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Health Insurance Coverage for Infertility Treatments

Written by Linda Rey on October 20, 2011 in Insurance  |   7 comments

Having a baby is sometimes called the miracle of life. And it is, unless you learn that it will be difficult for you or your loved one to get pregnant. Then, the breakdown of science and emotion can consume you. This can become one of…

insurance coverage for infertility treatmentsHaving a baby is sometimes called the miracle of life. And it is, unless you learn that it will be difficult for you or your loved one to get pregnant. Then, the breakdown of science and emotion can consume you. This can become one of those cases where health insurance coverage isn’t another monthly bill. It can save your finances, and it can also change your whole life.

Insurance coverage for infertility treatments

The American Society of Reproductive Medicine (ASRM) defines infertility as the inability to achieve a pregnancy after trying for 12 months if you are under 35 and six months if you are over 35. Additional regulations regarding infertility insurance coverage can vary from state to state.

Each insurance carrier may have different policies, but one of the companies I work with in New York outlines the “Procedures to Treat Infertility” as follows:

Assisted reproductive services include Comprehensive (mid level) fertility enhancing techniques (from Ovulation Induction up to and including Artificial Insemination) and the more technologically complex Advanced Infertility Services (InVitro services). All New York groups have coverage for Comprehensive level infertility techniques, but not all New York groups have coverage for Advanced Infertility Services.

Remember that pre-existing condition restrictions may apply. If they do, the patient must be covered under an insurance policy for at least 12 months before receiving infertility coverage. However, depending on your state and the type of plan, treatment for infertility may be mandated. In addition, a specific dollar or procedural coverage will be outlined in your plan summary.

Also note that policies that provide prescription drug coverage should also include drugs that are approved by the FDA for use in the diagnosis and treatment of infertility

Whenever you are discussing any type of fertility treatment with your doctor, you should also talk to your insurance agent about your benefits and how they apply to the intended procedure or treatment. It’s better to know before the treatment how it will be covered and what is required of you by way of pre-certification, out-of-pocket expenses, and referrals needed from your primary doctor or specialist. If you don’t do your research ahead of time, you could be denied coverage.

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Linda Rey is a licensed insurance agent at Rey Insurance with a broad spectrum of expertise in life, accident, health, property and casualty insurance as well as retirement planning and college funding strategies.

Follow Linda on Twitter.

7 comments

  1. Craig R. Sweet, M.D. says:

    Thank you for posting the above information. I’m sure many will find it helpful.

    I did want to make a comment regarding the suggested contact to the patient’s insurance agent regarding infertility coverage. I have always been hesitant to do this as the insurance company normally take notes of such contacts and could conceivably flag the patient’s chart. Once documented, it may be more difficult to get basic procedures covered, such as a laparoscopy for pelvic pain, because they thought it was entirely infertility related. Instead I usually suggest the following:

    • Contact human resources first to see if they can tell you what you options are before you call the insurance company directly.
    • Contact the insurance carrier indirectly indicating you are considering a job at XYZ and were concerned about getting infertility treatments covered under their existing plan. This will free you to ask what you want without their knowing your name or pulling your chart.

    I’m sure others will have additional ideas but I have always been concerned about notifying the insurance carrier too early when there are other ways to find out the same insurance information without placing oneself in potential harms way.

    Keep up the good work!

    Craig R. Sweet, M.D.
    Reproductive Endocrinologist
    Founder, Medical & Practice Director
    Embryo Donation International
    Specialists In Reproductive Medicine & Surgery, P.A.
    Info@DreamABaby.com
    Info@EmbryoDonation.com

    • Linda Rey says:

      Thank you Dr. Sweet for such an insightful comment. I understand completely your concern and the potential risk.

      HR is a great way to secure valuable information without compromising the coverage.

      As an agent, there have been times i’ve inquired as a “hypothetical” for that very reason.

      Thank you again.

    • Maya says:

      Well, if she’s 40 and perfectly htelahy, it’s going to cost her about $500 a month to have a low/no deductible plan that covers checkups. You BUY it on a month to month basis. If you want low monthly payments, you have to cut the coverage like take a $10,000 deductible. Or higher. That would cut payments down to maybe $200 a month or less. The older she is, the less htelahy she is, the more it costs.Your best bet, is to find a local, independent agent, who can help you balance cost with coverage.References :

  2. John says:

    Infertility treatment insurance coverage is minimal. Only one-quarter of employer-sponsored health insurance plans offer infertility benefits. Even when coverage is offered, the benefits can vary widely. Some plans do not cover IVF (in-vitro fertilization), other plans may demand a 50% co-pay, and some insurers will only cover certain drugs. Also depending upon where you live, there are different laws regarding fertility insurance which makes it more difficult to find insurance policy that will cover all your expenses.

  3. EFX Finance Blog Editor, JF says:

    @John – Thanks so much for reading and commenting. Great information.

  4. Ashley George says:

    Treating infertility problems is the main job of fertility treatment centers. Lots of infertile male and female patients are taking these treatment options as it help to remove their hormonal problems which are like a barrier in having a baby naturally. Thanks for giving such an informative post on health insurance coverage for infertility treatments. From here you can get more information about hoe infertility treatments are useful for the infertile people.
    http://onlineinfertilitytreatments.net/

  5. Jimmy Jackson says:

    The problem of infertility is really big issue for the infertile person. Whenever anyone take infertility treatment or any IVF treatment it include lots of chances of misconducts or personal damages. But if a person having infertility insurance then it makes them to easy recover from their problems as the cost of whole treatment if given by the insurance company. http://www.onlineinfertilitytreatments.com/


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