In
order to accommodate the needs and requests of our
patients, Texas Fertility Center is enrolled in
several managed care health plans. We will be happy
to file all claims for covered services rendered if
we are contracted with your insurance carrier. In
the event that we are not contracted providers, we
will supply a detailed receipt of services to you
that you can submit directly to your insurance
carrier for reimbursement.
Insurance coverage for infertility can often be
confusing. Many policies offer coverage for testing
to determine the cause of infertility -- but no
coverage for fertility treatment. Usually, your
first visit and first sonogram are considered to be
diagnostic services and are therefore covered by
those policies that cover diagnostic services.
Payment and coverage for any individual service may
vary based on the cause or diagnosis addressed at
that visit. For example, policies that exclude
infertility treatment will often cover an ultrasound
that is being performed to evaluate an ovarian cyst
or uterine fibroid. However, if the ultrasound is
being performed to track your response to fertility
medications, or as part of a fertility treatment
cycle, it may not be covered. Knowing what your
policy covers before seeing your physician or
beginning treatment can be very beneficial. An
insurance benefit
questionnaire, along with sample letters of predetermination , are available on our
website to aid our patients in determining what is
covered by their insurance plan.
Our
billing staff is available to answer any questions
patients may have regarding their insurance
benefits, insurance coverage and pricing. The
Billing Staff can be reached at (512) 451-0149 option #8..
Contracted Insurance Plans
At this
time, Texas Fertility Center is contracted with the
following plans
Aetna
(Patients must register with the “Aetna
Infertility Program” by calling (800) 575-5999
prior to the initial appointment.)
Blue
Cross Blue Shield (NOT Blue Choice Solutions,
Traditional or Indemnity)
Cigna
Galaxy (excluding discount programs)
Healthsmart
Meritan (Capital Metro ONLY)
Seton
Health Plans
United Healthcare
Humana (Due to dramatic changes in provider agreements, effective September 24,2011 we will no longer be participating providers for Humana. Our billing department will be happy to answer questions on how this change might affect your coverage)
All HMO plans and some other specific plans (i.e.
Healthselect) require a referral from a Primary Care
Physician before a patient can be seen at Texas
Fertility Center. We strongly encourage patients to
check with their insurance company to confirm
whether or not a referral is required. Also,
Texas Fertility Center does not participate in any
government-sponsored health plans such as Medicare,
Medicaid, MAP, or Tricare.
Referrals and Authorizations
Our
Referral and Authorization Coordinators will obtain
the necessary pre-certifications and authorizations
required by your insurance carrier for treatment
procedures and medications This includes the
initiation of out-of-network requests, if available,
through your insurance carrier. These coordinators
will also ensure that you have been cleared for
specialty service office visits by maintaining
referral records and notifying you any time a
referral is required.
Our
coordinators gather pertinent information from the
insurance carriers and pharmacy benefit managers in
order to provide accurate cost estimates for the
care being delivered. They will also guide you
to appropriate resources to obtain additional
information. In addition, they will
investigate pharmacy benefits and place orders at
appropriate specialty pharmacies to help you utilize
your specific insurance benefits with maximum
efficiency.
