Progyny Smart Cycles explained: what you'll actually pay
Progyny is not insurance in the usual sense. Your clinic bills Progyny, Progyny adjudicates against a bundle called a Smart Cycle, and you get one invoice reflecting your medical plan's deductible and coinsurance. Clinic bills Progyny, not your health plan. You receive one invoice from Progyny after adjudication reflecting your medical plan's deductible/coinsurance. Member guides say you should never pay the clinic directly for covered services.
How Smart Cycle units are spent
| Treatment | Units |
|---|---|
| Ivf Fresh | 0.75 |
| Ivf Freeze All | 0.75 |
| Fet | 0.25 |
| Egg Freezing | 0.5 |
| Iui | 0.25 |
| Reciprocal Ivf | 1.25 |
| Surrogacy Ivf | 1.5 |
A typical employer benefit is 2–3 Smart Cycles. A freeze-all IVF (0.75) plus one frozen transfer (0.25) uses exactly one unit; a second transfer from the same retrieval costs another 0.25.
Included in the bundle: anesthesia, icsi, pgt biopsy, pgt genetics lab, embryo freezing, storage year1. Storage beyond the first year is usually on you.
Medications: Progyny Rx under the same authorization when the employer buys Rx; otherwise through the pharmacy benefit.
What Progyny does not do
- Reconcile your medical plan's own EOBs
- Handle bills from non-Progyny providers (outside labs, anesthesia groups not in network, OB)
- Run appeals — routed to the medical carrier's ERISA process or third-party review
What members complain about
- Claims denied despite written pre-authorization (administrative error)
- 8–11 week reimbursement waits
- Full-cost billing for unused Progyny Rx medications
- Storage-fee denials after year one
If something is denied
Progyny Patient Care Advocate first; formal appeal through the medical carrier (ERISA) with third-party review.