Financial Policies

Below are the financial flowcharts for the following services at Atlantic Reproductive Medicine:

Atlantic Reproductive Medicine’s Financial Policies

Thank you for choosing Atlantic Reproductive Medicine, (hereinafter referred to as “ARM”), for your infertility needs. We are committed to providing personalized financial services to each patient. We understand that the cost of fertility treatment can add additional stress to an already stressful process, and ARM wants to be as upfront as possible about costs associated with your infertility care. One of the toughest aspects of financial is having to inform our patients that they do not have coverage for treatment.

We always want our patients to have a wonderful experience and we do everything we can to ensure we are providing accurate information. However, the information we provide is only going to be as accurate as the information provided to us. We ask that all patients reach out to their insurance member services department to better understand their insurance benefits, coverage, and limitations.

As a courtesy, our Benefits Coordinator will reach out via email shortly after you schedule your new patient consultation visit to provide you with a brief overview of your infertility benefits, and your appointment responsibility. There may be an instance that we will require your assistance in verifying your benefits. If we need your assistance, we will reach out to you. Our verification of your insurance benefits is not a guarantee of payment. All benefit quotes provided are based on the information provided by your insurance carrier.

There is such a variance in pricing depending on cycle type that we do not provide detailed pricing until we have a treatment plan from the physician. After your consultation, our financial coordinator will be happy to provide you with a detailed breakdown of the fees based on the recommended treatment and how it relates to your quoted benefit coverage. You can visit our website’s Affording Care tab at https://www.atlanticfertility.com/estimating-fertility-treatment-costs/ to help estimate costs.

Our patients are the most important part of our practice, and we work timelessly to ensure your complete satisfaction, now and throughout your journey. Financial is available to answer any questions you may have about our fees, financial policies, or your insurance coverage. You can contact financial by either email at financial@atlanticreproductive.com or phone at 919-248-8777 option 4.

The following are the financial policies we have established for our practice. Your clear understanding of our financial policy is important to our professional relationship. Take time to carefully review the following information. Please ask if you have any questions regarding our policies.

PLEASE READ EACH SECTION CAREFULLY

INSURANCE

Atlantic Reproductive Medicine is IN NETWORK with:

AETNA – Our office does not participate with Duke Select plans.
BLUE CROSS BLUE SHIELD – Our office does not participate with Blue Home/Local plans.
CIGNA – Our office does not participate with Cigna Connect plans.
PROGYNY – A third-party insurance company that provides employer fertility benefits. It is the patient’s responsibility to contact their assigned Patient Care Advocate (PCA) through Progyny to receive authorization for their initial appointment and every appointment thereafter.
TRICARE – We do not participate with Tricare. As a courtesy we do accept Tricare for diagnostics only. Prime members must have a referral from their PCM to our physician. It is the patient’s responsibility to obtain the referral.
ARM will not file out-of-network claims and does not file secondary claims.

Please remember that insurance is a contract between the patient and the insurance company, and ultimately the patient is responsible for payment in full. If your insurance plan requires a referral from your primary care physician for specialist visits, registration before treatment or you use a preferred provider, it is your responsibility to abide by your insurance plan policy guidelines.

Accepting your insurance does not place all financial responsibilities onto this practice, and you will be held accountable for any unpaid balances by your plan. It is your responsibility to keep us updated with your correct insurance information and of any changes in coverage. If your claim is processed differently from the benefits we were quoted, the insurance company will side with the plan and will not honor the misquoted benefits we received. It is your responsibility to make sure we receive prompt payment from your insurance plan.

Insurance Disclaimer: “A quote of benefits and/or authorization does not guarantee payment or verify eligibility. Payment of benefits are subject to all terms, conditions, limitations, and exclusions of the member’s contract at time of service.” If your insurance determines that a particular service is not medically necessary, or that a particular service is not covered under the plan or you fail to abide by policy guidelines, you understand and agree you are financially responsible for any amount not covered regardless of reason.

Beneficiary Agreement: I understand that my insurance may deny payment for the services identified above, for the reasons stated. If my insurance denies payment, I agree to be personally and fully responsible for payment. I also understand that if my health insurance company does make payment for services, I will be responsible for any copay, deductible, or coinsurance that applies.

