Fertility Insurance Overview: Navigating the System
Here is a guide to help you learn more about infertility insurance.
Do I have infertility insurance coverage?
Currently 15 states have laws that require or make provisions for infertility insurance coverage. The states are: Arkansas, California, Connecticut, Hawaii, Illinois, Louisiana, Maryland, Massachusetts, Montana, New Jersey, New York, Ohio, Rhode Island, Texas and West Virginia. Coverage varies from state to state, so be sure to check what your state covers.
Even if you don’t live in one of these 15 states, your insurance plan may include some type of benefits for infertility insurance coverage. As a general rule of thumb, infertility falls into two areas: diagnostics and treatment. Most insurance policies will provide some level of coverage for diagnosis and testing. Coverage of infertility treatment can vary widely, if it’s covered at all.
Who can help me understand my infertility insurance coverage?
The first step is to read your health insurance policy. Most insurance companies provide online access to your health benefits as well as a provider lookup for the doctors within their network.
Once you’ve reviewed your policy, you may want to discuss your benefits with your company’s health plan administrator (if your insurance is through you or your partner’s employer) or you can call the insurance carrier directly and speak with a representative. Always ask for a written confirmation of your benefits coverage that you can keep for your files.
Your fertility practice’s financial counselor or insurance specialist will also be an excellent resource in helping your understand your fertility insurance coverage and how you can maximize your benefits. Most fertility centers will contact your insurance carrier and define your financial responsibility before you proceed with treatment. Some fertility centers also provide patients with sample letters you can use to clarify your fertility insurance coverage with your carrier.
Does Medicaid cover infertility treatment?
Many fertility centers do not accept Medicaid, so it may be best to check with your center first.
Final words of wisdom
Before you begin infertility testing and treatment, take the time to understand your infertility insurance coverage. Identifying who can provide guidance will ensure that you are maximizing your benefits and minimizing your out-of-pocket expenses… and keep you on the path towards realizing your dream of having a baby.