Finance & Insurance FAQs

Illume Fertility partners with many major insurers and employer benefit platforms, including:

• Aetna
• Anthem Blue Cross Blue Shield
• Carrot
• Cigna
• ConnectiCare
• EmblemHealth
• Kindbody
• MagnaCare
• Maven 
• MVP Health Care
• Oxford Health Plans
• Progyny
• United Healthcare (including UMR)

Because network status can vary by plan and employer group, review the information on our Accepted Insurance Plans page, then call your insurer to confirm network status and policy details.

If you’re unsure what to ask, read our in-depth guide to communicating with your insurance provider. Your Illume Financial Coordinator can also offer additional one-on-one support after you schedule your consultation.

Choosing a healthcare provider that is in-network with your insurance plan typically means lower out-of-pocket costs, but you’ll still have deductibles, copays, and coinsurance.

When you select a provider who is out-of-network, your insurer may still provide partial benefits, but with higher patient responsibility and more approvals required.

Many insurance plans cover diagnostic testing, and some cover IUI or IVF with limits or certain criteria. Benefits are highly plan-specific.

We encourage you to obtain a written benefits summary from your insurer now; after your consultation, your Financial Coordinator will translate that into a clear "what’s covered vs. what’s not" for your personal treatment plan.

These programs often bundle services and medications differently than traditional insurance. Provide your member details to your Financial Coordinator and they'll be happy to work with your benefits provider to ensure a smooth journey.

Our team works with these providers regularly and will help you understand your options and any steps you need to take to activate fertility benefits.

Some HMO plans require a referral from your primary care provider or OB-GYN. If you think (or know) that you’re on an HMO, ask your insurer now so the referral is in place when you're ready to get started.

If you’re not sure, schedule a consult and we’ll help you confirm what's needed.

Have your insurance card, plan type, employer group information, any benefits summaries you’ve received, and (if applicable) fertility benefit platform details.

If you already requested a benefits confirmation from your insurer, bring that too—every detail you provide helps your Financial Coordinator give you the clearest cost estimate possible.

1. Start by confirming network status for Illume Fertility and our lab partners.
2. Ask your insurer about coverage for diagnostics, IUI, IVF, and medications, and note any cycle, age, or dollar limits.
3. Request a written benefits confirmation or predetermination.

After your first consultation with an Illume Fertility physician, you and your Financial Coordinator will review everything together and fill in the gaps.

Not always. You can usually get confirmation of your benefits in writing without a plan in place. For a formal predetermination or prior authorization, many insurers require anticipated services and codes.

After you meet with your Illume Fertility physician, we’ll provide specific codes and submit any documentation your plan requires.

Ask whether Illume Fertility is in-network; what’s covered for diagnostic testing, IUI, and IVF; if medications are covered under medical or pharmacy benefits; whether a specialty pharmacy is required; and if there are cycle caps, age limits, or lifetime dollar maximums.

For insurance codes and more detailed questions to ask, read this guide.

Dealing with insurance can be frustrating - we get it! Here's what to do if you're not getting the information you need from the representative you're speaking with:

• Request that the insurer email you a benefits summary or plan excerpt (with specific details regarding fertility testing and treatment, if possible).
• Ask for the representative's name, direct line (if available), and the call reference number. 

Timelines vary by payer but typically range from a few business days to a couple of weeks. We’ll manage the process once your plan of care is set and keep you updated so your treatment timeline stays on track.

Yes. Your Illume Financial Coordinator will review the denial reason, supply supporting documentation, and help you understand the appeal steps and timelines.

While denials can be stressful to receive, remember - this isn't final! Many issues can be resolved when criteria and documentation are clarified.

Not necessarily.

State insurance mandates only apply to certain plan types (often fully insured plans) and may not apply to self-funded employer plans or those with religious exemptions.

Explore our Connecticut State Infertility Mandate and New York State Infertility Mandate pages to learn the basics, then confirm with your insurer how the rules apply to your specific plan.

Your HR team or benefits administrator can confirm this for you quickly. Fully insured plans are more likely to follow state mandates; self-funded plans are governed by the employer’s chosen benefits.

If your plan is self-funded, there still may be fertility coverage—ask HR for your plan’s summary of benefits to learn more.

Coverage varies, but state insurance mandates often address diagnostics and certain treatments like IUI or IVF (with eligibility criteria).

Our state pages explain common inclusions and limitations so you know what to ask your insurer about next:

• Connecticut State Infertility Mandate
• New York State Infertility Mandate

Some plans include age limits, cycle limits, or lifetime dollar maximums even when a mandate applies. Always ask your insurer about any caps so we can plan your care and timeline accordingly.