APPOINTMENTS

Your New Patient Consultation and Established Patient appointments at ARM will be either in the office or telehealth via Microsoft Teams with your physician. You will need to download the app prior to your scheduled appointment. The Benefits Coordinator will email you the day before or the morning of your scheduled appointment with your patient responsibility.

PAYMENT

It is the policy of ARM to request payment of any copay, unmet deductible, coinsurance, non-covered charges, or previous balances at the beginning of each visit. The amount you are asked to pay at each visit is an estimate of the charges for the appointment type scheduled. If you do not have insurance coverage payment in full is expected at the time of your visit. The Benefits Coordinator will email you the afternoon before or the morning of your scheduled visit with your patient responsibility. Please ensure to pay your visit responsibility prior to arriving to avoid any delays.

We accept cash, check, Visa, MasterCard, Discover and American Express credit cards. Please use our contactless payment option via our website at https://www.atlanticfertility.com/pay-medical-bills/

A $35 fee will be charged for any checks returned for insufficient funds. Regretfully, we will not accept any further check payments and you will be asked to bring cash, certified funds, or a money order for future payments.

SELF-PAY

It is our policy to require self-pay patients to provide credit card information that will be securely kept with Atlantic Reproductive Medicine. Under HIPAA, we are under strict state and federal rules and guidelines to protect patient privacy and the credit card is considered protected health information. Our practice management system securely stores and encrypts your credit card information, which will enable us to run the bank card transactions through our computer system. None of our employees will have access to your bank card information. No credit card information will be stored at our practice.

You will be asked for a credit card at the time you register for a new patient visit. By providing your credit card information, you are giving Atlantic Reproductive Medicine permission to automatically charge $150 to your credit card the morning of your New Patient Consultation, and a receipt will be immediately emailed to the email address provided during registration. The $150 collected is non-refundable and will be applied towards the $320 New Patient Consultation fee. The remaining amount of $170 will be charged to the credit card on file upon check-in to your visit and a receipt will be provided.

Credit Card on File Agreement: If the credit card provided at registration changes, expires, or is denied for any reason, you agree to immediately give Atlantic Reproductive Medicine a new, valid credit card which will be updated over the phone. Even though Atlantic Reproductive Medicine is not processing the card in person, I agree that the card may be used with the same authorization. I authorize Atlantic Reproductive Medicine to charge the credit card provided according to the terms outlined above. I certify that I am an authorized user of this credit card and that I will not dispute the payment with my credit card company; so long as the transaction corresponds to the terms indicated and is in accordance with the cancellation policy

INFERTILITY COVERAGE

Insurance coverage for infertility services can be confusing. It is the patient’s responsibility to contact their insurance and become familiar with their benefits. The following are the most common benefits for infertility services and treatment.

No coverage for infertility services. Unfortunately, this means you will not have coverage for any service in our office. You will be self-pay and will be expected to pay in full at the time of service.
Only coverage for the diagnosis/treatment of underlying cause of infertility. In this scenario, the insurance plan will usually cover the diagnostic services to determine the cause of infertility. This may include new patient consultation, labs, and other procedures.
Coverage for the diagnostic testing and coverage for infertility treatment. In these circumstances, coverage is provided for diagnostic testing and for some methods of infertility treatment. Understanding your individual coverage will help you anticipate whether a particular service is covered.

NOTE: Most plans exclude coverage of infertility services for couples in which either of the partners has had a sterilization procedure (ex. tubal sterilization or vasectomy), with or without surgical reversal. The inability to conceive in a couple who has undergone a voluntary sterilization procedure is not the result of disease, but the result of an elective procedure intended to prevent conception.

PATIENT BILLING

All charges may not be captured at the time of service, so you may be asked to make an additional payment at your next appointment or receive a statement. The statement will reflect the amount you owe after your insurance, if any, has processed your claim. Payment in full is expected on receipt of your billing statement. No further treatments may be started until previous balance is paid in full.

We understand your need for documentation. We will provide a detailed pricing sheet before treatment begins, which will indicate when payment is due. This will serve as your invoice for treatment. Upon request, once services have been rendered and insurance has processed your claim an itemized receipt will be provided. For all services, please allow seven business days for charges to be added.

TREATMENT CYCLE PAYMENTS

We require payment in full for any treatment cycle one week prior to the baseline ultrasound, and any previous balances. This also, includes spouse/partner accounts. If you have a previous cycle not processed by insurance, you will need to delay starting a new treatment cycle until the prior claim is paid.

