Fertility Insurance Coverage

Fertility Insurance Coverage: Plans Accepted by IVF Plano

IVF Plano accepts most insurance plans, including PPO, POS, and HMO plans. If you would like to verify that we can take your carrier, please contact our business department at 972-612-2500. For more detailed information, submit a New Patient Form online for a verification of benefits.

Common Insurance Plans We Accept:

  • Accountable (First Health) PPO
  • Aetna – PPO & HMO
  • Beechstreet PPO
  • Blue Cross/Blue Shield PPO/POS/HMO
  • Coalition America (Formally NPPN)
  • CCN PPO
  • ChoiceCare – Concentric Network PPO
  • ChoiceCare – PPO
  • Cigna PPO/HMO
  • Community Health Plan – PPO
  • Doctor and Patient IPN – PPO
  • First Health Network – PPO
  • Galaxy Health Network – PPO
  • Great West Open Access
  • Great West POS
  • Great West PPO
  • Galaxy Health Network – PPO

  • Healthcare Partners of ETX
  • Healthsmart – PPO
  • Humana/Choice Care PPO
  • IMS PPO
  • Medcorp southwest – PPO
  • Multiple Independent School Districts – PPO
  • PPONext
  • Richardson Independent School District – PPO
  • Texas Health Choice – PPO
  • Texas True Choice – PPO
  • Texas True Choice – Star Network
  • United Healthcare PPO/POS/HMO
  • USC Health Services – PPO
  • Principal Commercial PPO
  • PHCS PPO
  • Plano Independent School District
  • PlanVista – PPO
  • And MANY others!

 The Fertility Insurance Verification Process

With verification of insurance, your carrier may require additional forms such as pre-authorization for infertility related services. We are happy to file the paperwork for you, but this information may take several days to complete and be returned to our office by your insurance company. To help expedite this you process, we ask that you secure any pre-certifications and referrals, when necessary, prior to your first appointment so that you can begin treatment as quickly as possible.

The Insurance Benefit Verification Form can be a helpful resource in uncovering your exact medical benefits by giving you the right questions to ask. Also writing a letter to your insurance company outlining your treatment plan may also be helpful in gaining coverage for procedures and medications. You can use the letter templates: letter for requesting predetermination and letter requesting predetermination for drug coverage to help you with this task. If you have questions about your insurance coverage or the coverage letters, please call the business office at 972-612-2500; or contact your insurance provider if you have any questions about benefits and additional paperwork.

**NOTE- Some insurance plans will have IVF Plano listed as Dr James W. Douglas, MD, PA so be sure to ask for both names when verifying your insurance benefits.

**For additional resources about insurance verification and pre-determination visit Fertility Lifelines

Although we have a great deal of experience with insurance verification, sometimes insurance companies will refuse payment of a claim or state conflicting information even after benefits have been verified. If you receive a denied claim or refusal of benefits, we recommend that you call the insurance provider or your human resources department for additional verification.

Additional Information on Fertility Insurance Coverage

In an effort to make infertility treatments less of a financial worry and to ease some of the stress that comes with treatment, our practice has contracted with a number of insurance companies who offer varying degrees of infertility treatment coverage. Please contact your insurance provider to determine whether they offer coverage for infertility treatment.

**NOTE- Some insurance plans will have IVF Plano listed as Dr James W. Douglas, MD, PA so be sure to ask for both names when verifying your insurance benefits.

Covered Labs

Insurance companies usually require their members to use certain laboratories for diagnostic tests. In most cases, we cannot verify lab information along with medical coverage for fertility. Please inform our office staff which laboratory contracts with your insurance company to ensure that we send your lab orders to the correct provider. Unfortunately, once blood work is drawn, our staff can’t undo an error in the laboratory choice, and you will be responsible for denied lab tests, or high out-of-pocket co-pays.

Pharmacy Benefits

Some insurance companies require that you use a specialty or mail-order pharmacy for your infertility medications. This pharmacy benefit information may not appear on the medical card that you provide to our staff. If you know that you have this type of plan, please give us the appropriate paperwork or fax numbers to expedite your prescriptions, and we will see that your prescription goes to the correct provider.

IVF Plano works with several dependable specialty pharmacies that will double check prescription and medical benefits, as well as mail medications and supplies directly to your door. These specialty pharmacies have extensive knowledge concerning fertility therapy and will usually provide quick delivery of needed medication.

True mail order pharmacies, like Merck Medco, may have enrollment procedures that will require several weeks of processing before medications can be shipped. Make sure to begin the enrollment process for your mail order pharmacy as soon as possible so you do not experience a delay in receiving your medications.