Out-of-Network/Non-Participating Insurances

Most Point of Service plans allow you the flexibility to choose at the “point of service” to seek medical care out of network. If you have out of network benefits, please see below:

Step One

  • Confirm that your plan has both out of network and infertility benefits.
  • Payment is required at the time of service and prior to the start of any treatment cycle. Please call your RMA of New York Billing Coordinator to discuss financial payment options: credit card, check, cash, wire transfers, or loan programs.

Step Two

  • RMA of New York will provide you with a statement for you to submit to your insurance provider for reimbursement.
  • Depending on your plan, you will receive the percentage reimbursement of charges.The following is an example of an Out of Network Plan. Please note this is only an example; for specific information regarding your plan, please review your out of network coverage with your insurance carrier. You may speak with our Finance Department to review specific dollar amounts.
Health Options PPO Plans

In Network

Out of Network

Calendar Year Deductible None $250.00 amount per individual $500.00 amount per family
Calendar Year Out of Pocket Maximum Dollar Amount Deductible Per Individual $250.00 deductible 80% of Reasonable and Customary Charges* up to $2,000.00 Out Of Pocket, then 100% for the remainder of the calendar year.
Outpatient Doctor Visit 100% After $10 co-pay 80% of reasonable charges after deductible

Using the above example and applying to a typical IVF cycle, the following is an approximate cost:

Estimated Cost for IVF Cycle
$ 9,215.00 (1)
LESS: Est. Deductible
$ 250.00
Coinsurance (20%)
$ 1,800.00
Estimated insurance reimbursement to you for a typical IVF Cycle
$ 7,165.00

* Your insurance company determines reasonable and customary charges. For better reimbursement, you can submit a pre-determination letter that includes the breakdown of fees and CPT codes to your carrier.

(1) Estimated IVF Cycle cost does not include ICSIEmbryo StoragePGD, Medications, or services rendered prior to the start of your IVF cycle or after the first pregnancy test.

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