Progyny Insurance Patients at TRM

Tennessee Reproductive Medicine is pleased to be a participating in-network provider with Progyny, an insurance provider that collaborates with employers to offer top-notch fertility benefits.

Progyny benefits are available only through employer-sponsored health plans, either yours or your partner’s if you are on their plan. This includes 460 companies and counting in more than 45 industries. To confirm if an employer offers Progyny benefits, speak with your HR department or contact Progyny directly at 833-233-1020 to get more information.

How Progyny works

Services include comprehensive coverage for infertility treatments, medications and pregnancy monitoring for a certain time period. The company offers its plans to premier fertility clinics like Tennessee Reproductive Medicine (TRM).

To get started, please call Progyny (833-233-1020). A Patient Care Advocate will tell you if you are eligible, answer all your questions, go over your coverage and give you access to the Progyny app. Following are elements in the plan.

• Patient care advocates (PCA): PCAs guide patients through the process, including billing and registration before any visits, testing or treatment.
• Authorizations: Patients must enroll with Progyny and notify TRM when they have received their Progyny identification number. TRM will then request the appropriate authorization for the specific time period; individuals cannot request prior authorization from the company.
• Smart Cycle: A Smart Cycle is a treatment package that encompasses services needed for a complete course of treatment. This includes all essential diagnostic testing and standard treatments such as intracytoplasmic sperm injection (ICSI), assisted hatching and preimplantation genetic testing for aneuploidy. A variety of Smart Cycle packages can be combined in different ways depending on the treatment plan. Progyny assigns each aspect of treatment with a Smart Cycle value that helps members and doctors keep track of coverage.
• Financial responsibility: Patients receive bills directly from Progyny for their share of covered services. Costs vary, so patients should contact the company for benefit details.
• Coordination of benefits: Patients with multiple fertility benefits must use their primary insurance first before accessing Progyny benefits.

Learn more about coverage

FAQ about Progyny

How much will it cost me?

When you are enrolled in an eligible employer healthcare plan, the cost of Progyny services may be included in your employer’s health benefits. Depending on that plan, you may have financial responsibility for certain covered services; please speak with your PCA for specific information regarding your costs for coverage and services.

Does this plan require TRM to adhere to set treatment guidelines?

Plan benefits are adaptable and eliminate barriers, allowing TRM’s fertility specialists to provide the best treatment choices tailored to what is best for the individual patient.

How does plan handle fertility medications?

Progyny Rx has partnered with specialty pharmacies in the fertility industry to provide fertility medications. Most of employers offering Progyny through their health plans include the integrated medication benefit through Progyny Rx. The Patient Confirmation Statement will indicate if the patient has Progyny Rx coverage and specify the pharmacy to which the prescription should be sent.

Do the plans include lab work?

Progyny partners with leading laboratories and ancillary services to provide preconception carrier screening, diagnostic bloodwork, preimplantation genetic testing, endometrial receptivity array (ERA), and tissue storage services required for treatment. These labs should be used exclusively for bloodwork not reimbursed through your Progyny Fee Schedule. Your PCA can help you understand this process.

For more information on the above or to answer any other questions, please consult with a company PCA (833-233-1020).

Understanding Progyny benefits

• Personalized plans. Personalized treatment plans are tailored to individual needs, ensuring the best possible care.
• Comprehensive fertility coverage. Benefits include a range of fertility treatments, medications and support services.
• Support services. Progyny Pregnancy and Postpartum services include access to postpartum support, pregnancy coaching, nutrition counseling and more.
• Financial clarity. Direct billing with detailed cost explanations.
• Coordination of benefits. Plans utilize primary insurance benefits first.