It is your responsibility to reach out to financial to ensure you understand the costs associated with your treatment. The financial coordinator will prepare your treatment cycle quote and will answer any questions you may have about your financial responsibility. This is an estimate of your cycle responsibility based on your treatment plan and the benefits quoted. We cannot guarantee all services will be performed or if we have missed any fees, as not every cycle is the same. If your treatment plan should change beyond the services included in this quote, it is your responsibility to reach out to Financial for updated pricing. You are financially responsible for any amount not covered regardless of reason.

Your treatment cycle quote will provide you with a listing of Additional and Possible Additional fees not included in the total payment due. If your treatment cycle results in additional fees, you will be asked to make an additional payment at your next appointment.

We accept cash, cashier’s check, Visa, MasterCard, Discover and American Express. We do not accept personal checks for cycle payments. Please use our contactless payment option via our website at https://www.atlanticfertility.com/pay-medical-bills/

APPEALING TREATMENT DENIAL

Even with infertility coverage you can have treatment denied. You Have the Right to Appeal. If your insurance denies coverage for a particular treatment, service, test or procedure, an appeal still gives you another chance to have the service paid. The most important thing to remember when appealing is not to give up, especially if the denial can affect whether you can continue with treatment.

When it comes to appealing, the biggest challenge may be the time and effort it requires to appeal the denial. The process can feel overwhelming, just know that we are here to help guide you. Your health care team will work together to provide you with the information to support your appeal. The ability to have coverage for treatment is worth any extra effort that is required. The following are the most common reasons for denials:

Lifetime Maximum Benefit has been reached: Unfortunately, we cannot get this overturned. However, you can go to your employer’s HR to see if they can help you.
Treatment is deemed “Experimental and Investigational”: Unfortunately, this denial type cannot be overturned.
Treatment determined as “Not Medically Necessary”: Your insurance has determined that the treatment you requested is not medically necessary for your condition. Remember, your provider is never going to recommend treatment that they do not feel is medically necessary.
Infertility Benefit Denial: The terms of your plan limit coverage with guidelines that must be met. An example of this would be the member must undergo “x” amount of IUI cycles before moving to IVF. Unfortunately, ARM cannot appeal this denial. However, you can still appeal and/or go to your employer’s HR department to see if they can help by changing the criteria in the guidelines.
Medical Director Denial: Requests that do not meet the criteria for immediate authorization are reviewed by the Medical Director. Understanding what exactly is being denied will help determine the appeal approach. Does your policy require that you undergo a specified number of treatments or limit how many treatments they will cover?
Administrative Denial: The service is not covered under the policy. Unfortunately, this denial type cannot be overturned.

TREATMENT DIAGNOSIS MEDICAL CODING

The physicians in our office are specialists in Reproductive Endocrinology. If you are seeking care to achieve a pregnancy, most, if not all, of your visits will be coded as infertility or infertility related. This means the primary diagnosis will be infertility, followed by codes that describe any coexisting conditions, e.g., endometriosis, PCOS, RPL, abnormal menstrual cycle, etc. To request a change in diagnosis solely for securing reimbursement from an insurance carrier is inappropriate and is considered insurance fraud. Many insurance plans only cover services for the diagnosis and treatment of the underlying cause of infertility. Once treatment begins, claims for non-covered services will not be billed to your insurance company.

BLOODWORK

If your insurance requires you to use a preferred lab, it is your responsibility to inform the clinical staff. Depending on the type of bloodwork ordered, you will receive bills from the processing lab. Please contact the servicing lab with billing questions. Diagnostic bloodwork done in our office will be processed and billed by LabCorp. Please contact LabCorp at 800-762-4344 with billing questions.

ADMINISTRATIVE FEE

A non-refundable administrative fee will be charged for each treatment cycle. This fee covers the coordination of the treatment cycle including but is not limited to medication training and management, coordination with the ART lab, and other agencies (e.g., Igenomix, LabCorp, Myriad, etc.). Repeated nurse coordination appointments will incur an additional administrative fee.

Please note we do not use standard CPT codes for administrative fees, and they are not billable to insurance.

