Getting the Most Out of Insurance Coverage for Fertility Treatment

What do you need to know about health insurance coverage for infertility? How do you know if your policy covers treatment or diagnosis of infertility and what can you do to maximize your coverage.  Host Dawn Davenport, Executive Director of Creating a Family, the national infertility education and support nonprofit interviews, Davina Fankhauser, the foremost expert on policy related to benefits for fertility treatment and preservation, and Dr. Dan Potter, a board-certified reproductive endocrinologist with HRC Fertility.

Hit the Highlights
  • Treatment for infertility, unlike most other diseases is often not covered by health insurance or covered in various way.  How do health insurance companies generally handle insurance coverage for infertility?
  •  State mandate for insurance to cover infertility
  • To maximize coverage it is important that your physician checks the right boxes on the insurance forms. What boxes to avoid. checking the right box-don’t check reproductive counseling or infertility
  • How can you tell if your insurance policy covers any part of treatment?
  • Is your Summary of Benefits enough to inform you of your insurance coverage for infertility?
  • Where in your policy should you specifically look?  “covered benefits”, “exclusions” and “restrictions”.
  • What terms should you be particularly search for to in your policy?
  • Generally speaking people who are struggling to get pregnant start with their gynecologist. What testing should you have done with your gynecologist to increase the odds of your health insurance covering it? How long should they stay before they move on to a specialist-an RE?
  • What do many or some insurance policies require that you have before you move to an infertility clinic? Or to ask it another way, what do you need to do or get or research while still at your Gynecologist to increase the chances of coverage at the RE?
  • How important is a letter of predetermination of benefits before you start treatment. Should you get a copy.
  • What test/treatments/procedures make sense to have at your gynecologist or other non-infertility specialist in order to increase your odds of treatment.
  • How can you work with your doctor to maximize your insurance benefits to get the most coverage and to reduce out of pocket expenses? In network providers?
  • Insurance policies that cover infertility treatment often have restrictions such as age of the patient, diagnosis, limits, such as the number of IVF cycles covered, allowing certain procedure and not others, certain medications and not others. What are some typical procedures that may not be covered?
  • How can patients best work with their doctor to work around these restrictions?
  • Yearly deductible- how to maximize
  • Do they sell insurance policies or riders specifically to cover infertility?
  • Can you get insurance policies for surrogacy or egg donation?
  • Infertility Insurance coverage issues for the LGBTQ community.
  • How to advocate for insurance coverage for infertility?

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Music Credit: Michael Ashworth

Image Credit: edar from Pixabay