Know Before You Bill —
Fertility Benefits Verified
Fertility insurance benefits are notoriously complex — lifetime maximums, shared-risk riders, state mandate differences, and frequent mid-cycle coverage changes. We verify the full picture before each cycle so your team and your patients have clarity upfront.
Book a Free Audit →What We Verify
Our verification checklist covers every field that affects fertility claim outcome — going beyond the basic active/inactive check that standard billing teams perform.
- ✓Active coverage confirmation
- ✓IVF & ART benefit rider lookup
- ✓Lifetime maximum remaining
- ✓Shared-risk plan details
- ✓Coordination of benefits (COB)
- ✓Deductible & out-of-pocket status
- ✓Prior auth requirements per payer
- ✓Patient cost estimate generation
Why This Matters for Fertility
Fertility benefits are carved out differently by each payer. A patient may have general health coverage but no IVF benefit — or a hidden ART rider that wasn't attached at enrollment.
Missing this upfront creates the worst outcome: a completed cycle with no coverage, a denied claim, and a patient facing an unexpected bill.
Our verification process is designed to surface these issues before the cycle begins — giving your financial counselors accurate information for patient conversations.
Common Questions About Fertility Eligibility Verification
How do I know if a patient's plan covers IVF?
You cannot rely on the insurance card alone. A thorough eligibility verification requires calling the payer or checking the provider portal to confirm: whether an ART or fertility benefit exists, whether the procedure is covered or only monitoring, what the lifetime maximum is, and whether the benefit is managed through a separate fertility benefit manager.
What is a fertility benefit manager and how does it affect billing?
A fertility benefit manager (FBM) — like Progyny, WINFertility, or Maven — is a specialty administrator that employers use to carve out fertility benefits from the main health plan. Fertility procedure claims must be submitted to the FBM, not the primary insurer. Billing the wrong entity typically results in a voided claim that cannot be retroactively corrected.
How do fertility insurance lifetime maximums work?
Most fertility benefits carry a lifetime maximum — either in dollars or in cycle counts. Monitoring this balance is critical because once the maximum is exhausted, claims become non-covered. We track remaining lifetime benefits at each eligibility verification and alert your financial counselors when a patient is approaching their limit.
What is coordination of benefits (COB) in fertility billing?
COB applies when a patient has more than one active insurance policy. The primary payer processes the claim first; the secondary may cover some or all of the remaining balance. In fertility billing, COB is complex because a spouse's plan or a secondary fertility benefit manager may be involved. Incorrect COB billing can result in overpayments that trigger recovery requests months later.
Reduce financial surprises for your patients
Book a free audit to see how your current eligibility workflow compares — and what improvements could reduce downstream denials.
Book Your Free Audit →