YES, Repromedix Accepts Insurance!

If you have been navigating the maze of rules and regulations surrounding insurance and infertility treatment, you won’t be surprised to learn that insurance coverage for advanced infertility testing is complicated. Coverage varies by patient, depending upon your insurer, your policy, and your diagnosis.

Repromedix cannot verify or guarantee that the cost of your testing will be covered by your specific insurance plan, but our unique Patient Support Program demonstrates our commitment to helping you receive the maximum amount of coverage for any testing that we perform.

If your insurance company does not pay for all or part of your test, it does not mean the test is not appropriate or necessary. Your physician knows you and your condition, and he or she is the best judge of your care. While it is ultimately your choice whether to have the test performed, you should make an informed decision in consultation with your doctor.

The Repromedix Patient Support Program

One of the goals of our Patient Support Program is to educate patients about the insurance process and help them maximize their coverage. We recognize there may be an expense involved when your doctor orders a test through us, and we want you to know what to expect from your insurer.

Our Program has three components, each unique in the field of advanced reproductive diagnostics:

• The Patient Advocate
• The Safeguard Payment Plan
• Flexible Payment Options

The Patient Advocate

The Repromedix Patient Advocate helps you work with your insurance company to obtain maximum coverage for your tests. You’ll hear from our Advocate as soon as your doctor submits a test requisition form to Repromedix…here’s how the process will work.

• Upon receiving your test requisition form, the Patient Advocate will contact you by phone and leave a message if you are unavailable. PLEASE RETURN THE CALL PROMPTLY so that you will have the maximum amount of time to consider your options.
• The Patient Advocate will discuss the cost of the test(s) your doctor has ordered, Repromedix’s payment options (including our Safeguard Payment Plan that limits patient costs), and the insurance billing process. We will answer any questions you may have about working with your insurer to maximize coverage, as well as any questions about our tests.
• You will then receive a letter from Repromedix explaining the payment options in writing. The letter will include a form for you to sign and return to Repromedix, to let us know which option, if any, you are selecting.
• If your insurance company declines to pay for all or part of your test, our experienced medical billing team will file all appropriate appeals. You’ll also receive guidance on advocating for yourself with the insurer. As the insurance subscriber, you are in the best position to resolve coverage issues with your insurer.

Our Patient Advocate is on your side and always available for consultation.

Safeguard Payment Plan*

Repromedix recognizes that patient copays and deductibles are an increasing part of your health care dollar. In addition, because the rules of managed care plans often vary depending on the status of the health services provider, such as whether they are in network or “out of network,” we know that it is often difficult for patients to understand how much they will ultimately be asked to pay.  We developed the Safeguard Payment Plan so it would be clear—upfront—the amount that you would be financially responsible for.

If you select the Safeguard Payment Plan, you pay a fraction of the total cost of your testing. This is the amount we have calculated as the patient payment average including all balance bills, copays, and deductibles. If you pay that amount, Repromedix will not hold you responsible for any additional cost. Repromedix will work with your insurance company to obtain payment for the insurer’s share. And, if it turns out that you did not owe the full amount that you paid, we will refund the difference to you.

Example

If we collect nothing from your insurer, you are still only responsible for the Safeguard Payment amount—guaranteed.

You do not have to select the Safeguard Payment Plan. If you do not, Repromedix will bill your insurance company for our usual and customary fee, and you may be held responsible for the difference between the amount paid by insurance and our fee.

Flexible Payment Options

Repromedix accepts most major credit cards, including VISA, MasterCard, Discover, and American Express. Under certain circumstances, we will work with you to establish a mutually acceptable payment schedule.

* Commercial Health Insurance includes most PPO and traditional indemnity insurance programs. Commercial Health Insurance does not include Medicaid, Medicare, and Champus insurance plans. Call our Patient Advocate to see if your Commercial Health Insurance qualifies you to participate in the Safeguard Payment Plan. Patients without  Commercial Health Insurance are not eligible for the Safeguard Payment Plan.

Patients without Commercial Health Insurance are not eligible for the Safeguard Payment Plan.

How Your Clinician Can Help

To increase the likelihood of your insurer covering tests ordered through Repromedix, a few minutes of your clinician's time can make a big difference. Pass these suggestions along to your physician, nurse, or other practitioner:

• Infertility tests are more likely to be covered than infertility treatments. Your physician should consider the potentially broader health problem associated with infertility when selecting a diagnosis code for your Repromedix tests
• Make sure to include a copy of your current insurance card along with the test requisition to Repromedix

Your Clinician CAN Go Out of Network: Pass the Word Along!

• Many clinicians are under the incorrect impression that they cannot order a test from an out-of-network laboratory
• In fact, hundreds of physicians regularly go outside their network to order tests through Repromedix
• If your practitioner's Exclusive Laboratory does not offer the "equivalent test" to ours, or does not offer the test at all, he or she can order the test from Repromedix
• Clinicians can generally also go outside their Preferred or Participating Laboratory to order tests from Repromedix without any sanctions.
• As an out-of-network laboratory, Repromedix participates as a willing provider to hundreds of health plans.

Tests vs. Treatments

Why is infertility testing generally covered by insurance while infertility treatment generally is not, and what are the differences in coverage?

Treatment

• In 13 states, insurance companies are required by law to offer some coverage of infertility treatment (called "mandated coverage")
• In the remaining states there is no mandated coverage for infertility treatment, and specific infertility coverage may not always be available to the policy subscriber

Diagnostic Tests

• Hundreds of insurance companies throughout the United States regularly cover infertility testing, even if they do not cover infertility treatment
• One key reason is that many causes of infertility are basic health problems, often with serious and diverse health consequences that go beyond infertility
• Despite a greater willingness to cover tests, patients with limited fertility coverage on their policies may initially be denied reimbursement for these tests. Repromedix works diligently with you to advocate on your behalf.

Click here for a list of insurance companies, by state, with which Repromedix has recently worked successfully

For more information, contact our Client Services department at 800-667-8893 or email us at clientservices@repromedix.com.