10 Tips for Using Health Insurance to Cover Fertility Treatment
- Understand your insurance coverage BEFORE you see a specialist or at the same time you have your first appointment. (Most fertility clinics have someone on staff that can help you review and understand your insurance policy.)
- Make sure you have the latest copy of the Evidence of Coverage document detailing the coverage benefits offered by your policy. This document changes frequently.
- Get your infertility coverage in writing from the insurance company before you start incurring costs.
- For help in determining what fertility treatments are covered by your health insurance policy, go to:
- The human resources department of your employer.
- The infertility clinic you are considering or are using.
- A wonderful place to ask your fertility insurance questions is the Fertility LifeLines provided by EMD Serono. 1-866-LETS-TRY (1-866-538-7879).
- Pay close attention to what diagnostic codes your infertility clinic uses for procedures, especially if your insurance only covers diagnosis, not treatment.
- If your insurance policy limits the number of IVF cycles it will cover, know beforehand how the policy defines an IVF cycle. You want to know if and when you can stop an unpromising cycle so it will not count against your total.
- If your insurance company denies coverage for fertility treatment, consider an appeal that specifically addresses the reason for the rejection. The appeal process in included in your policy.
- Pay special attention to the time limit for appeals. Again, this information is included in your policy.
- Get a copy of the book Budgeting for Infertility by Evelina Sterling and Angie Best-Boss. The chapter on Insurance Benefits is worth the cost of the book.
First published in 2011. Updated in 2016.