4. PAYING FOR YOUR FERTILITY TREATMENT A. Introduction The CWRC is proud to be one of the only large, medical school faculty-staffed practices that accepts many managed care insurance plans in-network. However, working with managed care contracts can be a challenge for us, as healthcare providers, and for you, the patient. Care coordination among the Center, the insurance company, and the patient is not always easy or seamless. Insurance coverage can be fragmented due to the types of diagnosis codes submitted, because our healthcare providers can only submit the diagnosis codes that are appropriate for infertility assessment and care. The Billing Department at the CWRC will make all reasonable efforts to get this information from your insurance, but you as the patient are ultimately responsible to verify benefits and coverage. B. Managed Care Insurance Information Our Admissions Counselor can assist new patients in determining if our physicians are in-network with your managed care insurance plan. Please check with our billing office if you plan to use your health insurance plan benefits to pay for all or part of the costs of your diagnostic workup and/or treatment. Many insurance plans have specific preauthorization and referral requirements for coverage. Once you are seen by a CWRC physician and become a patient here, our Billing Department staff is available to assist you in determining the requirements of your plan. You must contact your insurance plan directly to determine if you need a referral to see our physicians. If your plan requires a referral for your physician visit, then we will need a copy of the referral at the time you arrive at the office in order for you to see the physician. Please note that some insurance plans require electronic referrals instead of paper referrals. If you do not have the referral at the time of the appointment we may have to reschedule your appointment. These rules are imposed on us by some managed care companies. Please check with your referring physician’s office to determine whether they have completed and forwarded the required paperwork prior to your appointment. Fortunately, because we are a group practice, we can bill insurances as a group, which can streamline your care as you are treated by a variety of members of our treatment team. In addition, all of our treating physicians are in-network with the managed care insurance plans with which we participate. It is your responsibility to check with your insurance company to determine whether any referrals have expired, to ensure that all preauthorization requirements have been Center for Women’s Reproductive Care

fulfilled, and that benefit coverage is available for the dates of service you are seen in the office. Patients who proceed with treatment at the CWRC without the expected insurance benefits and/or necessary preauthorization from their managed care insurance companies do so at their own risk and will be responsible for all fees incurred. Our Billing Call Center is available to answer your billing questions Monday through Friday from 9:00 am – 4:00 pm. You can contact them at 646-756-8284 during these designated hours. Please remember that your call is taken in the order in which it is received, and Billing Call Center phone calls are recorded. Patients are responsible for medical fees resulting from services provided after insurance company referrals or benefit coverage have expired. Patients are encouraged and expected to obtain new and updated fee schedules and financial counseling forms as their treatment plans change. Fees are subject to change without notice. Our patients are responsible for knowing their individual managed care insurance plan’s coverage details and limitations. Patients should inform themselves of policy term dates, age restrictions, and policy changes. Should your coverage terminate or you do not inform us of any updates or changes, you will be responsible for any charges incurred after coverage ends. Our billing and appointment system automatically sends out bills to be processed by your insurance. If the name on the billing claim does not match the name on your card then the claim may be rejected by your insurance and you will get a bill. If you are enrolled with an insurance plan in addition to your primary managed care insurance plan, typically called a ‘secondary insurance’ plan, we require this information in addition to your primary insurance information. Failure to disclose information about secondary or additional policies risks the CWRC’s ability to obtain reimbursement from these payers, potentially leaving you with additional costs or benefits not accessed. Patients not using managed care coverage for their treatment should refer to our “Fee Schedule” for the price of non-covered services. The “Fee Schedule” is included in your package for your initial appointment and is available upon request from reception or billing. Please note the fee schedule is subject to change without notice. C. Using Insurance Throughout Your Treatment New Patients If you are preparing for your first appointment at the CWRC, these are a few billing matters about which you should inform yourself:  Is the CWRC an in-network provider with your primary and/or secondary managed care medical insurance?

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 Are you required to present a referral at your first visit with a CWRC physician? Is a referral required for any subsequent visits or appointment types?  Does your insurance require precertification for any assessment or treatment? If so, what does this require? Existing Patients Once you complete your checklist items in preparation to initiate treatment, please contact your insurance to determine what, if anything needs to be done before you can access any available benefits. Also, because you have probably been to the office numerous times, you may need to request new referrals, if relevant for your plan. Any necessary precertification or preauthorization must be done as prescribed by the insurance plan in order to maximize your benefit utilization. If you initiate treatment without this information, then you will be responsible for any fees incurred. Verification of Benefits and Treatment Plan It is important to remember that treatment authorization can be invalidated by a number of items. This includes a lapse in time or change of benefits from verification to use and/or a change in clinical requirements. Please be aware that a change in benefits post-verification and prior to use can occur around January 1st or if your employer changes health insurance contract. Graduating Patients For patients whose treatment results in pregnancy, the CWRC will monitor you for approximately eight (8) weeks before discharging you to an obstetrician for the continuation of your care. Because you are pregnant, your insurance will be billed with a pregnancy-related diagnosis. However, this diagnosis is still sent to your insurance by a reproductive endocrinologist, so this may affect your benefit coverage. Furthermore, if you present to the CWRC for pregnancy care for a pregnancy achieved outside of the CWRC, this may cause significant insurance issues. The CWRC can provide you with medical care, but must submit as reproductive endocrinologists under the diagnosis of infertility, which may result in denials from insurance. We strongly encourage patients to determine the coverage available for them from their managed care insurance plans, as patients are financially responsible for any bills incurred. For example, we are aware that the Empire Plan will not cover any pregnancy-related testing from a reproductive endocrinologist. D. Change of Insurance Please notify reception and billing if your insurance changes. It is your responsibility to ensure that the Billing Department at the CWRC has the most current information on your “Patient Registration Form”. In the event that you do not inform the CWRC of such insurance changes and receive treatment without doing so, you will be responsible for

