1. Financial responsibility
Payment at Time of Service (TOS):
All patients at Wisconsin Fertility Institute (WFI) are required to sign a financial responsibility form prior to medical care / treatment. WFI will accept payment by cash, check, or major credit card for all services rendered at the time of service (TOS). If a patient is unable or unwilling to pay for insurance co-payments, deductibles, out of pocket expenses not covered by insurance, non-covered charges or any outstanding balances at check in, WFI reserves the right to refuse care and will reschedule the patient, if desired.
Proof of Insurance Coverage & Identity:
All patients are required to present insurance cards and a valid driver’s license at the initial visit as proof of coverage and identity. If applicable, the insurance card will need to be presented at every visit. If a patient has more than one health insurance plan, all insurance cards must be presented in the interest of coordination of benefits.
All patients are responsible for informing the practice of any changes to their insurance plan or personal demographic information at time of check in.
Patients without fertility benefits must sign a self-pay waiver prior to treatment; this waiver states that payment for services must be received by WFI prior to treatment or at TOS.
2. Insurance billing
If WFI is not contracted with your insurance plan and services are provided, WFI has the right to bill beyond “usual and customary” charges. WFI has a standard fee schedule available for your review if these charges apply.
WFI does not participate in any HMO or EPO plans and will not routinely bill for services rendered. If a patient requires demonstration of denial to cover out of pocket expenses for the purpose of accessing flex account funds, WFI will collect the entire amount billed to the patient. As a courtesy, WFI will then bill the insurance plan.
Referrals & Self Pay:
In the absence of complete insurance information, benefit and coverage verification and a preauthorization or valid referral (if required by the insurance plan), the patient is considered self-pay. If patients wish to have insurance coverage for services, they are responsible for obtaining a referral and/or a prior authorization if it is required by their insurance plan. WFI will not bill the insurance provider for patients who have not obtained the required referral or authorization for the initial visit and all subsequent visits. If these insurance billing requirements are not met, the patient will be required to pay at TOS or may opt to reschedule their appointment until they are able to satisfy their insurance plan’s billing requirement.
Non-Covered Benefits & Waivers:
Patients will be responsible for full payment of non-covered benefits. If WFI is not contracted with a payer and the payer denies payment for service, the patient will be responsible for the services rendered. WFI has a standard fee schedule available for your review if this should apply.
If WFI is contracted with a payer; and the payer denies payment for care, the patient may be responsible for payment based on payer guidelines that state that “a service is not a covered benefit but is the responsibility of the patient”.
Patients will be asked to sign a waiver to pay for services not covered by insurance. Failure to pay at TOS will result in the cancellation and/or rescheduling of the appointment.
Denied Pre-Authorized Visits:
Pending payer guidelines, if an insurance plan denies payment for a service that has been pre-authorized, WFI will contact the plan and perform one (1) appeal. Following outcome of this appeal, the patient will be deemed responsible for any unpaid balance. If further appeals are desired by the patient, WFI will provide the patient with all medical records, prior authorization information, and appeal information to enable the patient to personally submit additional appeals.
Special Surgical and Ancillary Services:
All procedures, including surgery, hysterosalpingograms, and sonohysterograms must be preauthorized; all deductibles, coinsurance, and non-covered services must be paid prior to the procedures with no exceptions. Procedures that are denied pre-authorization or are pending authorization will be considered non-covered services; patients may proceed with these procedures only by prepaying the estimated cost in full prior to the procedure.
Billing Process & Collections Agencies:
WFI processes all claims and submits them on a timely basis. All patient & insurance payments are posted daily. All patients receive current statements no less than every 30 days.
Be advised that any past due accounts will be sent to a collection agency regularly and failure to pay could result in your account being reported to all national credit bureaus.
Insurance Payment Refunds:
In the event that insurance remits a payment resulting in a credit on a patient account, WFI will refund the credit to the patient after reviewing all account information and verifying that there are no outstanding balances due for other dates of service. Refunds will only be rendered upon payment from insurance.
3. In Vitro Fertilization (IVF)
All patients wishing to undergo IVF treatments will sign an IVF financial agreement. All IVF services must be paid prior to or at the time of the baseline visit; the estimated payment must be reviewed and approved by the WFI financial department. If a patient is expecting insurance coverage for all or part of the treatment cycle, all authorizations must be in place prior to the baseline visit. While WFI will send a letter requesting predetermination and preauthorization of IVF treatment benefits, the patients are responsible for contacting the preauthorization representative of their insurance company in advance of treatment to notify WFI and provide proof of coverage. Payment by the patient will only be reduced upon written authorization of IVF coverage by the insurance carrier. Note that charges, including charges for ultrasound examinations and blood tests, will not be billed to insurance carriers unless preauthorization of benefits have been determined specifically for an IVF treatment cycle. Also note that the prepayment for many IVF treatment cycles is an estimate only, and charges may vary depending upon the precise services rendered.