Cost and financial considerations frequently play a major role in decision making about fertility treatments. Many patients have insurance coverage but the extent of coverage varies widely and figuring it out can be a challenge. Our financial coordinator, Maria Castillo, acts as a patient advocate to determine if a patient’s insurance includes infertility treatments, how much is in fact covered and how best to utilize this coverage.
There are 3 main types of health insurance: traditional indemnity policies, PPOs and HMOs. Indemnity and PPO policies do not restrict their subscribers’ choice of a fertility specialist, but HMOs typically require pre-authorization in advance of a visit to a fertility doctor and any treatment.
In the case of PPO insurance, receiving care from a physician who is a preferred provider usually reduces the patient’s out-of-pocket expense. Dr. Chetkowski is currently a preferred provider with Aetna PPO/Managed Choice through an individual provider contract. In addition, through his membership in the Alta Bates, Hill Physicians and Bay Valley Medical Groups, he participates in the following physician networks:
| HMO: |
Alta Bates Medical Group Hill Physicians Medical Group Bay Valley Medical Group
Sutter East Bay Medical Foundation
|
| PPO: |
Aetna PPO/ Managed Choice
First Health/CCN
BRMS (Benefit & Risk Management)
Galaxy Health Network
Great West
Health Net PPO
Interplan
Multiplan
PHCS (Private Health Care Systems)
CFMC (California Foundation for Medical Care) |
Even if your insurance plan is not on the above list, you may still have coverage for treatment by Dr. Chetkowski.
The exact terms of coverage depend upon which plan is purchased by your employer because insurance companies typically offer multiple plans. Insurance plans purchased individually rarely, if ever, offer infertily coverage. After your initial visit, our financial coordinator, Maria Castillo, will work with you and your insurance carrier directly to assure the most favorable terms of coverage for treatment.
In advance of your initial consultation, you can review your health plan summary description which lists services that are excluded from coverage. If the plan states that “infertility is covered but inseminations and assisted reproductive technology treatment are excluded,” that usually indicates that diagnostic procedures, surgery, ultrasounds, blood tests and fertility medications may be covered but that the laboratory portion of IVF is excluded.