Financial Support

Financial suppot is broken into two segments here. The first involves insurance issues and the second is what is to be done when insurance covers less than desired or needed.

What Insurance Companies Does EDI Participate With?

We participate in a variety of managed care program. Accountable/Interplan, Aetna, Beechstreet, Blue Shield, Cigna, First Health/Coventry, GreatWest Healthcare, Multiplan, NPPN, PPO Next/Healthstar, Self-Insured Benefits Admin. (SIBA), Self-Insured Plans (SIP*Specific Employment Groups Only), Web TPA, and Wellcare Healthy Kid, just to name a few.

Understand, however; we simply cannot participate with all carriers. It is also quite possible that the above listing may not be entirely accurate as contracts as these are often moving targets. If you have any questions regarding our current participation with your plan, I suggest that you contact us.

Why These Q & A?

The insurance staff at SRMS is commonly asked the questions included on this page. We thought it would be helpful to place the answers here on the web. If you have other questions that you would like answered, please give us a call and we will be more than happy to assist.

What Insurance Companies Does SRMS Participate With?

We participate in a variety of managed care programs

Accountable/Interplan, Aetna, Beechstreet, Blue Shield, Cigna, First Health/Coventry, GreatWest Healthcare, Multiplan, NPPN, PPO Next/Healthstar, Self-Insured Benefits Admin. (SIBA), Self-Insured Plans (SIP*Specific Employment Groups Only), Web TPA, and Wellcare Healthy Kids

Understand, however; we simply cannot participate with all carriers. It is also quite possible that the above listing may not be entirely accurate as contracts may have changed before the web site has been updated. If you have any questions regarding our current participation with your plan, I suggest that you contact the practice office at (239) 275-8118.


How Do I Find Out If Infertility Benefits Are Included On My Policy?

We ask that you take a pro-active approach to your infertility questions and subsequent care. Contact your carrier and educate yourself on your plan coverage. We will call your insurance carrier prior to your appointment to verify your benefits. We ask specifically what procedures are and are not covered. Make certain that you have received a copy of your insurance plan with the listed benefits from your carrier or employer. While we do our best to obtain some of this same information, you will ultimately be responsible for services not covered on your plan.

It is strongly recommended that you do the following:

  1. Review the provided insurance list (above) to determine whether we are participating providers for your plan.
  2. Call the benefits number on your insurance card to verify what are and what are not covered services (see below).
  3. Request that the insurance company sends you documentation regarding covered services for infertility under your particular plan.
  4. When speaking to an insurance company, it is best that you obtain everything in writing. Please also keep a log of your phone calls and be certain to get the names of the individuals you speak to when obtaining any insurance information. It is a lot of work but well worth the effort when problems occur (and you are almost guaranteed that they will...).
  5. Ask your insurance company what procedures will require pre-certification (primarily diagnostic procedures and surgeries).
  6. Be aware of what co-pays, deductibles or co-insurances that you will be responsible for.
  7. Find out what laboratory facilities your insurance company wants you to use so that you can obtain maximum financial reimbursement. SRMS will try to send your laboratory work to these laboratories to minimize the "out-of-pocket" expenses you may incur.

There are a couple of methods you can use to find out what the covered services are on your plan:

  1. Consider calling your insurance company and say that you are "Jane" or "John Doe." Let them know that you are currently thinking about working for a business (your current business) and that your physician said that you would need XXX procedures. Ask them if the plan covered by your potential (current) employer covers such services
  2. Understand that the insurance carrier may be hesitant to commit to covering certain procedures, but they should be able to tell you what items are definitely not covered on the plan.

It is unfortunate that you have to consider such tactics, but the insurance industry requires imaginative procedures to protect your individual rights. By using this method, you will not "red-flag" your policy/chart.

WhatInsurance Plans Cover Insemination and IVF Procedures?

All insurance plans vary depending on what particular plan your employer purchases. Understand that a particular insurance company may cover IVF, but that your employer may have decided to not purchase that particular plan. If you want something covered, discuss the concerns with your employer.

There are other plans out there that carry benefits for your services provided at SRMS. If you are unsure, again, we urge you to take a pro-active approach to your healthcare and educate yourself on what your plan covers in detail. Our approach to your insurance company should just then be confirming what you already have knowledge of.

Aetna currently has an infertility program that covers everything leading up to and including artificial insemination. For more information you can call 1-800-575-5999.

Blue Cross Blue Shield has a plan that covers IVF. For more information call 1-800-348-7921.

Cigna has a plan that covers artificial insemination and IVF. For more information call 1-800-877-1209.

United Healthcare also has plans that cover infertility treatment. They may be contacted at 1-877-842-3210.

If We Do Not Have Infertility Insurance Benefits, Will Our First Visit Be Covered?

