Fertility Treatment-6 Tips for Maximizing Insurance Coverage

Dawn Davenport

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Infertility Treatment Insurance

I love the Creating a Family Online Support Group! After we posted our Top Ten Tips for Using Health Insurance to Cover Infertility Treatment, one of our community members sent me more tips. She knows of what she speaks since she works for a major health insurance company assisting Human Resources representatives with their group’s coverage.

  1. If you can’t find your policy online, ask your employer for a copy. Don’t take the smaller 2 page summary they often given employees. An actual Summary Plan Description (SPD) will be much longer and include exclusions laid out clearly in a section.
  2. Get specific CPT codes (the codes the doctor will bill for EACH procedure) before calling the insurance company. They will need these to verify if everything will be covered. Sometimes there is fertility treatment coverage, but not for certain CPT codes. For example, sometimes diagnostic tests are covered but not the actual treatments.
  3. Make sure to ask about limits. Your health insurance might only cover 1 diagnostic test or not cover further tests after treatment begins.
  4. If you are using a network of doctors, make sure you call to verify your doctor is in-network and then document the date and time of the call and ask the call representative for their ID. This comes back to bite people often when they are misquoted. If you use a doctor outside of the network, be sure you have out of network coverage. Some plans do not provide this. (This situation that comes up a lot.)
  5. If you use out of network coverage, check if your plan will only apply your benefits up to a certain amount and if you will be responsible for the amount over that. For instance, if the infertility treatment charges are $1000 and you have 50% coverage, but your health insurance plan won’t apply these benefits to more than $500. You would pay $250 (50% of the covered $500) and insurance would pay $250 (the other 50% of $500), but then you would be responsible for the additional $500 they didn’t apply benefits to making it a total of $750 that you owe. A lot of people don’t realize this and end up owing a lot more money.
  6. If you don’t have infertility coverage, petition your employer to provide this coverage. I have definitely seen employers successfully add fertility treatment insurance coverage , and even have it apply retroactively to cover a procedure that happened earlier in the year. It won’t happen unless you ask!

More resources you might find helpful:

Were you successful in getting some of your fertility treatment covered by your health insurance?

Image credit: Cheap Full Coverage Auto Insurance™

31/08/2015 | by Dawn Davenport | Categories: Blog, Infertility, Infertility Blog, Infertility Resources | 4 Comments



4 Responses to Fertility Treatment-6 Tips for Maximizing Insurance Coverage

  1. kevin @ Growing Family Benefits says:

    In addition to point six, couples should investigate options from both spouses’ employers. Rather than look at premium cost (the employer contribution level is often the biggest factor), consider which plan covers infertility.

    If one employer is based in a mandate state, the odds are better that you will have some level of coverage. The mandates apply in the state where the group issues the policy. So even if you live in a non-mandate state, one employer’s plan might have coverage.

  2. Gina says:

    What are the costs of getting a donor. I am about 47 and my husband is couple of years younger. IS there anyway that I’d be only a surrogate mother and have my husband kid?

    • Dawn Davenport Dawn Davenport says:

      Gina, the cost of using donor eggs with your husband’s sperm with IVF is include on our Egg Donation page. I’m not exactly sure what you mean by being “only a surrogate mother” to your husband’s child. You would be 100% the mother of your child, but would not share DNA. Being a mom involves more, much more, than a genetic connection. I strongly urge you to see a counselor, who is knowledgable about infertility grief, to help you work through these very normal feelings of grief at losing a genetic connection to your child. Most infertility clinics can recommend such a counselor.

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