Insurance Coverage for Fertility Treatments in New Jersey

Insurance and Billing Representatives in New Jersey

Our insurance and billing representatives will work closely with you by:
1. Verifying your insurance coverage
2. Documenting what fertility treatment coverage you have
3. Advising you of your out-of-pocket costs
4. Aiding you with outside financing

This is not to be considered any guarantee of coverage or payment by your insurance company. Patients must remember that their insurance coverage is an arrangement between the insurance company and themselves. All patients should verify and understand their own specific infertility benefits. We are very fortunate in New Jersey to have a state law called the Family Building Act which mandates fertility treatment coverage; however, there are exclusions to the mandate, such as self funded insurance plans, patients with prior sterilizations and others. For more specific information on the mandate please go to Resolve’s Website.

Understanding insurance coverage for infertility can be frustrating and confusing at times. South Jersey Fertility Center has many years of experience with the insurance and billing process. Our goal is to help our patients manage their financial obligations, making their infertility testing and treatment less stressful.

Infertility Insurance Coverage

For those patients who have infertility insurance coverage or who are covered under the Family Building Act, our insurance counselors will advise you of what is and is not covered.  We will work with you regarding any referrals or authorizations that you may be responsible for obtaining.  In addition, our insurance/billing counselors will provide the insurance company with the appropriate information in order to obtain the necessary authorizations.  We will bill your insurance for all covered procedures; however, you will be responsible for your co-pay, deductible or co-insurances that your insurance company may apply.

In cases where patients do not have fertility treatment coverage, we do provide a discounted rate and you may speak to one of our representatives concerning the costs.  For patients that are paying out-of-pocket, all financial arrangements and applicable payments must be made prior to the start of treatment, in the form of cash, check, money order, credit card or bank/cashier’s check.

Payment Methods for Fertility Treatment:

We accept cash, check, VISA, MasterCard, Discover and American Express.

To contact one of our insurance counselors, please call 856.596.2233 and press the option for our billing department.
For questions regarding IVF or Donor Egg cycle fees, coverage and financial arrangements please call 856.596.2233 Ext. 1227.

Are Fertility Treatments Covered by Insurance?

Understanding the ins and outs of infertility coverage with your specific insurance company is challenging. Once you have become a patient of South Jersey Fertility Center you will receive a detailed “Insurance Confirmation” package which will outline your specific coverage.  This information will be obtained from your insurance company by one of our financial counselors.  We encourage you to review this information and confirm it with your insurance company since the policy is between you and the insurance company.

However, to aid you with some of the basic requirements of insurance companies please select your insurance company for more information:

Horizon Blue Cross/Shield of New Jersey
  • Most plans require a history, Day 3/AMH blood work, semen analysis, ultrasound and uterine evaluation before obtaining an authorization.
  • Authorizations can take up 7 days from the date of submission of your paperwork.
  • If medical necessity letters are required, this may take up to 30 days.
  • Authorization is required for each treatment plan cycle.
  • Many plans require lesser before greater treatment prior to approval (such as hMG/Clomid prior to IVF treatment).
  • PGS is not covered. Patient must pay out of pocket for those services.
  • PGD may be covered with medical necessity. Patient must pay out of pocket and get reimbursed by insurance company.
Amerihealth
  • No authorization for treatment is required but the patient must sign a certification form which will be sent to them prior to the start of treatment.
  • If medical necessity letters are required, this may take up to 30 days.
  • PGS is not covered. Patient must pay out of pocket for those services .
  • PGD may be covered with medical necessity. Patient must pay out of pocket and get reimbursed by insurance company.
Qualcare
  • Authorization may take up to 10 days from the date of submission.
  • If medical necessity letters are required, this may take up to 30 days.
  • Many plans require lesser before greater treatment prior to approval (such as hMG/CC prior to IVF treatment).
  • Authorization is required for each treatment plan cycle.
  • PGS is not covered. Patient must pay out of pocket for those services .
  • PGD may be covered with medical necessity. Patient must pay out of pocket and get reimbursed by insurance company.
Massachusetts Blue Cross/Shield
  • Most plans require a history, Day 3/AMH blood work, semen analysis, ultrasound and uterine evaluation before obtaining an authorization.
  • Authorizations can take up 30 days from the date of submission of your paperwork
  • If medical necessity letters are required, this may take up to 30 days.
  • Authorization is required for each treatment plan cycle.
  • ICSI approved with severe male factor (< 10 ml total motile or 2% strict normal forms or < 3% total motile post processing.
  • For patients over 40, a Clomid Challenge Test may be required.
  • Treatment Cycle can be converted from IUI to IVF if there are 5 follicles greater than 13mm or E2 greater than 800 and patient must be under the age of 40.
  • Patient must not be a smoker and if there is a history of smoking and they recently stopped testing may be required.
  • Many plans require lesser before greater treatment prior to approval (such as hMG/CC prior to IVF treatment).
  • PGS is not covered. Patient must pay out of pocket for those services.
  • PGD may be covered with medical necessity. Patient must pay out of pocket and get reimbursed by insurance company.
Aetna
  • Patients must register with Women’s Health Management at 800-875-5999.
  • Most plans require a history, Day 3/AMH blood work, semen analysis, ultrasound and uterine evaluation before obtaining an authorization. Requirements for repeating the testing may depend on age. Must have day 3 blood work 6 months to 1 year.
  • Coverage for treatment will be denied if your FSH is over 19. For ICSI coverage partner must have 2 abnormal semen analyses at least 2 weeks apart.
  • Authorizations can take up 7 days from the date of submission of your paperwork and cannot be backdated.
  • If medical necessity letters are required, this may take up to 30 days.
  • Authorization is required for each treatment plan cycle.
  • If your medications are covered through Aetna specialty Pharmacy an authorization for the treatment cycle must be on file.
  • Many plans require lesser before greater treatment prior to approval (such as hMG/CC prior to IVF treatment).
  • Will cover up to 3 pregnancy monitoring visits prior to 8 weeks of gestation. Additional visits may be authorized is medically necessary.
  • Embryo or Oocyte banking are not covered.
  • PGS is not covered. Patient must pay out of pocket for those services.
  • PGD may be covered with medical necessity. Patient must pay out of pocket and get reimbursed by insurance company.
Cigna
  • Most plans do not require authorizations for treatment .
  • If medical necessity letters are required, this may take up to 30 days.
  • PGS is not covered. Patient must pay out of pocket for those services .
  • PGD may be covered with medical necessity. Patient must pay out of pocket and get reimbursed by insurance company.
United Healthcare/Oxford
  • Most plans require a history, Day 3/AMH blood work, semen analysis, ultrasound and uterine evaluation before obtaining an authorization.
  • Authorizations can take up 7 days from the date of submission of your paperwork and cannot be backdated.
  • If medical necessity letters are required, this may take up to 30 days.
  • Authorization is required for each treatment plan cycle.
  • Many plans require lesser before greater treatment prior to approval (such as hMG/CC prior to IVF treatment).
  • Will cover up to 3 pregnancy monitoring visits prior to 8 weeks of gestation. Additional visits may be authorized is medically necessary.
  • PGS is not covered. Patient must pay out of pocket for those services.
  • PGD may be covered with medical necessity. Patient must pay out of pocket and get reimbursed by insurance company.
General rules for all other insurance companies
  • Many insurance companies have specific criteria that must be met for coverage.
  • If medical necessity letters are required, this may take up to 30 days.
  • Many insurance companies have limitation on their coverage such as maximum lifetime benefit coverage (up to $5000, $10,000 etc).
  • Many plans require lesser before greater treatment prior to approval (such as hMG/CC prior to IVF treatment).
  • Some insurance plans have high deductible and/or large co-insurances that you will have to meet.
  • PGS is not covered. Patient must pay out of pocket for those services.
  • PGD may be covered with medical necessity. Patient must pay out of pocket and get reimbursed by insurance company.

Marlton

400 Lippincott Drive
Suite 130
Marlton, NJ 08053
P: 856.282.1231
F: 856.596.2411

Burlington

1900 Mt. Holly Road
Building 4, Suite A
Burlington, NJ 08016
P:
609.614.3191
F: 609.386.4750

Sewell

570 Egg Harbor Road
Building B, Suite 4
Sewell, NJ 08080
P: 856.314.5013
F: 856.218.4651

Egg Harbor Twp

2500 English Creek Ave
Suite 225
Egg Harbor Twp, NJ 08234
P: 609.336.4115
F: 609.813.2303