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additional fees incurred as a result. Providing updated demographic or insurance information to any other department within Columbia University or the CWRC does not ensure that your billing record will be updated, and could result in a lack of access to your insurance benefits. You must complete a new “Patient Registration” form to inform us of any changes. E. Insurances Accepted (In-Network) All of our doctors are “in-network” providers for all the insurances that we accept. By selecting in-network providers, such as the CWRC, you can save significantly on your out-of-pocket expenses. Negotiated fees between provider and insurance company are usually lower than those charged out-of-network. This is important to patients who have dollar limits on their infertility coverage and need to stretch those dollars over more than one treatment cycle. Patients usually do not incur out-of-pocket expenses for services covered except for copays and co-insurance. Insurances accepted upon verification are: 1199 Aetna/US Healthcare Cigna/MVP Empire Blue Cross Blue Shield/Unicare Empire Plan (Center of Excellence) GHI/Emblem Health HIP Oxford POMCO United Healthcare (Center of Excellence)

F. CWRC Anesthesia Services and Fees Columbia University CWRC has a contract with Medplex Mobile Anesthesia for the provision of needed Anesthesia Services at 1790 Broadway. It is the patients’ responsibility to check that Medplex is in-network with your insurance. Please contact Medplex by calling Mona at 516-466-3070. In the case that patients do not have in-network coverage, the Anesthesia fees are capped as follows: $500.00 for Surgery, IVF and DIVF Cycles $375.00 for Introductory IVF Cycles $300.00 for Aetna IVF Cycles Center for Women’s Reproductive Care

If for some reason Medplex Mobile Anesthesia does not have in-network coverage, the charges to the patients cannot exceed the above fees. We do not contract with any other Anesthesia service. G. Urology The CWRC has an affiliation with two Urologists who are Columbia University Faculty, Dr. Peter Stahl and Dr. David Kaufman. Both Dr. Kaufman and Dr. Stahl accept most of the same in-network insurances as the CWRC and thereby provide a seamless financial experience for patients in their fertility treatment cycles. However, patients must consult directly with the physicians’ offices to confirm insurance coverage and anticipated out-of-pocket expenses. Dr. Kaufman sees patients in the Columbus Circle area and Dr. Peter Stahl sees patients at the CWRC as well as other convenient locations. H. Center of Excellence – OptumHealth We are pleased to announce that our Center has been designated as a Center of Excellence by OptumHealth. Your employer might have purchased special programs for fertility care from OptumHealth, which makes you entitled to additional benefits. The Center for Women’s Reproductive Care at Columbia University participates in the “Reproductive Resource Services” – a Centers of Excellence program for members with infertility coverage that provides additional educational services. To find out if your employer has contracted this program in addition to your regular health insurance, please contact your Benefits Administrator directly. To learn more about the programs, please visit the website: https://www.urnweb.com/gateway/public/infertility/infertility.jsp I. When We Do Not Participate with Your Insurance If the CWRC does not participate with your health care insurance plan, you will be required to pay our fees in full at the time of service. Generally, a treatment cycle must be paid in advance. We can provide you with a breakdown of the services included in each treatment cycle at the time of payment. The CWRC can also provide the necessary forms, pre-populated with your identifying information and billing details, to patients after the services are delivered and paid in full. You can then submit these forms to your insurance for potential reimbursement, or proof of insurance denial. Please advise us if your out-of-network insurance plan has pre-authorization requirements for out-of-network providers, and we will do our best to assist with providing the requested material. Please be advised, however, that the CWRC is not