ANESTHESIA SERVICES

Our anesthesia services are provided by Certified Registered Nurse Anesthetists (CRNA). They are independent contractors that are not employed by ARM and do not accept or file insurance. Therefore, we are unable to bill your insurance for their services. We are unable to provide you with codes or billing information. We will provide a receipt for the payment. Please note that anesthesia services will not count towards any deductible or out of pocket totals and will not be billed to insurance.

The fee for anesthesia performed in our office is $650. There is a cancellation fee of $350 for the failure to adhere to pre-operative instructions resulting in the cancellation of your surgery for any reason.

OUTSIDE MONITORING FEE

To accommodate the needs of our patients, outside monitoring services are available for treatment cycle follicular ultrasounds and bloodwork. An Outside Monitoring Fee of $350 will be charged for each ultrasound visit not performed in our office that is not a part of a package. For all treatment cycles the standard monitoring fee applies in addition to a set outside monitoring fee based on treatment cycle and any fees paid to the performing office.

We do offer outside monitoring for ultrasounds and bloodwork to unestablished patients during normal business hours. If you are receiving care from another fertility practice and ARM is providing the outside monitoring service, the patient will be given self-pay rates.

MEDICATION COVERAGE

To provide our patients with a personalized pharmacy experience, we have partnered with Fertility Pharmacy of America (FPA). Your physician will send your prescriptions to FPA. A pharmacy technician from FPA will manage any needed authorizations and delivery of your medications. FPA will forward your prescription to any required pharmacy.

CANCELLATIONS, NO SHOWS & MISSED APPOINTMENTS

If it is necessary to cancel your scheduled appointment, we require 2-day/48-hour cancellation notice. Appointments are in high demand, and your early cancellation will give another person the possibility to be seen sooner.

Failure to provide a 2-day/48-hour notice for cancellation of your scheduled appointment will result in a $150 missed appointment fee. This fee must be paid before another appointment will be scheduled and you will be required to put a credit card on file to schedule a new appointment. Please note this fee will not be billed to your insurance.

CANCELLATION OF TREATMENT CYCLE

Should a cycle be cancelled for any reason, the patient will be responsible for any costs incurred prior to the cycle cancellation. A financial coordinator will review your treatment services rendered up to that point. If proceeding with another cycle, a credit will be issued for the difference between the original treatment cost and the costs incurred to the point of cancellation. Any credit balance can be used against future treatment costs, or a refund can be requested.

SURGERY BILLING

We want to help you understand how you will be billed for surgical services. In addition to our physicians performing surgery at ARM, they also perform surgery at Davis Ambulatory Surgical Center. We will provide a quote of the charges you will be responsible to pay based on your benefits. We do require payment in full to schedule your surgery. Please note ARM does not verify insurance coverage for any outside facility. Depending on your place of service, you will receive additional bills, described in the following details.

Surgery performed at ARM
- You will pay ARM directly for the physician surgical fee prior to scheduling surgery.
- You will pay ARM $650 for anesthesia. Anesthesia is not filed to insurance.
- You will receive a separate bill from the servicing provider of any Labs or Pathology.
Surgery at Davis Ambulatory Surgical Center (DASC) 919-470-1000
- You will pay ARM directly for the physician surgical fee to schedule your surgery (this includes assistant surgeon).
- DASC will contact you with your estimated responsibility for their facility fee.
- Anesthesia at DASC will be billed separately by Regional Anesthesia (919-384-0700).
- You will receive a separate bill from the servicing provider of any Labs, Pathology or Radiology.

MEDICAL RECORDS FEE

A $30 fee will be charged for copies of medical records given directly to the patient. However, we will forward your records free of charge to another medical office. ARM will have 10 business days to generate records before making them available for the patient to pick up. The 10 days will commence after payment has been received, and the patient has signed the appropriate medical records release form. It is requested that outstanding balances be paid in full prior to medical records being released. For medical records to be sent to another facility please allow up to 14 business days.

REFUNDS & OVERPAYMENTS

Patient or insurance payments for services resulting in overpayment will receive a refund check during the next refund cycle, if the patient and spouse/partner does not have any other patient responsibilities or pending insurance charges.

Learn More About What our Dedicated Financial Team can do for You!

Contact our financial team with any questions about fees, financial policies, financial options, and insurance coverage and benefits:

Email us: financial@atlanticreproductive.com
Call us: (919) 328-3126, option 4