Thus, it really does not matter whether you see an infertility specialist in or out of network, because no infertility services are covered. This means that even if you go to an in-network physician who provides infertility services to you, you will still be self-pay because the service itself is not a ‘covered benefit.’

In this circumstance, even though a practice may be in-network to you, you will be responsible for payment in full, since the services themselves will not be reimbursed by your insurance company. Identically, if the practice is out-of-network for you, you will also be responsible for payment in full at the time of each visit.

As you can see, in this situation, there is no difference in being in or out of network, if your particular insurance plan does not provide coverage for infertility services.

Our physicians are fellowship trained and Board Certified in Reproductive Endocrinology and Infertility.  They are dedicated to educating our patients regarding the various causes that affect fertility and working with you to develop a personal and successful treatment plan.  In addition to expert clinical care, Florida Fertility Institute is highly regarded for its commitment to the education of physicians, nurse practitioners, and physician assistants in-training as well as its involvement in clinical research.

Florida Fertility Institute takes pride as a leader and innovator in fertility care.

Florida Fertility Institute:

• Has the most experienced fertility experts in the Tampa Bay area.
• Is the only fertility practice offering family balancing (sex selection) in the Tampa Bay area.
• Has the largest selection of egg donors in the Tampa Bay area and encourages our patients to select their egg donor.
• Actively works with patients of the LGBT community to assist them in parenting.
• Has the most experienced microsurgeons in the United States to perform tubal reversals.

We welcome you to our practice.  It is our privilege to assist you in your journey.

In this scenario, the insurance plan will typically cover services rendered to determine that infertility does in fact exists, and that if it does, the nature or cause of the infertility. Once the above questions have been answered, which is at the time when the patient is given an infertility diagnosis by the physician, the diagnostic phase has come to an end.

During the diagnostic phase, an in-network office should collect your co-pay and file insurance claims for each visit in this phase. If you are out-of-network and have out-of-network benefits for the diagnostic phase, then you should expect to pay for services at each visit. You will then file your insurance claims and receive insurance reimbursement directly. In either case, some level of coverage is provided during this phase.

When the diagnostic phase ends, then no future infertility services are covered by the insurance plan in these cases. Thus, when the treatment phase begins, you will be expected to pay for all services when rendered, whether you are in or out of network.

In these circumstances, coverage is provided for some methods of infertility treatment, but not others. We have seen situations where oral agents such as Clomid therapy is covered, other ovulation induction using injectable gonadotropins is not covered, intrauterine insemination (IUI) is not covered, and so on.

We have seen few cases in which in vitro fertilization is a covered service, although we have seen some.

Again, whether you are in or out of network will not matter, because what matters is whether the service itself is a covered benefit. Thus, if the service is not a covered benefit, even though you see an in-network physician, you will still be self-pay at each visit, just as if you were out-of-network.

The question is whether your plan covers diagnostic infertility services and infertility treatment services; if it covers infertility treatment services, it is important to know which services are specifically covered and which are excluded from being covered.

There are as many combinations of possibilities with these insurance scenarios as there are companies for whom the insurance plans are developed.

We have had circumstances where patients have questioned whether a visit can be “coded” as something other than infertility, when in fact the infertility diagnosis is the proper one to assign. For example, although a couple’s infertility may be caused by endometriosis, a “covered” service, it would be misrepresentation on our part to state that we are seeing the patient just for the endometriosis when in actuality we are treating their infertility. Not only is such action unethical, but it may also constitute insurance fraud. Just as we commit to our patients to be honest and forthright, so too are we honest and straightforward with the insurance companies that we contract with.

It is also important that you know that your insurance companies have the right to review claims for proper reimbursement for up to three years after the claim is made. This means that reimbursements that were made in the past for what was communicated by the insurance company as a covered diagnosis for service can be reversed. When this occurs, the insurance company can demand refund reimbursement from you or from the practice, depending on who was paid for the benefit. Should an insurance company in the future deny benefits for services rendered in the past and thus request refund of payment to them, the payment for the services becomes the responsibility of the patient. Insurance companies can and will pursue reimbursement from patients and will use any and all means necessary to get these payments including legal action.

Understand your plan — what it covers and what it does not. Make certain that all of your decisions in your infertility treatment process are based on your full understanding of the nature and scope of the related clinical, psychological and financial elements.

Florida Fertility Institute utilizes the IVF Center for all in-vitro fertilization, egg retrievals and transfers of embryos. The IVF Center does not contract with any insurance company and all facility fees are paid directly to the The IVF Center.

The following are the IRS rules regarding medical expense deductions that may apply. It would seem to reason that if a wife needed her husband’s help to travel to and return from the medical treatment, his costs would also be deductible.

The costs of transportation primarily for and essential to medical care qualify as medical expenses under Internal Revenue Code Section 213(d)(1)(B). This includes food and lodging expense while en route to the place of medical treatment, (IRS Regulation 1.23-1(e)(1)(iv) as well as taxi, train, plane and bus fares. Expenses for meals and lodging away from home are medical expenses if they are part of the cost of care in a hospital or other institution or medical travel expenses. The taxpayer may deduct as a medical expense amounts paid for lodging (not food) while away from home, that is primarily for and essential to medical care in a hospital or equivalent, up to $50 per night for each individual (Internal Revenue Code Section 213(d)(2)). Please discuss this with your accountant since IRS rules change.