Carrot Fertility Terms of Service

Item: Carrot Fertility
Rating: 28
Author: Terms.Law Editorial Team

Last updated: November 2024 | Reviewed: February 2026

Global fertility benefits platform with reimbursement-based model. Flexibility in clinic choice comes with strict documentation requirements and claim denial processes.

Grade D

Bottom Line: Carrot's reimbursement model offers clinic flexibility but shifts significant administrative burden to patients. Documentation requirements are strict, claim denials are common, and the appeal process heavily favors Carrot's determinations. Patients often pay out-of-pocket first and fight for reimbursement later.

Category Scores

Coverage Determination 25/100

Reimbursement Process 22/100

Claim Disputes 28/100

Service Termination 35/100

Dispute Resolution 32/100

Key Findings

⚠ Pay First, Fight Later Model

Carrot's reimbursement model means patients pay for treatments upfront and submit claims afterward. If claims are denied, patients bear the financial burden while navigating appeals.

"Members are responsible for payment to providers at the time of service. Reimbursement is subject to Carrot's review and approval of submitted claims."

⚠ Strict Documentation Requirements

Claims require extensive documentation including itemized receipts, medical records, and sometimes letters of medical necessity. Missing or incomplete documentation results in denial.

"Claims must include itemized receipts with procedure codes, provider credentials, and may require additional documentation. Incomplete submissions will be denied."

⚠ Subjective Eligibility Determinations

Carrot retains discretion to determine what treatments qualify for reimbursement. The line between covered and non-covered services can be unclear and inconsistently applied.

"Carrot reserves the right to determine eligibility of services for reimbursement based on plan terms and Carrot's clinical guidelines."

⚠ Limited Appeal Success

When claims are denied, the appeals process is internal to Carrot. There's no independent review mechanism, and Carrot's initial determination is rarely overturned.

"Appeals of claim denials will be reviewed by Carrot's clinical team. Carrot's decision on appeal is final."

Comparison: Fertility Platforms

Feature	Carrot	Progyny	Kindbody
Payment Model	Reimbursement	Direct Pay	Hybrid
Clinic Choice	Any Clinic	Network	Prefers Own
Documentation	Extensive	Moderate	Moderate
Claim Denials	Common	Less Common	Moderate
Appeal Process	Internal Only	Limited	Arbitration

Recommendation

For Patients: Before any treatment, get written confirmation from Carrot that the specific procedure qualifies for reimbursement. Keep meticulous documentation and submit claims promptly. Assume you may need to appeal and document everything accordingly.

Financial Protection: Budget as if reimbursement may be denied or delayed. Ask providers for itemized super-bills that include procedure codes. Keep copies of all communications with Carrot regarding coverage.