Illume Fertility partners with many major insurance carriers to help make fertility treatment more accessible.
While insurance coverage varies widely by plan, this guide explains which insurers we accept, what being "in-network" really means, and how to confirm your specific benefits before beginning treatment.
We are in-network with many major insurance carriers and benefits providers, including:
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Here are a few things to keep in mind as you explore your options. Remember to always confirm all plan details with your insurer and your Illume Financial Coordinator before starting treatment.
Illume Fertility is not in-network with Medicaid, Medicare, Fidelis, or other government-funded programs.
If you have an HMO, you may need a referral from your primary care provider or OB-GYN before seeing us.
Coverage varies by employer and plan; participation can change. Financial Coordinators help verify in-network status.
Authorizations may be required; fertility medications may fall under pharmacy benefits and require a specialty pharmacy.
Insurance benefits can look very different from one patient to another. These four key points will help you understand what your plan may cover (or exclude) at Illume Fertility.
If Illume Fertility is in your insurance network, the costs you pay will usually be lower. You’ll still need to meet your normal deductible, copays, and co-insurance.
If Illume Fertility is out-of-network, you may still receive some coverage. Out-of-pocket costs are typically higher and prior authorization is often required.
Even with coverage, some plans cap the number of treatment cycles, set age limits, or place dollar maximums on benefits. Always confirm details before you begin.
Some plans only cover fertility medications, while others exclude them altogether. Ask specifically about medication coverage so there are no surprises later.
Wondering where to start? Here’s how to verify your fertility benefits and avoid stressful surprises before you begin treatment.
Verify that Illume Fertility and our labs are in-network.
Ask about diagnostics, IUI, IVF, medications, and any limits.
Request written documentation of coverage details.
Share info with your Financial Coordinator for a clear estimate.
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Details to Confirm
Documentation & Appeals
Learn the lingo used by insurers and providers so you can advocate for yourself effectively.
A written order from your primary care doctor or OB/GYN that allows you to see a specialist or access certain medical services.
Note: Obtaining referrals is the patient’s responsibility. A specialist’s name written on a prescription pad does not constitute a formal referral. Check with your insurance carrier for the proper referral procedure.
A decision by your health insurer or plan that a health care service, treatment plan, prescription drug, or durable medical equipment is medically necessary.
Note: Prior authorization is more commonly used for medications, specific treatments, or prescription drugs.
Like prior authorization, precertification confirms that the requested treatment or procedure is covered and medically necessary. May also include verifying that the provider or facility is in-network.
Note: Precertification tends to apply to more complex or high-cost procedures, hospital admissions, or specialized care.
A document from the insurance company providing an estimate or confirmation about whether a specific medical treatment, service, or procedure will be covered under your insurance plan.
The amount you must pay out-of-pocket for healthcare services before your insurance begins to pay. Deductibles typically reset each policy period.
The baseline amount you pay monthly for health insurance. May be paid directly to an insurance company or deducted from your paycheck via your employer.
Note: Your premium does not include deductibles, copays, or co-insurance.