Medication coverage may follow different rules than procedure coverage. Confirm whether fertility medications are included under the state mandate for your plan and whether a specific specialty pharmacy is required.

Don't give up! You still have options.

Many employers voluntarily offer fertility benefits, and there are financing programs to help spread out payments, financial assistance grants, and medication savings resources. We’ll help you explore these so cost isn’t the barrier to moving forward towards your goals.

Prior authorization is your insurer’s approval for specific services before you receive them—common for IUI, IVF, and certain medications.

Without prior authorization (when required), claims can be denied even if your plan lists coverage. Your Illume Financial Coordinator will handle any needed document submissions once your plan of care is set.

A predetermination letter is a written statement from your insurer outlining what they expect to cover for proposed services. While not always required, it can give you clarity on your personal level of coverage and strengthens your position if you need to file an appeal later.

Insurers often need procedure and diagnosis codes to process prior authorization or predetermination. After your initial consultation at Illume Fertility, your Care Team supplies the codes based on your treatment plan, and our Financial Coordinators submit what’s needed.

You’ll receive notice from your insurer, and your Financial Coordinator will confirm with you before scheduling key steps of treatment. If anything is missing, we’ll let you know exactly what’s needed to keep things moving.

Delays can happen sometimes, but we’ll always follow up with status updates and keep you informed. If a request is denied, we’ll review the reason, provide additional documentation if appropriate, and guide you through each step of the appeal process.

It’s a strong indicator, but not a guarantee.

Final payment from your insurer depends on eligibility at the time of service, remaining benefits, and plan rules. That’s why we also encourage you to get confirmation of your benefits in writing and stay in close communication with your Financial Coordinator.

Often they’re handled under pharmacy benefits with different copays, tiers, or specialty pharmacy requirements. Some plans cover medications but not procedures, or vice versa.

We’ll help you map out both sides so there are no surprises.

Often, yes! Many insurance plans require you to fill fertility medications through a preferred specialty pharmacy that’s in their network.

Your insurer (or your fertility benefits platform like Progyny/Carrot/Maven/Kindbody) can confirm which pharmacies you’re allowed to use. Once we know your approved pharmacy, we’ll route prescriptions there, coordinate any prior authorizations, and help you explore copay cards or manufacturer savings when available.

If your plan switches pharmacies or you prefer a different option that’s still in-network, we’ll help transfer prescriptions so your treatment timeline isn’t disrupted.

Wondering what to expect when working with a specialty pharmacy?

• Fertility-savvy support: Pharmacists who routinely handle stimulation meds, trigger shots, and progesterone, sometimes with 24/7 on-call support.
• Cold-chain shipping: Next-day or same-day delivery, insulated packaging, ice packs, and weekend delivery windows when needed.
• Stock management: Help arranging split fills (to reduce waste), emergency replacements for broken vials/pens, and vacation overrides if you’re traveling mid-cycle.
• Clear pricing: Quotes after insurance is applied, visibility into tiers/copays, and guidance on using HSA/FSA funds.

Common specialty pharmacies our patients frequently use (your plan’s network rules apply; availability can change):

• CVS Specialty
• Freedom Fertility Pharmacy
• Accredo (Express Scripts)
• Optum Specialty Pharmacy
• Walgreens/AllianceRx Pharmacy
• Mandell’s Clinical Pharmacy
• SMP Pharmacy Solutions
• Alto Pharmacy
• Village Fertility Pharmacy
• Metro Drugs (NYC area)

Pro tip: When you call your insurer, ask (1) which specialty pharmacy you must use, (2) whether prior authorization is required for each medication, (3) if split fills are allowed, and (4) how quickly they ship to your address.

Then share those details with your Care Team so we can align your prescription timing with your treatment calendar.

Most fertility plans include a handful of core medications. Your exact prescriptions will depend on your treatment plan, but you’ll often see:

• Ovarian stimulation (“stims”): Gonal-f®, Follistim AQ®, Menopur®
• Ovulation suppression: Cetrotide®, ganirelix acetate
• Trigger shot (final maturation/ovulation): Ovidrel®, hCG (Novarel®, Pregnyl®)
• Progesterone support after retrieval/transfer: progesterone in oil (IM), Endometrin®, Crinone®
• Adjuncts (as needed): letrozole, clomiphene citrate, low-dose leuprolide (Lupron), antibiotics, birth-control pills for cycle timing

How billing usually works:

• Benefit bucket: Many plans bill medications under pharmacy benefits (separate from procedure benefits). Some cover certain medications under medical benefits. Your Financial Coordinator will confirm which applies to you.
• Cost share: You’ll see copays (flat fees) or coinsurance (a percentage of the drug price) after your deductible is met.
• Tiers & brands: Brand-name injectables often sit on a specialty tier with higher cost share than generics (where a generic exists).
• Quantity limits: Plans may set quantity limits per fill and require prior authorization; we’ll handle any required paperwork once your treatment plan is set.
• Specialty pharmacy: Many insurers require fills through a preferred specialty pharmacy (we’ll route prescriptions for you).
• Split fills to save: Some pharmacies allow split fills (e.g., 7–10 days at a time) so you don’t overbuy if your dose changes (medications cannot be returned or refunded). 

What we do for you: After your first consultation with an Illume physician, we’ll begin mapping out your expected prescriptions, confirm which benefit bucket applies, submit any needed authorizations, and confirm your in-network specialty pharmacy.

We’ll also help you explore ways to lower costs (see savings programs below).

Sometimes yes, sometimes no.

It all depends on whether your plan has them listed under medical or pharmacy benefits. Ask your insurer how medication costs apply to your totals so we can help you plan accordingly.

We’ll work with your insurer and pharmacy to resolve it. If alternatives are needed, your physician will discuss options that fit your clinical needs and your coverage.

Yes! There are several helpful programs, and many fertility patients qualify. Savings will vary by medication, diagnosis, income level, and insurance type, but common options include:

• Manufacturer copay cards/discounts for brand-name injectables (these often reduce out-of-pocket costs on commercial insurance).
• Income-based discounts for uninsured or under-insured patients.
• Compassion/bridge programs for urgent cycle starts or coverage gaps.
• Pharmacy partner coupons that stack with insurer pricing in some cases.

Examples of programs you may hear about (availability and rules change; we’ll confirm current details for you):

• EMD Serono Compassionate Care — programs commonly associated with Gonal-f®, Ovidrel®, Cetrotide®.
• Ferring savings programs — support commonly associated with Menopur®, Endometrin® (plus certain compassion/oncology programs).
• Organon/Merck support — savings commonly associated with Follistim AQ®.
• Specialty-pharmacy offers — some in-network pharmacies provide their own coupons, cash-pay bundles, or split-fill options.

How we help you utilize these programs:

• We’ll identify which programs fit your medication needs and insurance plan type and provide any documentation your application needs.
• We’ll coordinate with your specialty pharmacy so manufacturer discounts are applied correctly at checkout.
• If your plan requires a specific pharmacy, we’ll help ensure that your prescription and savings follow you (and transfer if the insurer switches you mid-cycle).
• For uninsured/self-pay patients, we’ll pair savings programs with a Good Faith Estimate and financing options.

When you call your insurer or pharmacy, ask:

1. Whether your plan requires you to use a specific specialty pharmacy
2. If prior authorization is needed for each medication
3. Whether split fills are allowed
4. How manufacturer copay cards are processed with your plan

Costs vary widely by plan, treatment type, and medication needs. Our Fertility Treatment Cost page shares typical ranges and examples.

After you schedule your first consultation with an Illume Fertility physician, your Financial Coordinator will personalize a cost estimate for you using your benefits and your physician’s plan of care.

At Illume Fertility, your dedicated Financial Coordinator works to combine your written benefits, authorizations, and planned services to outline expected patient responsibility for each step.

You’ll receive a clear, plain-language estimate and have the opportunity to ask questions, allowing you to make decisions more confidently.

Network status, deductible and out-of-pocket maximums, copays, coinsurance, cycle or dollar caps, and medication coverage all matter. We’ll walk through each factor with you and help you time your care where it makes sense.

For example, if you've already met your annual deductible for the year, your Financial Coordinator and Care Team can offer recommendations (such as undergoing diagnostic testing now instead of waiting until the new year, when deductibles reset). This can help you maximize your insurance benefits and save money.

If you are uninsured or choose to self-pay for fertility treatment, you have the right to a Good Faith Estimate of expected charges under federal law (the No Surprises Act, which went into effect in 2022). 

Your Financial Coordinator will provide this during your review and will be happy to explain how it applies to your plan.

For more details, read the American Medical Association's fact sheet here.

Yes! Using in-network benefits, applying to savings programs for medications, considering financing, or timing care relative to your annual deductible can make a big difference.

Your Financial Coordinator will help you explore all of the options that best fit your personal situation.

