Out of Network Coverage 

If RMANJ does not participate in your health plan, you may still be eligible for coverage for a percentage of the costs of certain treatments as an out-of-network benefit through your own insurance plan. If you have a non-participating insurance company, RMANJ will require payment upfront for all services. Payment will be expected at the time of service for all non-IVF services and 2 weeks prior to the start of your cycle for IVF. We will submit claims on your behalf and request that the insurance reimburse you directly. RMANJ accepts several forms of payment: credit card, check, cash or FFP loan programs.

Most POS and PPO plans allow you the flexibility of seeking medical care out-of-network. The following is an example of an out-of-network Plan. Please note this is only an example. For information specific to your plan, please contact your insurance company.

 
 
Health Options PPO Plan
 
In
Network
Out
of Network
Calendar Year Deductible None $250.00 amount per individual
$500.00 amount per family
Calendar Year out of pocket maximum Dollar amount Deductible per individual $250.00 deductible 80% of Reasonable and customary charges up to $2,000.00 out of pocket then 100% for the remaining of the calendar year
Outpatient Doctor Visit 100% after $10 copay 80% of reasonable charges after deductible
Using the above example and applying to a typical IVF cycle, the following is an approximate cost:

Cost: $ 10,010.00*
Deductible: $250.00
Coinsurance: $1,793.00

The estimated insurance reimbursement to you for cycle = $7,265.00

* Estimated IVF Cycle cost does not include ICSI, Assisted Hatching, or Medications.

** Remember that your insurance company will reimburse you using their reasonable and customary rates. For example, if your insurance pays 80% for out of network services and we charge $50 but the insurance r&c rate is $40, they will reimburse you at 80% of the $40 amount, not our full fee.

Prices subject to change without notice