Financial policy

Thank you for choosing Atlantic Fertility for your fertility care. We are committed to providing clear, upfront financial information and personalized support throughout your journey.

Insurance coverage and fertility benefits can be complex. While we verify benefits as a courtesy, patients are ultimately responsible for understanding their individual insurance plan and all financial obligations.

Please review the following policies carefully. Your understanding of our financial policy is important to our professional relationship. Your signature confirms your understanding and agreement.

Insurance

Atlantic Fertility is In-Network with the following plans:

• North Carolina State Health Plan (SHP)
• Aetna
• Blue Cross Blue Shield (excluding Blue Home/Local & Marketplace plans)
• Cigna (excluding Duke & Cigna Connect plans)
• Progyny (authorization required for each visit)
• WinFertility

Tricare – Atlantic Fertility is not contracted with Tricare. However, we accept assignment for diagnostic services only. A referral is required for Tricare Prime beneficiaries.

Atlantic Fertility does not file out-of-network or secondary claims.

Insurance is a contract between you and your carrier. You are financially responsible for all copays, deductibles, coinsurance, non-covered services, and denied claims.

Insurance Disclaimer: A quote of benefits and/or authorization does not guarantee payment, eligibility, or coverage and is based solely on information provided by your carrier. All claims are subject to plan terms, limitations, exclusions, and medical necessity review at the time of service.

Patients are responsible for notifying Atlantic Fertility immediately of any changes to insurance coverage or eligibility. If coverage changes during treatment, the patient is financially responsible for all services rendered.

Beneficiary Agreement: If your insurance denies payment for any reason, you agree to be financially responsible for the balance, including copays, deductibles, coinsurance, non-covered services, and denied claims.

Appointments & Payment

Copays, deductibles, coinsurance, non-covered charges, and prior balances are due at the time of service. Payment in full is required for all self-pay services.

It is our policy to charge for physician telephone encounters that include evaluation and management of treatment.

A valid credit card is required on file for all patients, regardless of insurance coverage. Even when insurance is expected to pay in full, patient responsibility may still apply due to deductible, coinsurance, non-covered services, benefit limitations, or claim reprocessing.

Credit Card on File Agreement: I authorize Atlantic Fertility to charge my card for patient responsibility on the day of service. Receipts will be available via the patient portal. If my card changes, expires, or is declined, I agree to provide updated information immediately. I certify I am an authorized user and will not dispute charges consistent with this agreement.

Returned checks will incur a $35 fee. Personal checks are not accepted for treatment cycle payments.

Infertility coverage

Infertility coverage varies widely by plan. It is the patient’s responsibility to understand their specific benefit.

Common coverage scenarios include:

1. No infertility coverage — patient is fully self-pay.

2. Diagnostic coverage only.

3. Diagnostic and limited treatment coverage, subject to plan guidelines and criteria.

Many plans exclude infertility benefits when either partner has undergone voluntary sterilization (e.g., vasectomy or tubal ligation).

Treatment cycles, procedures & surgery billing

Payment in full is required prior to scheduling any treatment cycle, procedure, or surgery. All outstanding balances must also be paid in full before scheduling additional services. This includes any balances associated with a spouse or partner account.

If a prior treatment cycle or procedure claim has not yet been processed by your insurance carrier, you may be required to delay scheduling future services until the previous claim has been finalized.

Patients are responsible for contacting the Financial Department to review the estimated costs associated with their treatment. A Financial Coordinator will provide a written quote and answer any questions regarding your estimated financial responsibility.

Quotes are estimates only and are based on your treatment plan and the insurance benefits quoted at the time. Insurance benefit quotes are not a guarantee of payment by your insurance carrier. We cannot guarantee all services will be performed exactly as estimated or that additional services will not be required. If your treatment plan changes, additional charges may apply. Patients are financially responsible for any services not covered by insurance, regardless of the reason.

Procedure and treatment quotes will include a list of additional services not included in the total payment due. If your treatment results in additional services or fees, payment may be required at your next appointment.

Payment for physician surgical fees is required prior to scheduling surgery.

Surgical services may generate separate bills from other providers or facilities, including but not limited to:

• Surgery centers
• Anesthesia providers
• Pathology services
• Laboratory services

Certain services, including administrative fees, outside monitoring, and nitrous/anesthesia services, are not billable to insurance.

Prior Authorizations

Authorizations must be obtained prior to baseline ultrasound. If authorization is not in place, your cycle will be postponed.

Authorization does not guarantee payment. If a service is denied or not covered, you are financially responsible.

Billing & Balances

Balances are due upon receipt of statement. No further treatment may begin until outstanding balances are paid in full.

Charges are typically posted to your account within seven business days of service.

Third-Party Providers

To provide comprehensive care, Atlantic Fertility works with specialized outside providers for certain services. These providers bill separately from our office, and you may receive statements directly from them.

Common third-party services may include, but are not limited to:

• Laboratory testing (e.g., LabCorp)
• Genetic and embryo testing
• Endometrial testing
• Male fertility testing
• Surgery centers and anesthesia providers
• Cryostorage services (patients are responsible for ongoing storage fees associated with embryos, sperm, or reproductive tissue)

These providers determine their own participation status with insurance carriers. Atlantic Fertility does not verify coverage or file claims on behalf of third-party providers.

Patients are responsible for contacting the third-party provider directly regarding insurance or billing questions.

Appeals & Coverage Lifetime Maximus

You have the right to appeal insurance denials. However, certain denial types (lifetime maximum reached, non-covered services, administrative denials) cannot be overturned.

If your insurance plan includes a lifetime maximum for infertility treatment, it is your responsibility to monitor your remaining benefit.

Office visits, procedures, laboratory services, and medications may all apply toward your lifetime maximum. If your maximum is reached at any point during treatment, you will be financially responsible for all remaining charges. Future services become self-pay.

Atlantic Fertility will not knowingly submit claims for services that exceed your lifetime maximum benefit. If your insurance later recoups payment due to benefit exhaustion, you agree to be responsible for the balance.

Medical Coding

Services are coded according to medical necessity. Requests to alter diagnoses solely for insurance reimbursement are inappropriate and considered insurance fraud.

Medication Coverage

Atlantic Fertility works with specialty pharmacies. Prescriptions are sent to a specialty pharmacy, which assists with prior authorizations and medication coordination.

Medication coverage varies by plan. Patients are responsible for understanding pharmacy benefits and required authorizations.

Fertility medications are billed separately by the pharmacy and are not included in treatment cycle quotes.

Medical Records

Copies of medical records provided directly to patients are subject to a $30 fee. Records sent directly to another medical provider are provided at no charge.

Records will be released within 10 business days after payment (if applicable) and receipt of a signed authorization.

Cancellations

48-hour notice is required to cancel appointments. Missed appointments incur a $50 fee.

If a treatment cycle is cancelled or discontinued for any reason, patients are responsible for all services rendered prior to cancellation.