Most people assume that their health insurance will cover treatment for any diseases or conditions they may have. This is not necessarily the case for the treatment of infertility, including insurance coverage for IVF, so patients need to carefully assess at the beginning what their insurance policy covers. These 11 tips will help.
Tips for Using Health Insurance to Cover Fertility Treatment
- If possible, access your policy online so that you can use the Internet search function to find coverage and possible exclusions. Search for the following terms: fertility, infertility, assisted reproduction, IVF, or in vitro fertilization.
- Most infertility clinics have a person on staff who is knowledgeable on insurance issues and she/he can help you understand your policy.
- Call your insurance company and ask if your treatment will be covered. Ask them specifically where coverage or exclusions are stated in your policy.
- Be aware that the cost of infertility medications makes up a substantial portion of IVF and other fertility treatment, so specifically check the prescription coverage of your policy to determine if they are covered or excluded.
- Ask your insurance company for a letter of predetermination of benefits before you start treatment. Get it in writing.
- Take careful notes of all telephone calls you have with your insurance company. Include the name of the person you spoke with, the time, and the date. Most insurance companies require that their employees also document all phone conversations. Ask for a copy of these notes to be sent to you for your records.
- Your insurance may be more likely to cover diagnostic procedures when done by your gynecologist rather than a reproductive endocrinologist (infertility doctor). Find out before the tests are done.
- Explain to your doctor what your insurance will cover so that they can choose the correct billing code for testing and treatments of underlying conditions, if applicable.
- Ask your employer to offer a policy that includes coverage for infertility treatment. Most companies that offer this benefit do so because they have been asked. Believe it or not, it is good business to offer coverage, and it does not result in an increase in the company’s healthcare costs. Fertility Within Reach has resources to help you prepare for this request.
- It may be possible to buy an insurance policy or rider for your current policy that includes insurance coverage for IVF.
- If you have an insurance policy that includes IVF, it will most likely have restrictions, such as age or diagnosis, and limits, such as the number of IVF cycles covered. Work closely from the beginning with your infertility clinic to maximize this coverage.
For more information on using health insurance to cover IVF and other infertility treatment, I can’t recommend enough this Creating a Family Radio show with Davina Fankhauser, co-founder and President of Fertility Within Reach, and an expert on obtaining insurance benefits for fertility treatment and preservation.
Were you successful at getting your health insurance to cover all or part of your IVF or other fertility treatment?
Fist published in 2015: Updated in 2018
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