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responsible for determining pre-authorization or any other requirements for patients with out-of-network health insurance coverage. It is the patient’s responsibility to follow-up directly with the insurance plan regarding any out-of-network insurance carrier issues. J. CWRC Financial Counseling Form After your initial physician appointment, a nurse will discharge you with a “Patient Financial Counseling Form,” indicating your necessary diagnostic testing and initial treatment plan to take to our billing department. The billing department will research your coverage and will provide you with out-of-pocket estimates and insurance coverage information as clinically indicated on the form. It may take a few business days for our billing staff to get this information from your insurance. The purpose of the “Financial Counseling Form” is to advise you of available insurance coverage and potential out-of-pocket costs that you will incur if you move forward with the indicated diagnostic tests and treatment plan. It is important that you understand anticipated outof-pocket expenses as your treatment plan changes. We encourage you to request a new “Patient Financial Counseling Form” from a nurse any time there are changes to your treatment plan or insurance. You can find a sample “Financial Counseling Form” in the Appendix of this handbook. K. Medical School Billing System Like most offices affiliated with the Columbia University Medical Center, we use its automated billing system. We understand that these computer-generated bills can be confusing; our Billing Department is available to help you answer any related questions. The monthly statements are generated on an automatic production schedule. It may take two statements for a payment to be reflected to the account. Statements may be generated before payments are posted on your account. Please note that account history can be printed by the billing department in the form of a ledger. Assistance in reading the ledger may still be required Contact the Billing Department to get the current account information. Please note that although our Billing Department provides the courtesy of liaising with your insurance company, we recommend you speak directly to your carrier regarding your benefits. Patient refunds are also processed through the Columbia University Medical Center. Therefore, we are subject to their processing timelines before any money can be returned to patients. Patients requesting a refund must contact the CWRC Billing Department directly. From this date of request, refunds take 6–8 weeks to process depending on the type of payment. If the patient is due a refund from the CWRC, that refund will first be applied to any outstanding balances owed by the patient to the CWRC. Then, any remaining credit balance will be refunded to the patient. Refund credits can also be applied to any outstanding money owed to Columbia University’s

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Department of Ob/Gyn. L. Diagnosis Codes for Insurance Submission It is medically necessary for our physicians to bill appropriately for services rendered to patients. The diagnosis code applied to every visit is appropriately applied with an infertility diagnosis. Although insurance plans may have more coverage availability for other diagnoses, the CWRC cannot change diagnosis codes to try and access insurance benefit coverage. Not only does this violate Columbia University policy, but it is considered billing fraud and is against federal and state statutes. M. Updating Patient Information Please be sure to update your Patient Registration Form with the Front Desk, and advise the Billing Department directly of any demographic or insurance changes. Failure to update your Patient Registration Form with the Front Desk and notify a biller in the CWRC Billing Department of any demographic changes may result in misfiled insurance benefit claims, which may lead to processing delays which could incur additional or unexpected out-of-pocket expenses for patients. Our goal is to maximize your available insurance benefit coverage. By updating your Patient Registration Form with the Front Desk and informing the Billing Department about any relevant changes, we can ensure that we are utilizing your benefits to the fullest available extent. If this information is provided to other CWRC staff, we cannot guarantee that your records will be appropriately updated, potentially causing insurance claim-filing issues. N. Billing Call Center In order to assist patients in accessing their fertility benefits through their managed care insurance plans, we developed a Billing Call Center, staffed to assist patients with any billing inquiries. Please note that all calls are recorded. The Call Center is open and available Monday through Friday from 9am – 4pm and can be reached directly at 646-756-8284. O. Referral Requirement Highlights It is our wish to do what we can to facilitate your healthcare insurance arrangements when you are receiving treatment at the CWRC. We offer these referral highlights to you in order to assist you with the requirements of the various healthcare and managed care companies. The following are the current requirements, as we understand them, of the healthcare insurance contracts currently maintained by the CWRC as it relates to

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referral and pre-authorization requirements. From time to time, these requirements may change and it is the patients’ responsibility to obtain the most current information from their health care insurance providers.

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Please note when your referral expires so that you will be aware of the managed care companies’ limitations for insurance coverage. Insurance Company 1199 Aetna Aetna Chickering Cigna HMO Cigna PPO Cigna POS Emblem Health Empire BC/BS HMO Empire BC/BS PPO Empire Plan NY

Requirements None Referral Referral Prescription None Prescription None Referral None Referral

Authorized Referral Source N/A Aetna’s Infertility Program (800)575-5999 Student Health Primary MD or OB/GYN N/A Primary MD or OB/GYN N/A Primary MD N/A Notification required before appointment (877) 769-7447 N/A Primary MD or Managing Organization Primary MD, Notify Oxford of appointment at 877512-9340. N/A N/A

Format N/A Electronic Paper Paper N/A Paper N/A Paper N/A Confirmation # given to patient N/A Electronic Electronic

GHI HIP Oxford*

None Referral Referral

Pomco United Healthcare

None None

Insurance Company 1199 Aetna Aetna Chickering Cigna HMO Cigna PPO Cigna POS Emblem Health Empire BC/BS HMO Empire BC/BS PPO * Empire Plan NY

Requirements None Referral Referral Prescription None Prescription None Referral None Referral

Authorized Referral Source N/A Primary Physician Student Health Primary MD N/A Primary MD N/A Primary MD N/A Notification required before appointment (877) 769-7447

Referral None Referral None None

Primary MD N/A Primary MD or Managing Organization N/A N/A

Format N/A Electronic Paper Paper N/A Paper N/A Paper N/A Confirmation # given to patient Electronic N/A Electronic N/A N/A

United Healthcare

N/A N/A

I In addition, for the male partner, a referral is often required for semen analysis. The referral must be provided by the male patient’s physician, generally internal medicine or family practice.

O x Oxford* f GHI o HIP r Pomco d

*Referrals must be completed with the Center’s information, not the physician’s: A2019001Center for Women’s Reproductive Care at Columbia University.

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