Insurance’s role in cost of care
If you have ever made an appointment with us, you know that we do not ask for insurance information… but have you ever wondered why that is?
Well, many of us as patients don’t realize (until we are too far down this journey) just how little fertility care is actually covered by insurance… even if it says your treatments are covered!
It may be counter-intuitive, but taking insurance out of the picture actually results in lower and more cost transparent care, which is one of the core reasons why Bloom Fertility was founded.
You might be rolling your eyes, or scratching your head right now, but hear us out.
If you live in Georgia, and are seeking fertility care, you will fall into one of three buckets.
No insurance: This is where most patients are, whether they know it yet or not. Unfortunately, it is very rare for any fertility treatment to be covered through insurance.
Insurance for testing: This makes up the second largest group of patients, those who have coverage for fertility testing (to tell you that you may need help), but who have zero coverage for the actual treatment.
Insurance for treatment: A small portion of patients actually have fertility treatments covered under their insurance. However, many times the medicines required for the treatments, as well as the pre and post op appointments are not covered. So the out of pocket costs are unexpected and can be quite high. Not to mention the deductible you have to hit first.
Most offices employ multiple back office staff who spend their entire day working with the insurance companies on your behalf. More often than not, all of that work still sticks you, the patient, with a full bill and a confused look, “Didn’t I ask what I owed when I left and they said ‘$0’?”. Been there? Yeah, me too, way too many times. But it’s not the office’s fault, they don’t know what the insurance will cover so they can’t give you a straight answer either.
Is your mind spinning yet? Just wait.
Fertility practices (and most medical practices in general) actually have to accept a pre-determined, reduced rate of service for each office visit and procedure that the insurance company pays for. This leaves a hole in the bank account that is filled by… guess who… the uninsured patient!
What!?
Yes, you read that correctly. If you do not have insurance coverage (i.e., you are paying cash for services) you are actually paying a higher rate than the big insurance companies and supplementing the care of those who are covered!
Now do you see where we are going with our model?
Here at Bloom, we want to avoid administrative costs that do not add value to our patient care or experience, and we do not want our uninsured or partially insured patients (who are the majority) to over pay.
Our model allows us to give you three very important things throughout your fertility journey with us.
Transparent costs: Because we took the guessing game out of insurance coverage, and know what each service costs, you will always walk into an appointment or procedure knowing exactly what you will be paying.
Lower cost: Because we do not have a large back office staff, and because we do not have lower-negotiated rates with insurance companies, our savings go directly to you.
Personal touch: Our small office feel will walk with you hand in hand throughout your journey
Now, if you do in fact have insurance coverage, there are still ways of joining the Bloom family AND being covered. It’s a win-win.
If you have treatment coverage, you may be able to use out-of-network benefits for your care with Bloom.
If you have testing coverage, we can work with your primary OBGYN, Quest or Labcorp to plan an efficient testing strategy that will be covered. You will use our low cost model when you are ready for treatment.
If you do not have testing or treatment coverage for infertility, we expect to be your most cost-effective option for care
