Please click here to read Texas Fertility Center’s statement on the frozen embryo situations in Cleveland and San Francisco

Business OfficeTerms

The TFC Business Office can help you navigate the complicated world of Fertility Insurance & Fertility Financing Options.

Use our list of Business Office Terms below to start the conversation.

Allowed or Contracted Amount – The amount, determined by a contract between a healthcare provider and an insurance carrier that the carrier will pay the provider for a specific service.

Co-insurance – This refers to the portion (or percentage) of the overall medical cost of an office visit or treatment that a patient is responsible for — after any deductible is take care of. For example, if you have an ’80/20′ plan, the insurance company will pay 80% of the cost and the patient will pay 20% of the cost.

Co-pay – The set fee that a patient pays each time they have a doctor’s visit. Depending on the nature of the visit, there may be additional charges.

Deductible – The fixed dollar amount you must pay out of your own funds each calendar year before your health insurance begins to make payments for covered medical services.

Exclusion – A procedure or service that is not covered by your specific insurance plan.

Eligible Expense – An expense for a service that is covered under your plan.

Maternity care – Care and services provided for the treatment of pregnancy. Complications are not included.

Maximum Lifetime Benefits – The total amount of insurance benefits available to any one participant under an insurance plan for a lifetime; or the total amount of lifetime benefits available for a specific benefit, such as Infertility.

Medically Necessity – Services considered as essential for the diagnosis or the direct care and treatment of a medical condition. Such services are consistent with generally accepted standards of medical practice and are not performed primarily for the convenience of the patient or physician.

Network Provider – A Hospital, Physician or other provider that has entered into a contractual agreement to provide services to patients covered by a specific managed care plan.

Non Network Provider – A Hospital, Physician or other provider that has not entered into an agreement to participate as a managed care provider.

Pre-determination of Benefits – A request made to your insurance carrier that asks them to provide specific coverage details regarding a specific planned procedure.

Pre-existing Condition – A condition for which medical advice, diagnosis, care, or treatment was recommended or received during a specific time period prior to the date that your current insurance policy went into effect.