Now is a great time to check where you stand and decide whether to begin testing or treatment now or wait for the new plan year.

Your Illume Financial Coordinator will walk through this with you in more detail, but here are some tips on how to prepare:

• Know your totals: Log in to your insurer’s portal to see how much of your deductible and out-of-pocket (OOP) maximum you’ve met so far. If you’re close to your OOP maximum, finishing key steps before year-end may lower your costs.
• Map what resets: Most plans reset deductibles, OOP maximums, visit limits, and cycle counts on January 1 (or your employer’s plan year). Medication accumulators may reset separately, ask your insurer to confirm.
• Use FSA funds before they expire! Many FSA balances are "use it or lose it," though some plans allow a small carryover or grace period. Plan eligible expenses (medications, copays, cycle monitoring) now so you don’t leave money behind. HSA funds roll over, but you might still choose to time care for tax savings.
• Time authorizations and scripts: Prior authorizations and predeterminations can take days to weeks and sometimes expire after 30–90 days. If you’ll start treatment in January, we may queue approvals late in the year so they remain valid. 
• Schedule smart around holidays: Labs, monitoring, and procedures can book up quickly in November–January, and many clinics also close their labs for a short period at the end of the year for maintenance and improvements. If you’re aiming to complete diagnostics or a cycle before a reset, we’ll help you plan calendar milestones now.
• Open enrollment = chance to improve coverage. During open enrollment, you can switch plans, add dependents, or elect options like HDHP + HSA. Compare premiums, IVF/IUI coverage, medication tiers, required specialty pharmacy, and whether Illume is in-network. If your employer offers a fertility benefit (e.g., Progyny, Carrot, Maven, Kindbody), review what’s included and how to activate it.
• Confirm what changes on January 1: New ID cards, new deductibles, different copays/coinsurance, revised formularies, and sometimes, a new specialty pharmacy. Bring any new cards and summaries to your consultation so we can update records and quotes.
• If your plan is changing mid-care, tell us as early as possible. We’ll coordinate continuity of care, update authorizations, and re-estimate costs so there are no surprises. Qualifying life events (QLEs) like marriage or moving can open a special enrollment window if you need to switch outside the normal period.
• Keep documentation: Save benefits summaries, authorization approvals, and call reference numbers. These make it easier to resolve billing questions or appeals later.

Not sure whether to start now or wait?

After your first consultation, your Financial Coordinator will review your planned treatment timeline, then recommend a path that protects both your care and your budget.

Yes. Some patients choose to proceed with out-of-network benefits or a mix of coverage and self-pay. We’ll estimate your out-of-pocket costs and discuss options so you can choose the path that feels right to you.

While frustrating, this is fairly common. We’ll help you understand which parts of care are covered where and coordinate any required authorizations to minimize surprises.

It depends! Some HMO plans require it. If you think (or know) you're on an HMO, call your insurer now so the referral is ready when you are.

We’ll confirm requirements after your consult at Illume Fertility to keep your timeline smooth.

They’re similar to in-network approvals but may require a bit more documentation. Once your plan of care is set, we’ll submit what’s needed and keep you informed each step of the way.

Tell us as early as possible. We’ll help you plan timing, transfer medical records, and understand how these changes might affect coverage and costs.

Yes. We’ll help explain the insurer’s reasoning, gather supporting documents, and outline the steps and timelines for appeal so you’re not navigating it alone.

At Illume, you'll be connected to a dedicated Financial Coordinator (FC) after you schedule your initial consultation. Your FC becomes your main point person for benefits, authorizations, estimates, and billing questions throughout your journey with us.

We submit claims to your insurer for covered services. Once processed, your insurer determines the allowed amount and your patient portion. You’ll receive clear billing statements and can contact us with questions anytime.

If you're having trouble reaching your Financial Coordinator, please email care@illumefertility.com for assistance.

First, don’t panic - we're here to help!

Many denials can be reversed or resolved with additional documentation or clarification. We’ll review the reason, advise next steps, and support you through appeals when appropriate.

Yes! Many Illume patients do. We’ll provide itemized receipts and guidance so you can submit documentation to your HSA/FSA administrator.

Your Financial Coordinator is the best starting point. If specialized support is needed, we’ll loop in the right team member and follow through until you have the answers you need.

Illume Fertility accepts most common payment methods and offers bundled testing and treatment packages for self-pay patients to help reduce costs. Your Financial Coordinator will be happy to review these packages with you.

If you’re exploring third-party financing (such as Sunfish or Future Family) we’ll help you compare options so you can choose the best one for your situation.