Helpful Information Insurance: Participating Insurances The extent of coverage, benefits, and referral and authorization processes vary from policy to policy. It is important that you understand what is covered before you begin treatment, or what are the necessary requirements to get the maximum reimbursement. The finance department can provide some general guidelines on the most common policies within each plan. Some plans require referrals or authorizations. We encourage all patients to check the infertility benefits under your specific plan. Our participation with their insurance does not guarantee coverage for our services. The referral for the initial visit should include the following procedure codes: re 99245 or 99205 and 76856. The doctor issuing the referral will need to provide a diagnosis. RMA currently participates with 6 major insurance companies: Horizon Blue Cross/Blue Shield
The Horizon plan requires all patients to get referrals or authorizations from their Primary Care Physician (PCP). After the initial referral or authorization, the RMA Finance Department can obtain all future authorizations. Note: Spouses are not covered under patients' referrals and they must obtain their initial referral from their PCP. Commonly used codes include: Semen Analysis: 89320
Aetna US Healthcare (AUSHC)
AETNA/USHC: Most Aetna plans require authorizations from the infertility hotline at AUSHC. Please note, many plans that do not need referrals or authorizations for other specialists, including Choice POS and PPO plans, still need hotline authorizations for infertility services. The hotline can be reached at 800-575-5999. Infertility line authorizations are necessary to ensure coverage by your insurance. If you are not sure what your plan requires, please call the hotline. The infertility hotline does not authorize services for male partners. If your partner is covered under the same plan, he will need a Primary Care Physician (PCP) referral with codes for each specific test. Please contact finance for coding.
United Healthcare
United healthcare does not require referrals or authorizations for infertility services regardless of the type of plan.
Oxford Health Plan
Most plans do require a referral from the PCP or OB/GYN to us you should request a referral with 30 visits and for a 180 day (six months) time frame. Referrals must be submitted electronically to Oxford for all Oxford Members except those Members who have “No Referral” printed on the members Oxford ID card. Male Partners will also need to bring a referral from their PCP for any testing he may need to have at our office. Certain tests and or procedures will only be covered if your plan provides infertility benefits you should therefore contact Member service for specific benefit information regarding your policy.
Amerihealth
Some plans do require a referral from the PCP to see a specialist. Referrals are valid for 90 days and must be submitted electronically to Amerihealth for all members except those who have “No Referral” printed on their Amerihealth ID card. Male partners will also need to bring a referral from their PCP for any testing they may need to have at our office. Certain tests and or procedures will only be covered if your plan provides infertility benefits you should therefore contact Member service for specific benefit information regarding your policy. Cigna
While Cigna no longer uses actually referral forms, some plans (HMO and POS) do require patients be officially referred to specialists. If your plan does require referrals, you must obtain a script from your PCP referring you to an RMA physician. Male partners will also need to bring a script from their PCP for any testing they may need to have at our office. Certain tests and or procedures will only be covered if your plan provides infertility benefits you should therefore contact Member service for specific benefit information regarding your policy.
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