Provider and Lab Facility FAQ

Once you’ve identified a Progyny in-network clinic and you’re ready to schedule an initial consultation, contact the clinic directly to schedule an appointment and give them your Progyny member ID. Alternatively, if available at your clinic of choice, contact your PCA and they can send a referral by your request with your Progyny member ID and contact information to the clinic. The clinic will then reach out to you directly to schedule a consultation. If you are an existing patient at a Progyny in-network clinic, you can schedule directly with the clinic at any time. Upon scheduling, you must notify your PCA of all new appointments to ensure an authorization is processed in a timely manner.

An authorization is an approval for services. Upon authorization, Progyny generates a Confirmation Statement, which is a document that confirms your coverage and is sent to your clinic, which allows the clinic to bill Progyny directly. Prior authorization is the best way to prevent billing errors or delays in treatment. Note, retroactive authorizations are not possible in all cases and must fall within timely filing for your medical insurance plan. Contact your dedicated PCA to request an authorization before your first appointment and before you begin any treatment cycle. Some services require specific prior authorization. Contact your PCA for more information on the steps to get a prior authorization for a service should it be required under your Progyny benefit, and visit http://nputilizationalliance.com/ to learn more. Request for authorization for covered services will be reviewed based on your individual submission and our written clinical policy. The request will be timely adjudicated and based on that review may be approved, denied, or partially approved or partially denied. Reference the Authorization for Covered Services section for more information.

Before your appointment:

• Speak to a Progyny Clinical Educator to learn more about what to expect at your appointment.
• Make a list of questions you want to ask your provider. You can always include a partner or loved one to help you process the information you receive.
• Have a digital or print copy of your Progyny Confirmation Statement so that you can provide a copy to your clinic and to any diagnostic testing facility, if needed. In-network laboratories are listed on your Confirmation Statement. Provide them a copy of your confirmation in lieu of your medical insurance card.
• Request any relevant medical records from previous clinics/appointments be sent to your clinic ahead of your appointment. If you have any questions on how to initiate this, your PCA will guide you through the process.
• Arrive early to complete any documents or visit the clinic website to see if there’s paperwork you can print and fill out prior to your appointment.

At your appointment:

• Ensure the clinic has Progyny listed as your primary insurance, including your Progyny member ID number.
• You will be asked for your primary insurance card for procedures not managed by Progyny (e.g., certain blood tests, surgeries such as laparoscopies, and other non-covered services).
• If the initial consultation with your provider is an in-person visit, they may recommend performing bloodwork and other diagnostic tests during the same appointment. If your initial consultation is via telehealth, remember to schedule a follow-up appointment to have your bloodwork and diagnostic testing performed.

Once you complete your bloodwork, ultrasound, and other diagnostic tests, don’t forget to schedule a follow-up office visit with your provider to review your results and plan next steps.

As a reminder, your authorization for your initial consultation and all standard of care fertility-related diagnostic testing is valid for 90 days. Authorizations cannot be extended. Any testing performed outside the 90-day authorization window will be an out-of-pocket expense.

Before your appointment:

• Notify your PCA about the first day of your upcoming treatment cycle to ensure an authorization is in place prior to starting treatment.
• Bring a digital or print copy of your Progyny Confirmation Statement so you can provide a copy to your clinic and to any in-network preimplantation genetic testing (PGT) facility, if needed. In-network laboratories for preimplantation genetic testing are listed on your Confirmation Statement. Please provide the laboratory with a copy of your Progyny Confirmation Statement. There is no need for payment at this time since your member responsibility will be calculated after the laboratory has submitted the claim to Progyny.

At your appointment:

• Ensure the clinic has Progyny listed as the primary insurance, including your Progyny member ID number.
• Typically, you can expect to have bloodwork and an ultrasound performed at every appointment during in-cycle monitoring. Note, this protocol may vary depending on the treatment plan.

As a reminder, your authorization for your treatment cycle and standard of care fertility-related testing is valid for 60 days.

The Progyny benefit is in-network only and you must see a provider in Progyny’s network to utilize your Progyny benefit for covered services. If you are unsure if your clinic is in-network, contact your PCA to confirm.

You can search for reproductive endocrinologists, reproductive urologists, and clinics at progyny.com/find-a-provider or contact your dedicated PCA. We recommend you also cross-reference your clinic’s network status with your medical insurance carrier as your care at the clinic may include medical services not covered by the Progyny benefit.

Contact your PCA to discuss options and next steps.

After you’ve reviewed Progyny’s in-network list and selected a new clinic, notify your dedicated PCA. If you wish and if available at your clinic of choice, your PCA can send a referral to the clinic including your Progyny member ID and contact information. The clinic will then reach out to you to schedule your initial consultation. Once you’ve scheduled an appointment, your PCA can walk you through the process of sharing your medical records with your new clinic as allowed under applicable federal and state privacy laws and regulations. Contact your PCA for more information on how to get started.

Transporting tissue between clinics requires precise timing. You will need to coordinate with both clinics simultaneously and likely a third-party transfer company. Contact your PCA for more information on how to get started.

Refer to progyny.com/labs for our growing list of in-network laboratories for PGT-A and PGT-M testing.