Fertility Insurance

Conceive NJ is in Network and a participating provider with the following health insurance plans

• Aetna
• AmeriHealth
• Cigna
• EmblemHealth/GHI
• Horizon Blue Cross Blue Shield of NJ
• Optum/Oxford
• Magnacare
• Meritain
• Multiplan
• Out-of-state Blue Cross Blue Shield
• United Healthcare/UMR
• WIN Premier
• 1199

Call us or message us for custom quotes to check your plan coverage or self-pay pricing if needed. Before your first appointment, we check your personal fertility coverage and options – more details below. If you don’t see your insurance on our list, contact us to review your current coverage or to discuss financing options.

Explanation of fertility insurance benefits

What to expect when verifying your fertility insurance coverage

As you schedule your initial consultation, we’ll ask you to provide your ID and health insurance card(s) (along with your partner’s, if applicable), so that our billing team can verify and maximize your fertility benefits.

Within a few days you will get an email from our billing department once we verify your insurance coverage. Health insurance fertility benefits can vary widely depending on your plan and coverage, but may include (or specifically exclude) benefits such as:

• Infertility diagnostic testing and related procedures.
• Specific fertility treatments such as intrauterine insemination (IUI), in vitro fertilization (IVF), preimplantation genetic testing (PGT) of embryos, and/or cryopreservation (preservation by freezing and storage) of eggs, sperm and embryos.
• Inclusions/limits to number of treatment cycles and/or dollar amounts.
• Whether or not fertility medications are covered as part of your plan.

We will also uncover other health insurance details for your plan, such as:

• When pre-authorizations are required.
• Expected out-of-pocket patient costs dictated by your insurance plan, including co-pays, deductible amounts and percentage of co-insurance that you may be responsible for.
• Services that may not be covered by your plan such as embryo biopsy or long-term egg or embryo storage.

Conceive NJ patients will get a Klara text message from billing about estimated consultation fees due at the time of appointment. These fees will either be billed toward your deductible or a specialist co-pay, depending on coverage.

If you require clarification regarding your out-of-pocket cost share, you may also check with your insurance company’s member services department (the phone number is typically on your health insurance card).

Following both your initial consultation as well as the treatment plan follow-up visit with our doctor, you will have the opportunity to discuss your out-of-pocket responsibility with your Conceive NJ financial counselor.

Disclaimer: Coverage and benefits are subject to the terms and conditions of your health insurance policy. Please consult with your insurance provider for specific information regarding your plan, as eligibility, cost share and limitations may vary. This communication is for informational purposes only and does not guarantee coverage or payment by your insurance provider.

Definitions of common insurance benefit terms

Co-pay

A co-pay (co-payment) is a standard charge the patient must pay up front for a specific healthcare service. Co-pays sometimes go into effect after a patient has met their deductible fee.

Co-insurance

Co-insurance is the percentage of a particular service’s cost the patient is responsible for. It’s similar to a co-pay, but instead of a fixed co-pay fee, the patient would have a co-insurance fee that might be 20% of the service’s cost. The insurer would pay the remainder of the service cost.

Deductible

This is the patient’s financial responsibility for a covered service before the insurance plan begins to make any payments. If a patient has a $1,500 deductible in their annual insurance plan, they must have paid $1,500 of their own funds for medical care before the insurance plan is responsible for making any additional payments for covered services.

Maximum out-of-pocket

Insurance plans often put a cap on what the patient must pay themselves for healthcare services over the term of the insurance plan. This is called a maximum out-of-pocket cost. After the patient has reached the plan’s cap on out-of-pocket payments, the insurer typically pays 100% of care moving forward, provided it’s a covered benefit.

Definitions of common fertility insurance benefit terms

Each insurance company and its specific plans can have different definitions of treatments covered, as well as many types of qualifying information and requirements per treatment. The following are general definitions and are not specific to any one fertility insurance plan.

Fertility testing

Female fertility testing may be covered services when necessary to establish cause of infertility. These can include: medical history and physical exam, laboratory testing for hormones, ultrasound, hysterosalpingography, saline sonography, hysteroscopy, ovarian reserve testing, and other related tests and examinations.

Male fertility testing services necessary to determine cause of infertility that may be covered include: medical history and exam, semen analysis and laboratory test for hormone values.

IVF cycle

An in vitro fertilization (IVF) cycle coverage may include these elements: ovulation induction, lab testing and ultrasounds, egg retrieval, sperm prep, embryo evaluation and embryologist services, and embryo transfer for an intended pregnancy.

FET

Frozen embryo transfer (FET) is the process of transferring frozen embryos created in a prior IVF cycle. The embryo is placed into the uterus after thawing during a treatment cycle. Coverage can include thawing, preparation of the uterine lining, and monitoring via labs and ultrasound.

IUI

Intrauterine insemination (IUI) is a fertility treatment procedure where sperm is collected and processed, then placed directly into the uterus around ovulation or in the case of donor sperm, it is thawed and prepped for an IUI.

ICSI

Intracytoplasmic sperm injection (ICSI) is standard in many IVF laboratories during IVF in which a single sperm is directly injected into an egg’s cytoplasm to facilitate fertilization.

Anesthesia

Anesthesia for fertility treatment is anesthesia or conscious sedation used during procedures such as egg retrieval during IVF in order to keep the patient safe and comfortable during the retrieval process.

Embryo biopsy

Frozen embryo biopsy is a process where the outer layer of the embryo is opened using a laser and a small number of cells from the outer layer is removed for use in genetic analysis.

PGT

Preimplantation genetic testing (PGT) is the actual genetic analysis of IVF-created embryos to detect a variety of abnormalities that can result in implantation failure, miscarriage or birth defects in a child.

Assisted hatching

Assisted hatching is a micromanipulation technique used in IVF to create a small opening in the zona pellucida, the outer shell of the embryo. This process serves two main purposes: it allows access for embryo biopsy, enabling the safe removal of cells for genetic testing (PGT); and it can help the embryo hatch and implant more easily into the uterine lining, particularly in cases of implantation challenges.

Cryopreservation

Cryopreservation is the process of freezing and storing biological materials at extremely low temperatures for future use, often used in IVF to preserve extra embryos or for fertility preservation. The most common method is vitrification, a rapid freezing technique that uses high concentrations of cryoprotectants and quick cooling in liquid nitrogen to prevent ice crystal formation, which could damage the cells. This same vitrification method is also used to freeze unfertilized eggs, allowing individuals to preserve fertility before undergoing treatments or when delaying childbearing.

Fertility medications

Fertility medications are prescription medications for uterine lining preparation or for ovulation induction and ovarian stimulation, for use with either IUI or with IVF. For self-pay patients, Conceive NJ partners with reputable pharmacies that offer competitive self-pay pricing, helping patients save as much as possible on their fertility medications.