Insurance Coverage & Questions

Emory Healthcare is pleased to provide our Emory Reproductive Center patients with resources for financial assistance.

Once your fertility treatment plan has been finalized, you will meet with a financial counselor who can help you to coordinate payment. Generally, patients use some combination of their health insurance, health savings accounts and personal savings to pay for fertility treatments. For your convenience, we accept, cash, checks, American Express, Visa, Master Card and Discover and will submit claims to your insurance company.

If you have already decided to undergo in vitro fertilization (IVF) treatment and would like to compare pricing, please contact the financial counselor at 404-686-1843. We understand that timing is critical for those approaching the start of a cycle and will make every effort to accommodate you. Please call 404-778-3401 for an IVF consultation appointment.

If you are just beginning your journey, we encourage you to attend one of our free monthly fertility seminars.

Insurance Coverage for Fertility Treatments

Emory Reproductive Center accepts most insurance plans for fertility services. Fertility benefits vary not just by insurance provider, but also by employer. Insurance plans may not offer any fertility coverage benefits. Some will cover diagnostic tests. Still others may cover some fertility treatments. Few employers offer full coverage for fertility treatments. Typically, plans do not distinguish between in-network or out-of-network physicians since fertility benefits are determined by the employer. The Emory Reproductive Center is as honest and open with insurance companies as we are with our patients. If your insurance plan does cover fertility services, we will not change a diagnosis on claims to something your insurance plan will cover. We encourage all patients to ask their insurance company questions before beginning their fertility journey.

For additional information, please contact our financial counselor at 404-686-1843.

Accepted Insurance Plans

Please note, we do not accept Medicaid.

Aetna PPO – MC Beech Street PPO Blue Cross/Blue Shield Indemnity
Blue Cross/Blue Shield PPO,
EPO, POS (we accept out-of-network PPO Benefits)
CCN Cigna HMO, PPO, POS
Coventry HMO, PPO, POS
(no WellStar HMO plans)
Evolutions Healthcare First Health
Georgia First Guardian Resources Humana Choice Care PPO
Open Choice II, EPO Private Health Care Systems (PHCS) SouthCare PPO
Unicare United Healthcare HMO, PPO, POS, EPO
 
We will file insurance claims as follows:

Commercial Payers — The Clinic, at its discretion, will collect 20% of charges at the time of service and will wait 30 days from claim submission for payment by the insurance carrier(s) before requiring payment from patient/guarantor.

Managed Care Payers — The Clinic will collect co-payments and deductibles at the time of service and will wait 30 days from claim submission for payment by the insurance carrier(s) before requiring payment from patient/guarantor, except where otherwise prohibited by contract.

Patients with HMO/POS plans, please have a referral form generated from your Primary Care Physician when scheduling your appointment. If we do not receive a referral form, our computing system will automatically bill you and not your insurance carrier. (It is your responsibility to have the referral generated from your Primary Care Physician.)

Questions to ask your insurance company about your infertility benefits

General:

  • What are my fertility benefits?
  • Do I need a referral to obtain fertility treatments?
  • Do I need a pre-certification to obtain fertility treatments?
  • Do I have a lifetime maximum benefit for infertility?
  • Do I have a maximum number of allowed attempts for intrauterine insemination (IUI) and/or in vitro fertilization (IVF)?
  • Do I have a co-pay or deductible for fertility treatments?

What diagnostic testing is covered?

  • Diagnostic prenatal labs (e.g., hepatitis B, hepatitis C and HIV)?
  • Progesterone and estrogen testing?
  • Follicle-stimulating hormone (FSH), Luteinizing hormone (LH), Thyroid Stimulating Hormone (TSH)  and prolactin testing?
  • Semen analysis?
  • Hysterosalpingograms (HSGs), sonohysterograms (SHGs), endometrial biopsies and sonograms?

Are lab fees covered in the Emory Reproductive Center lab, or am I restricted to certain labs/facilities?

Which medications are covered?

  • Clomiphene citrate (Clomid/Letrozole)?
  • Gonadotropin injectables (FSH or LH medications such as Follistim, Gonal-f, Bravelle, Luveris, Menopur and Repronex)?
  • Human chorionic gonadotropin (hCG) (e.g., Ovidrel)?
  • GnRH agonists/antagonists (e.g., Lupron, Ganirelix and Cetrorelix)?
  • Progesterone/Prometrium (tablets, suppositories, injections, etc.)?
  • Estrogen (tablets or patches)?

What treatment-related or procedures are covered?

  • Ultrasonography?
  • Medical fertility therapy?
  • IUI/artificial insemination?
  • IVF?
  • Intracytoplasmic sperm injection (ICSI)?
  • Cryopreservation?
  • Assisted hatching?
  • Preimplantation genetic diagnosis (PGD)?

What treatments are excluded?

Are donor sperm and/or donor egg options covered?

Is cystic fibrosis carrier screening covered?

Are CPT codes 83894, 83901, 83896, 83912 covered?

Is ICD9 code V26.3 covered?

NOTE: These questions are meant as a guide only. Patients are responsible for determining individual insurance coverage and should be aware that all expenses may not be covered.