According to the American Pregnancy Association, 6.1 million American females struggle with infertility. This does not include the couples who may have been affected by infertility in men. Many couples are choosing to begin families later, which can increase difficulty with conception at an older age. No matter the reason, many people are affected and are seeking out fertility treatment to start or expand their families. If you are looking for the answer to: Does health insurance cover fertility treatment costs? You will find it in this article.
What is the Cost of Fertility Treatment?
Many things may be required for your fertility treatment, and it will vary by the individual. Some of which include, Dr appointments, blood tests to check hormone levels, ultrasound for further assessment, medications, egg storage, egg fertilization, and IVF. The cost of in vitro can vary from $10,000 – $15,000 for one cycle.
What Does Health Insurance Cover?
Health insurance coverage for fertility diagnosis and treatment varies widely from plan to plan and can even be affected by the state you live in. Many insurance companies consider childbearing an elective service. Because of this, they zero coverage for fertility treatment, while others offer coverage for diagnostic testing but will not cover IVF. Certain plans will cover IVF but not the needed injections. Still, others offer full coverage, which leaves the patients responsible for copays only. It is important to call the customer service number for your health insurance provider. Speak to a representative to verify your coverage, so you know exactly what you will be financially responsible for paying. The fertility office will likely also verify your insurance benefits for both partners. Both partners will need to be evaluated to determine the necessary treatments. If you find that there is a discrepancy and you are not given the same coverage information, you may want to call your insurance provider again to clarify. Additionally, if a preauthorization is required for your treatment, make sure the fertility office has acquired that so your visits are covered.
Fertility coverage by State
The state you live in may have laws requiring health insurance companies to provide fertility coverage as well. Sixteen states currently require that fertility coverage is included in health plans, and five states require fertility coverage for individuals who have medically induced infertility. Medically induced infertility can occur in individuals who have gone through chemo. For a list of fertility coverage by state, click here.
For most couples, the thought of needing to go through fertility treatment to start their family may be tough to face, although worth it in the end. For other same sex-couples or future single parents seeking egg or sperm donors to help for growing a family, it can be a ray of hope. The good news regarding insurance coverage is there seems to be an increasing trend for the need for fertility treatment. This means more and more people are using medical insurance to pay for treatment, and more and more insurance companies are being billed by fertility clinics. There will be families who are denied coverage as well due to their plan limitations. We as patients need to talk to these insurance companies who have very limited coverage for fertility treatment. We need to advocate for ourselves and explain the importance of insurance coverage. Infertility is a diagnosis that is difficult to navigate and understand for patients. They deserve the right to seek treatment without the worry of astronomical bills.
