FET and me: An Information resource for IVF

IVF Bills.

You may be self-pay or have insurance coverage. This perspective is from someone who has used insurance for costs for IVF coverage.

• The clinic obtained a prior authorization from our insurance at the beginning of our infertility treatment and gave use a breakdown of exactly what was covered. For example, an egg retrieval and associated costs were covered (the procedure and the anesthesia), but the embryo biopsy, cryo, and storage was not.

• Before we could start any cycles (retrieval or transfers), the financial counselor would make sure she had a deposit prior to starting. This would not include medications.
• While our insurance covered both medications and procedures, the prior authorization for medications took less time than procedures.

Important concepts to understand for insurance. I am not going to go over each definition, and every insurance carrier will be different. But these all play a factor into costs.

• Copay – what you will owe for each medication, lab, procedure, ultrasound
• Deductable
• Out-of-pocket max
• In-network/out-of-network

Codes: Insurance billing is confusing, but may be broken down into parts.

• CPT code
• Diagnosis code
• What your insurance is willing to pay the clinic
• What your clinic charges your insurance
• What you owe

I only really understand CPT codes and diagnoses codes, so I will explain that.

• CPT code: These are numerical codes (usually 5 digits) used to describe medical and surgical procedures and services, basically how your clinic bills for the things that your had done. It’s not one code per procedure, for example, one lab draw may have 3 lab codes and one code for the actual drawing of blood. Procedures are more complicated, because they may have facility codes, physician codes, medications codes, and anesthesia codes.
  • Your clinic can provide these for you prior to a procedure.
• Diagnosis Code: Each CPT code should be linked to a diagnosis code. Essentially, each CPT needs a “reason”, and that is the diagnosis. These are based on ICD-10, which is a medical coding system. There are websites that have all the codes you can search.
  • Your clinic can provide these codes for you.

If you think a bill was not coded properly, you can ask for it to be resubmitted to your insurance. For example, my clinic linked the wrong diagnosis code and my insurance denied the coverage, and I asked them to resubmit it with the right code, and it was accepted.

• When choosing an insurance plan or looking over what your insurance covers on their website/plan brochure, they may include codes.

Codes!! (examples, not exhaustive list and may have errors. Double check yourself for updates on codes)