances, coverage is provided for some methods of infertility treatment, but not others. We have seen situations where oral agents such as Clomid therapy is/is not covered, other ovulation induction using injectable gonadotropins is/is not covered, intrauterine insemination (IUI) is/is not covered, and so on.
The key question is whether your plan covers diagnostic infertility services and infertility treatment services. If it covers infertility treatment services, it is important to know which services are specifically covered and which are excluded from being covered. Our practice manager will help you understand the details of your coverage. A few examples are:
- Although a plan may cover a particular treatment service, there is a limit as to the number of services, e.g. not more than 3 IUI treatment attempts, not more than 2 lifetime IVF cycles, etc.
- Oral medications may be covered while injectable medications may not be covered.
- There may be a maximum dollar amount stated in the policy that can be paid for infertility services, such as a $25,000 lifetime cap.
Keep in mind that there are no two insurance plans that are alike. The degree to which diagnostic services or treatment services are covered or not covered is strictly dependent on what your employer has purchased as coverage in the policy they obtained for your company.
We strongly encourage all new patients to call their insurance company to ask about the coverages that are and are not provided for infertility care. We will provide you with a list of suggested questions to ask your insurance company to assist you in determining your coverage. Some plans require prior authorization in order to cover services, so it is crucial that you inform us of insurance coverage well in advance of treatment.
9. I have Medicare or Medicaid. How much will these plans cover?
Medicare and Medicaid plans cover only medically necessary treatment. Fertility treatments are not considered medically necessary, so these plans will not cover any diagnostic testing, or any treatment of infertility.
10. How much does a Tubal Reversal cost?
We have negotiated a special package rate for our patients to include the hospital facility and the anesthesia services. For patients who are eligible for an outpatient surgery, with a healthy body mass index (BMI), the fee is $6,000. For those with a high BMI, there are additional fees, but the maximum would be $7,550. See our website dedicated to this topic, www.bestreversal.com.
11. Does insurance cover Tubal Reversal?
No. Insurance will not cover the reversal of a voluntary sterilization.
12. Do you have financing available?
We do have some financing options available for our patients. We have found that the least expensive way for our patients to finance their treatment is through personal funds, equity loans, or introductory credit card offers, but we do work with WinFertility (click here), Lending Club Patient Solutions, and Prosper Healthcare Lending. PLEASE NOTE: When applying for financing, you must enter "Jeffrey A. Keenan, MD" as the provider.
13. What is WinFertility?
The WINFertility Treatment Program is offered to Southeastern Center for Fertility & Reproductive Surgery patients who have no infertility insurance coverage or who have exhausted their benefits and seek an efficient, economical way to obtain and pay for advanced fertility treatment. Please click here for more detailed information.