Financial FAQs

What insurance plans does PFC take?

PFC physicians are providers with Brown and Toland Medical Group (BTMG) and Mills Peninsula Medical Group (MPMG) for HMO plans only, not PPO plans. 

Which plans cover infertility services and treatment?

This depends if the patient’s employer offers a group plan with a fertility benefit to their employees. A patient must check their own group benefit plan to determine coverage. If they are in a BTMG or MPMG HMO Plan, we will submit authorization requests to determine coverage for them.

Are medications covered under a patient’s plan?

If a patient has fertility coverage, medications will often also be covered. This is determined after benefits have been confirmed. 

Which pharmacy will cover a patient’s medications?

This is determined after benefits have been checked. Again, this will depend on the patient’s individual fertility coverage.

Does treatment require prior authorization?

With BTMG and MPMG, definitely yes. For other types of coverage, especially In Vitro Fertilization coverage, pre-authorization is often required. This is determined after benefits have been confirmed.

What does Courtesy Billing mean?

Although PFC does not contract with many insurance plans, we can submit claims on behalf of patients to expedite reimbursement if the patient does have a fertility benefit. This means that PFC will file our patients’ claims for them so they can get reimbursed for these services.

When is Courtesy Billing done?

Courtesy billing is done after services have been rendered.

Can PFC courtesy bill a patient’s insurance for the full amount paid before services are rendered?

No. Insurance claims can only be filed after services have been rendered.

When does a patient receive reimbursement from their insurance?

It takes 45 -60 days for insurance to process claims once they are received.

Why did the insurance company pay PFC instead of the patient?

Occasionally, the insurance company will send PFC payment. If this happens, PFC will refund the patient.

Are there financing or other payment plans available?

PFC does not offer financing or scheduled payment plans. We require payment at the time that services are provided.

How is it determined if a patient can be on the IVF Refund Plan or IVF Single Cycle Financial Plan?

A PFC doctor will determine whether or not a patient qualifies for these plans based on specific medical criteria. 

What is the overall cost for an IVF Cycle?

The costs of an IVF cycle can be highly variable depending on the patient’s diagnosis and treatment plan. This is determined once the patient’s protocol has been finalized by the PFC physician. Each patient is assigned a financial coordinator that will either meet with or have a telephone consultation with each patient to go over these costs in detail. 

Can PFC check insurance benefits?

Yes. Our Financial and Insurance Coordinators can check benefits and obtain the proper authorization for our patients’ service(s).

Is there a discount for cash paying patients?

No. Our contracted insurance plans do not allow us to discount services to non-covered patients. 

Can you resubmit claims to an insurance company if a patient’s claim is denied?

Yes. We can attempt to submit a rebuttal to an insurance denial if there are sufficient reasons to suspect there should be coverage.

If a patient has credit on account, when will they receive their refund?

Refunds are processed on the 15th and at the end of each month.