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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 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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