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Patient Resources - Insurance and Financing
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Insurance |
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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.
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 5 major insurance companies:
- Blue Cross/Blue Shield - (Excluding Blue Choice Plan)
- Aetna
- Cofinity/PPOM
- United Healthcare
- William Beaumont Hospitals Health Plan
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.
| Health Options | PPO Plan | |
| In Network | Out of Net Work | |
| Calendar Year Deductible | None | $250.00 amount per individual $500.00 amount per family |
| Calendar Year Out of Pocket Maximum | Dollar amount Deductible per individual | $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 | 100% after $10 copay | 80% of reasonable charges after deductible |
Using the above example and applying to a typical IVF cycle the following is an approximate cost:
| 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.
Financing
Premier IVF 100% Refund Program™
Planning For IVF Treatment
RMA of Michigan physicians and staff are dedicated to the successful outcome that their patients expect: the live birth of a baby. We recognize that economic resources for treatment may be limited for many people, and thoughtful consideration must be given to financial planning. So we have teamed with Premier IVF to offer a 100% Refund Program for IVF patients age 39 and younger who meet the Program criteria and whose treatment is not covered or only partially covered by their health insurance.
A Live Birth or 100% Refund of Program Fees
Most women who undergo IVF treatment will need more than one IVF cycle in order to become pregnant and deliver a baby. The chance of having a baby increases dramatically when the patient commits to three or more cycles.
The Premier IVF 100% Refund Program™ allows IVF patients age 39 and younger who meet the Program criteria to pay a fixed, discounted fee for up to three (3) fresh cycles and three (3) frozen cycles. The fixed fee is based on the established IVF cycle charges at RMA of Michigan.
The Premier IVF 100% Donor Refund Program allows IVF patients who are using donor eggs and who meet the Program criteria to pay a fixed, discounted fee for up to three (3) fresh cycles and three (3) frozen cycles.
- If the couple completes the Program and does not experience a live birth then they are refunded 100% of the Program fees.
- If Premier IVF withdraws them from the Program then they receive a 100% refund of their Program fee.
- If the couple withdraws voluntarily before Program completion then they will forfeit their Program fees. Other conditions apply.
Check with your Financial Counselor for details.
Most Advanced Reproductive Science
RMA of Michigan can make this unique economic option available to our patients because we employ the most advanced reproductive science in the world. RMA of Michigan consistently offers high success rates. The Premier IVF 100% Refund Program is only offered in Michigan at RMA of Michigan.
Frequently Asked Questions
What does the Program cover?
- Your discounted fee covers up to three (3) fresh IVF cycles and three (3) frozen cycles.
What is not covered?
- The Program does not cover initial diagnostic testing, office visits, medications, complications, anesthesia and, once pregnant, monitoring until you are discharged to your obstetrician.
Will you accept my insurance coverage for the Premier IVF 100% Refund Program?
- This Program is only for self-pay patients or patients that have limited or no insurance coverage.
What if my pregnancy goes beyond 24 weeks and I lose my baby before delivering?
- If you have not used all your available cycles; you would be entitled to try again. If you have used all of the fresh and frozen cycles available to you thereby having completed the Program, you will receive a 100% refund of your Program fees. We determine live birth to be when your state issues a birth certificate.
What if my embryos need assisted hatching?
- Are those costs included in the program? Intracytoplasmic Sperm Injection (ICSI) and assisted hatching or blastocyst culture fees are included.
Frequently Asked Questions when Donor Eggs are used.
What does the Program cover if I choose to use donor eggs?
- As a donor egg user, your discounted fee covers up to three (3) fresh IVF cycles and three (3) frozen (FET) cycles.
What is not covered?
- The Program does not cover initial diagnostic testing, office visits, medication, complications, anesthesia or monitoring during pregnancy up to the time you are discharged to your obstetrician. It also doesn’t cover the cost of your egg donor's treatments, testing, office visits, medications, complications or anesthesia.
Will you accept my insurance coverage for the Premier IVF 100% Donor Refund Program?
- This Program is only for self-pay patients or patients that have limited or no insurance coverage.
What if my pregnancy goes beyond 24 weeks and I lose my baby before delivering?
- If you have not used all your available cycles; you would be entitled to try again. If you have used all of the fresh and frozen cycles available to you thereby having completed the Program, you will receive a 100% refund of your Program fees. We determine live birth to be when your state issues a birth certificate.
What if my eggs need sperm injection or my embryos need assisted hatching?
- Are those costs included in the Program? Intracytoplasmic Sperm Injection (ICSI) and assisted hatching or blastocyst culture fees are included.
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.
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