A common misperception about fertility care is that it is not covered by insurance, prohibitively expensive and out of the reach of those who cannot afford large out of pocket payments. As a result, couples confronting the need for fertility therapy often anticipate that they will need to expend part or all of their life savings in order to pay for their care. Fortunately, these notions are untrue. Most couples at GENESIS are insured for fertility treatments, including IVF. Here’s why:
Insurance companies generally have a preset reimbursement rate for procedures performed, which are described using common procedure terminology or CPT codes. The ways in which these rates are determined vary by insurance company, but once they are set the companies do not waiver from them, regardless of what specialty the doctor practices, what training or expertise are involved, or what the quality is of the service delivered. Just a few years ago, CPT codes did not even exist for many of the treatments used in reproductive medicine. Because insurance companies were unprepared to deal with this specialty, most services were “uncovered.” Patients had to pay for most of the treatments, even if their physician was a “participating provider” with their insurance company.
Thanks to the efforts of the American Society for Reproductive Medicine, CPT codes now exist for virtually every aspect of fertility care. Pressure from infertility advocacy groups such as RESOLVE and Path2Parenthood (formerly know as the American Fertility Association) have convinced most large insurers that covering fertility care is proper, and in many states, New York included, nearly all insurance companies are required by law to cover the costs of fertility care. Still, most reproductive specialists have shied away from participating on the panels of insurance companies, leaving their patients to bear the costs of care. This minimizes their need to work with insurance companies and maximizes their reimbursement. On the other hand, it leaves most patients unable to afford their care.
At GENESIS, we believe in promoting access to care. To that end, we have worked long and hard with insurance company executives to arrange fair reimbursement rates for the services we render. As a result, our physicians are able to participate in most insurance plans, and most of our patients are therefore insured for their treatment. GENESIS is one of only five fertility practices in New York City that has been designated by the Empire Plan as a Center of Excellence and recently nationally recognized as a Clinical Center of Excellence for Reproductive Medicine by Contemporary Ob/Gyn, a well respected professional health care magazine for Obstetricians and Gynecologists. Additionally, our physicians have repeatly received local and national acknowledgment for their expertise in Reproductive Medicine by well-known publications that have included New York Magazine, Castle Connelly and Good Housekeeping.
Patients who require in vitro fertilization who are not insured may be able to take advantage of a number of programs to assist them with financing their care. The most popular of these has been run by New York State, and is called the Fertility Demonstration Project. GENESIS has been one of seven centers in the state participating in the project, whereby patients who are New York State residents and whose insurance does not cover IVF are given a government grant to assist in paying for their care. The amount of the grant is proportional to their income. Our billing department has a long experience in managing the grant program and is fully able to counsel our patients to determine their eligibility and benefit level.
Patients requiring advanced reproductive services who are not insured and not eligible for the NYS Demonstration Project have other options to consider, including financing coverage and participating in money-back refund programs. For further information regarding these programs, please click here or contact our billing office at 718-283-8600.