Financial FAQs

• PPO plans (Preferred Provider Organization) typically do not require any referral but it is important to call the plan prior to any initial consultation/treatment to check with them regarding this issue.
• HMO plans (Health Maintenance Organization) ALWAYS require a pre-authorization from your Primary Care Physician (PCP) for a specialist visit.
• EPO plans can be either Managed Care or not. Please check with your plan to make sure any registration or pre-authorization/certification issues have been resolved prior to your initial consultation.
• FSA (Flexible Spending Account) is also known as a health saving account. It essentially moves the full burden of costs to you, the patient. If you do not spend any money on health care, you get to save the money in a special tax-free account. If you do utilize any health care services, you pay for the cost yourself.
• Co-payment is the amount due for an office visit (i.e. consult, follow-up visit, etc.). This fee is due at the time of service and is a pre-determined amount set by your health plan.
• Co-insurance is the percent of patient financial responsibility pre-specified by your health plan.
• Deductible is the pre-determined amount (or percentage) of expenses that must be paid.

• The answer to this question is not a simple yes or no
• You will need to contact your insurance directly to find out whether your employer has purchased infertility benefits and the extent of the infertility coverage

“Common” services that may be considered fertility-related and thus may not be covered:

• Diagnostic testing
• Saline sonogram
• Surgery
• Artificial Insemination (AI/IUI)
• In Vitro Fertilization (IVF)
• Egg cryopreservation

• Your first call should be to your health plan’s member services department
• You can also call your employee benefits office within the HR department
• Your HR representative should be able to walk you through your options

• Name of the insured person
• Insurance plan name
• Employee/Patient ID number or SSN • Group number
• Employer name 
• Patient’s name and DOB

Questions for your insurance provider:

• What are the specific infertility benefits in my plan?
• Will I have to meet a deductible before coverage begins? If so, how much?
• What is my level or percentage of coverage once my deductible has been satisfied?
• Is there a maximum payment or cycle cap on infertility treatment or on specific procedures?
• Are my infertility medications covered? If so, is the medication benefit separate from my infertility dollar or cycle maximum?
  • Please note that we do not dispense or bill for medications. Once you have a finalized medication protocol, please contact the outside specialty pharmacy of your choice to request a financial quote.
• Are there any exclusions or restrictions on my policy?
• “Is there an age limit?”
• Are there any criteria that must be met before you can access your benefits?
• “Am I required to have been trying to conceive prior to being able to access my infertility benefit?”
• “Is there an IUI requirement prior to proceeding with IVF?”
• “Are there any required lab tests that I must complete prior to accessing my infertility benefit such as FSH or E2 (estradiol)? If so, how often must I complete these labs?”
• Which blood draw labs/pharmacies are contracted with my insurance carrier?

Questions for your employer:

• Does my current health plan cover infertility treatments?
• If my current plan does not cover infertility treatment, is there another plan available that provides benefits? If so, what is the cost difference between the two plans? How and when can I change plans?
• Is there any required waiting period before I can start infertility treatment for pre-existing conditions?

• We offer a self-pay discount for patients that do not have insurance coverage or may have a limited benefit. Kindly note that you may not submit receipts or claims to insurance for reimbursement for self-paid services. The codes used to reflect this discounted rate are not recognized by insurance payers.
• Additionally, due to the nature of our self-pay packages, you are not able to self-pay for certain portions of an IUI or IVF cycle while billing insurance for others. The decision to self-pay or bill insurance must be made prior to the start of each treatment cycle.
• Additional resources for financing fertility treatment can be found through RESOLVE (www.resolve.org) and through ARC (www.arcfertility.com).

UCSF is partnered with ARC Fertility, an organization that provides financing for fertility treatment, as well as cycle packages for patients undergoing both IVF and fertility preservation cycles.