The staff at SRMS understands that many insurance carriers do not currently have infertility benefits. Whenever possible, we will code for the many diseases that cause infertility. We will use the infertility diagnosis when necessary. We use imaginative, but ethical coding.

What Are We Responsible For If SRMS Does Not Participate In Our Insurance Plan?

If we don't participate with your insurance company, you will be responsible for payment at the time of service. We will provide you with a receipt of payment, which you may then submit to your carrier for direct reimbursement.

What Are The Patient's Responsibilities And What Forms Of Payment Are Accepted?

It is your responsibility to determine if SRMS is on your plan and where any lab tests must be sent in order for you to receive the maximum reimbursement allowed under your insurance plan. This information must be obtained before your first visit. It is also in your best interest for you to notify us of any changes in your insurance plan or you may be asked to reschedule your appointment to ensure that we can obtain proper benefit information. Co-payments or deductibles may be requested depending upon your particular

Cash, checks and major credit cards are accepted as payment for any services not covered by your insurance. We will ask that you keep a credit card on file here at the office to pay for items that are not covered via an automatic payment method that helps to reduce costs for SRMS and reduce late fees that may accrue on overdue balances.

We encourage you to ask any questions of the front office staff regarding fees before the procedures take place. We attempt to code the medical diseases that bring you to the facility whenever possible to maximize your insurance reimbursement.

What If I Already Know My Care Plan Participates?

If yours is one of the care plans with which we participate, SRMS will assist you in obtaining the appropriate authorizations and determine which services will be covered under your plan.

It will be your responsibility; however, to make certain that subsequent visits are cleared by the "gatekeeper," when this is required by your plan.

If you are member of a managed care plan in which we participate, but your treatments are not covered under your plan, pre-payment may be requested prior to the visit.

What If SRMS Does Not Participate In My Plan or I Do Not Have Insurance?

If yours is a plan in which we are not currently participating, or if you do not have insurance coverage, please remember that payment is expected at the time the service is provided. If we do not participate with your plan and your referring physician feels that it is absolutely necessary to be seen by a reproductive endocrinologist, and you have no reproductive endocrinologist on your plan, you might consider petitioning your insurance plan for appropriate coverage. Many patients have been successful with this process.

What Fees Should I Expect?

We suggest that fees for surgical procedures be discussed well in advance of the surgery. A deposit may be required by your pre-operative visit. This deposit will be for any surgical co-insurance that your plan may require for your procedure as well as any non-covered procedure to be performed. The hospital will collect any unpaid deductible on your plan prior to surgery. As a service to our patients, SRMS will file your health claim to your insurance. If there should be any funds remaining once payment from your carrier has been received, you will be sent the difference.

Some laboratory tests will be processed by outside labs. In these cases, you will generally receive separate statements from those facilities. If you have any questions regarding these charges, please contact the lab(s) directly. Due to quality assurance and the necessity of obtaining endocrine laboratory studies within a reasonable amount of time such that important clinical decisions can be made, we may request that some labs be performed by our in-office facility. The turn-around time in our facility is hours instead of days as in the outside facilities.

Additional fees are generally charged for extensive records reviews, as well as for off-hour, weekend, holiday and emergency room visits. Some of these fees may not be covered by your insurance and will be billed to you at the time the service is rendered.

SRMS reserves the right to request reimbursement for expensive copying of records, and the creation of detailed legal reports and insurance letters.

Are Loans Available?

The staff at SRMS feels that your financial well-being is very important. We have taken the time to research the various options available to couples in similar situations to yours. Working with your personal bank is a great way to start the process. Home equity loans may be the least expensive loans to obtain and service.

With your best interests in mind, we have teamed up with Credit Funders to offer you affordable financial assistance. They provide high approval rates and flexible payment options. To learn moreand to complete the application, please download the brochure containing the application and fax it back to the our office for review and submission.

Are Grants Available?

Baby Quest is a relatively new organization, founded in 2011, dedicated to helping those who cannot afford the high cost of infertility treatments such as IUI, IVF and/or surrogacy.

Baby Quest is funded by donations from both businesses and individuals. They offer grants and periodically select individuals who have medical insurance, but who are uninsured for fertility treatments.

To learn more about Baby Quest, visit their website at

Who Is Responsible For My Bill?

It is understood that the professional services offered by our physician are provided to you, the patient. Therefore, the payment of the bill is your direct responsibility, even if you are having a dispute with your insurance company. Please understand that although we strive to obtain the most accurate information from your insurance company, sometimes even they can quote incorrect benefits. Their own disclaimer states that the "quote of benefits is not a guarantee of coverage".

It is our policy to charge reasonable fees on balances which are 30 days past due.

Please feel free to discuss our fees at any time. We realize that the expense involved in the diagnosis and treatment can sometimes be significant, and we are sensitive to your concerns.

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