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Patient Resources - Insurance and Financing

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 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.

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 has collaborative efforts with two companies to offer Financial Programs. Please call an RMA Financial Counselor at 248-619-3100 to review the available loan programs and the Attain™ IVF Refund & Multi Cycle 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

Attain™ IVF Program through IntegraMed® Financial Services.

Thousands of people have made their dream of having a family come true through In-Vitro Fertilization (IVF) treatment. But the reality is that most people will require more than one IVF cycle to be successful. Patients who commit to three cycles almost double their chances of having a baby.

At RMA of Michigan, we understand that many patients do not have insurance coverage for assisted reproductive technology and that financial anxiety can complicate the decision to pursue treatment. We’re pleased to announce the availability of the Attain IVF Program (formerly known as the IntegraMed® Shared Risk® Refund Program) as well as the new Multi Cycle Program. RMA of Michigan is committed to helping patients stay in treatment so they can increase their chances of taking home a baby. We want to help you build your family.

Watch the Video

  • You pay a single, discounted fee
  • You receive up to 6 cycles (3 IVF and 3 frozen embryo transfers)
  • If you don’t take a baby home from the hospital, you’re guaranteed a refund—70% for IVF treatment plans
  • Special program for patients using donor eggs —up to 100% refund

Three out of four participants who complete the program take home a baby. There are no risks or obligations to find out if you qualify.

Find out if you qualify—ask one of our financial counselors to submit a clinical application on your behalf or click here

For more information, call IntegraMed at 1-866-YOUR-IVF (1-866-968-7483) or click here.

*NEW* Attain™ Multi Cycle Program

The Multi Cycle Program is offered to all patients whose doctor recommends IVF treatment using their own eggs, including those who are not eligible for the Refund Program. The Multi Cycle Program includes up to 4 treatment cycles (2 IVF cycles and 2 frozen embryo cycles). The Multi Cycle Program does provide a lower cost option while still increasing your chance of success and reducing the stress associated with IVF.

Click here for the Attain IVF Programs brochure.

In Vitro Sciences IVF Financial Share Program

The IVF Financial Share Program offers an up front, discounted fee, which allows for up to three fresh cycles of IVF and up to three frozen embryo transfers to achieve a live birth. If after up to these six attempts, treatment has not resulted in a birth, you will be eligible for a 70% refund. The up front discounted fee for this multiple-cycle, money-back program usually totals from about $20,000 to $30,000 depending on your age and whether you require the use of donated eggs. You can choose to finance this fee with a loan that In Vitro Sciences can help you arrange.

For more information please call 1-877-678-1999 or visit www.invitrosciences.com

Click here to download In Vitro Sciences brochure

Moving forward with treatment is easy with Springstone Patient Financing!

  • Low fixed rates – as low as 5.99%
  • Plans from $2,000 - $40,000
  • Flexible Terms – 24 to 84 months
  • Easy application process and quick decisions
  • No prepayment penalty for ultimate flexibility

Just ask us for more information or visit Springstone at www.springstoneplan.com/fertility.

MyMedicalLoan.com is created to provide consumers with easy and affordable options to pay for medical expenses. Please click here to download a loan application