Understanding Insurance Coverage
At RADfertility, we recognize that a primary obstacle to pursuing fertility treatment is affording care. As part of your comprehensive treatment, we have a financial team who can help you through this process and offer a variety of financial options.
Understanding Your Insurance Coverage
It is important that you know what your benefits cover to ensure you understand your potential out-of-pocket costs. Your member services number is listed on the back of your card. Listed below are the most common types of insurance coverage and some questions you may want to review with your insurance carrier.
Types of Insurance Coverage
- HMO – These plans usually only offer in-network benefits. In addition, you will usually have to provide a referral for any visit.
- POS – These plans usually offer in and out-of-network benefits. However, you may still need a referral in order to maximize coverage.
- PPO – These plans offer both in and out-of-network coverage. You usually do not need a referral or authorization for these services either, but should always verify this with your insurance carrier.
Questions to Ask Your Insurance About Benefits
- Does my plan cover testing for infertility?
- Does my plan cover assisted reproductive treatment?
- What procedures require preauthorization?
- What limits, if any, apply to your coverage? (# of treatment cycles, procedures, months of therapy, embryo transfers, & age of patient)
- What is the maximum dollar limit on my infertility benefits? Does this maximum include prescriptions? If so, what portion is allocated to prescriptions, and what is allocated for treatment?
- Is the maximum dollar benefit lifetime or annual?
- What is the coinsurance or copayment for medical services?
- What is my out-of-pocket maximum and does it include my deductible?
- When does my plan year begin and end?
- What procedures are listed in the exclusions section?
- Do I have to undergo “lesser before greater”? This means, would I have to do IUIs before IVF?
- Does voluntary sterilization affect my benefits?
As always, please remember that you, the patient, are calling member services. Unfortunately, there are times that they provide incorrect information. RADfertility will also verify your benefits with physician services and review them with you. Until actual payment is received, benefits are not guaranteed.
Questions to Ask Your Insurance About Pharmacy Benefits
- Is there drug coverage?
- Are infertility drugs covered under the pharmacy benefit or medical benefit?
- What is the coinsurance or copayment for drug coverage?
- What prior authorization policies are in effect for medications?
- Are there 30-day drug prescription limits for infertility medications?
- Does the plan pay for self administered subcutaneous, under the skin injection (SQ) and/or oral (PO) medications?
- Does the plan pay for intramuscular (IM) medications?
- Are there discounts for mail order medications?
- Are infertility specialists encouraged to prescribe one drug over another?
- Can I get a medication that is not a preferred drug or formulary? Can I get a medication that is not covered? If so, am I expected to pay a higher copayment or coinsurance or pay for it completely? And what is that amount compared to the preferred drug copayment or coinsurance?
Always record when and who you spoke with, as well as the reason and the outcome. It is also suggested that you obtain a written pre-determination of your benefits. This is your most effective tool if you need to challenge a future decision made by your insurance company.
Request an Appointment
If you would like to schedule an appointment, please let us know which dates and times work for you. A Patient Navigator will contact you to confirm your appointment.
Take Our Fertility Assessment
Are you wondering if it's time to talk to a fertility doctor? Complete our fertility assessment and you will receive a personalized response from one of our fertility experts.
Get a Second Opinion
Second opinions can provide new possibilities on your journey. Call (302) 602-8822 to speak to one of our Patient Navigators and schedule a second opinion consult.
Learn More About Affording Care at RADfertility
In-Network Insurance Carriers
RADfertility has compiled a list of in-network insurance carriers to help you navigate your coverage.
RADfertility has a financial team who can help you through this process and offer a variety of financial options.
Does My Company Provide IVF Coverage?
According to FertilityIQ, employers nationwide continue to implement increased or enhanced fertility benefits year after year.
RADfertility has partnered with three different companies who finance fertility treatment to help you on the financial portion of your journey.
Treatment Discount Programs
RADfertility's discount programs can help offset some of the costs associated with treatment.
Medicine Discount Programs
In an effort to offset the costs associated with treatment, RADfertility participates in programs that offer medication discounts.
Delaware's Fertility Care & Preservation Law (SB139)
On June 30, 2018, history was made! Governor John Carney signed SB139, Delaware’s Fertility Care & Preservation Bill into law.
Peggy Sue O.
"I feel so lucky to have found RADfertility. I tried two other clinics before I expanded my search and found RADfertility. I drive an hour each way to go to them but I don’t regret a thing. They are so caring and so professional. Every time I message them they respond quickly. Every time I see them they have a friendly smile and warm welcome. They explain everything so well and I never feel lost in the process as I did elsewhere. They also took the time to figure out what was wrong. Other clinics threw up their hands, said 'I don’t know' and pushed me to try IVF."
"Dr. Feinberg and the entire staff at RADfertility are absolutely amazing. The receptionists, coordinators, nurses, and lab staff are compassionate, caring, and straight forward. I’ve had a 12-year infertility journey and I’ve tried other clinics but RADfertility was the only one I felt at ease with. They answered any questions that I had and were there any time I needed them. My coordinator, Amy, was the absolute best and always had my back. Dr. Feinberg’s dedication to his patients is incredible. You are not just a number there, you are a person with individualized needs and care."
"The RADfertility team gives you so much emotional support and positivity that it adds to your strength and keeps you focused on the end goal - a healthy and happy baby."
"My journey with RADfertility and Dr. McGuirk started when my husband and I were trying to conceive and were having difficulty. We went to RADfertility, where we met Dr. McGuirk. I always say she changed my life and 'fixed' me. Dr. McGuirk is always learning more about endometriosis and how to help her patients. She’s brilliant and truly cares for you! I’m eternally grateful to her and everyone at RADfertility for their unwavering support, love, and care."
"Every step of our journey was tailored to us. We were treated so respectfully. Every detail was clearly explained and we felt so comfortable. Rhonda Wright was a Godsend and inspiring. I highly recommend this place! I cried when my weekly appointments were done and I 'graduated.'"
"The staff and doctors are amazing. It will feel like home every time you walk in the door. They gifted us with our miracle baby and we couldn’t be happier. I will always recommend RADfertility above all others!"
"RADfertility's staff has heart and provided me with exceptional health care. I knew I was in good hands and felt like we were in this together. The doctors and nursing staff always answered all of my questions and provided thorough information about all of my options. I am so fortunate and appreciative of the care that I received at RADfertility. They go above and beyond."
"I cannot begin to explain how wonderful RADfertility is. We were frustrated with trying to start a family and it not working for us. The entire team of doctors and nurses made us feel comfortable and hopeful that we would be parents. We experienced so many ups and downs but we never felt like we were on our IVF journey alone, we had our RADfertility team every step of the way. If you're looking for a supportive team on the IVF journey, look no further. RADfertility is the absolute best."
Anonymous on FertilityIQ
"Dr. Schillings always kept us informed and never gave up on us. She always explained our options and risks with each procedure. She called us personally when there were any issues or sensitive subjects to cover. Dr. Schillings was the first doctor that had answers for us and wanted to help us have our miracle baby!"
4735 Ogletown-Stanton Road
MAP 2, Suite 3217
Newark, DE 19713
Silverside Medical Center
2700 Silverside Road, Suite 2A
Wilmington, DE 19810
Eden Hill Medical Center
200 Banning Street, Suite 240
Dover, DE 19904
Phone: (302) 602-8822
Fax: (302) 602-8832