Infertility is one of the most difficult battles many couples can face. Advances in fertility treatments offer an excellent chance of overcoming this challenge and achieving their dreams of becoming parents. Yet, insurance coverage, in many cases, is spotty at best. Paying for fertility treatments out of pocket is very expensive, and it can put a financial strain on your family.
If you’ve tried and tried to conceive with no luck, then it may be time to seek help from fertility specialists like those at Western Fertility Institute. Before embarking on your fertility journey, you can find out about available treatments by doing a little research and by speaking to our friendly medical professionals.
Once you have a general idea about your treatment options, it’s time to talk to your insurance provider. Not even half of the states in the U.S. have fertility insurance coverage laws. This means understanding how insurance works for fertility treatments is often confusing.
Don’t worry, and don’t panic. In this post, we’ll discuss some of the information you’ll need to know about this tricky subject and get the answers you need.
Coverage for Fertility Treatments: What Is or Is Not Typically Covered?
Fertility treatment coverage is highly subjective. Some insurance providers offer little to no coverage, while others only cover diagnostic testing to determine any underlying issues. Other insurances may completely cover meds or one full round of IVF. Any coverage you receive for fertility treatments depends on what insurance plan you have.
A number of variables determine what fertility services you may receive. Insurance companies have medical boards that decide whether or not fertility health is a medically necessary benefit. Coverage can also depend on what type of plan your employer has selected.
The best way to understand your insurance coverage is to find out what your policy says about fertility testing and treatment. In that way, you’ll stay ahead before incurring some serious debt that’s not covered by your insurance. There are three ways to get the information you need:
- Contact your insurance company: The billing department should be able to explain your benefits and what exactly is covered.
- Explanation of Benefits (EOB): This document is not a bill. Instead, it outlines what is or is not covered by your insurance policy. When your fertility specialist submits a claim, an EOB comes to you in the mail containing information about amounts you will have to pay out of pocket in the future.
- Talk to your employer or human resources department: If you get insurance through your workplace, talk to your HR department to find out what is covered in your plan and what isn’t.
Questions to Ask About Your Insurance Coverage
Before speaking to anyone, it’s a good idea to have a list of questions handy. Here are some of the questions we recommend asking that will give you a clearer picture as to what is or is not covered by your insurance:
- Is fertility testing covered for both women and men? If so, what kind?
- Does my plan cover particular medications prescribed by my physician?
- Which infertility treatments are fully or partially covered — Intrauterine insemination? In vitro fertilization? Frozen embryo transfer?
- Are there any coverage limitations?
- Are there any restrictions for age or marital status I should be aware of?
Expenses Involved in Fertility Treatments
As you prepare to find out about your insurance coverage, it’s always a good idea to be fully aware of the different costs involved with fertility treatments. Components of the fertility treatment process include:
- Doctor’s appointments
- Blood tests to determine hormone levels
- Diagnostic tests, such as ultrasound to see if there is an underlying condition preventing conception
- Hormonal birth control or injections that promote ovulation, help eggs mature or prepare the uterine lining for receiving the embryo
- Anesthesia during egg retrieval
- Rent for egg storage
- Egg fertilization
- The embryo transfer process
- Costs for specialists and medical professionals involved
Some of these items may be fully or partially covered. Others won’t be. Costs also vary, so speak to your fertility team if you have any concerns. Also, several rounds of IUI or IVF may be needed, incurring additional costs.
How to Get IVF and Fertility Treatments Covered by Insurance
If your insurance does not cover your treatment, that doesn’t mean this is the end of your journey to becoming a parent. There are ways you and your partner can offset some of the costs involved with fertility treatments. Here are just a few things you can consider as you move forward:
- Talk to your employer about fertility insurance providers: Most companies that offer infertility benefits do so because they’ve been asked by an employee. Let your boss know that you would prefer a plan that covers fertility treatments. This could impact their decision about which insurance providers they choose in the future. After all, great fertility coverage can attract and retain top-notch employees.
- Use your HSA or FSA: Many health care plans provided through the workplace have a health savings account (HSA) or flexible spending account (FSA) attached to them. These accounts allow you to contribute money from your paycheck into accounts that can be used for medical costs that aren’t covered by insurance. However, there is usually a limit to how much you can contribute each year.
- See if you qualify for grants or financial assistance: Many nonprofits and foundations offer financial assistance to couples struggling with infertility. To receive these grants, you must apply and often must meet certain qualifications, such as income limitations, state residency or be interested in a particular type of fertility treatment. Check out the National Infertility Association’s website for more information.
Learn More About Insurance Coverage at Western Fertility Institute
Navigating the ins and outs of fertility testing and treatment as well as your insurance coverage can be daunting. That’s why the compassionate and experienced team at Western Fertility Institute wants to make this process as simple and straightforward as possible. During your initial appointment, you can talk to a fertility expert about possible treatment options. At the same time, you can find out if we are in-network with your insurance provider.
If you’ve always dreamt of having a child, we will walk with you every step of the way to make your dream a reality. Schedule your appointment today to find out more.