Insurance Coverage For Fertility Treatment
Insurance coverage for fertility testing and treatment varies depending on your insurance carrier. Two people covered by the same health insurance company may have very different coverage, rules, and restrictions depending on the plan their employer has purchased. We encourage you to review the benefits and requirements of your medical plan, specifically infertility insurance coverage.
Insurance Benefits & Coverage For Fertility Treatments
Health insurance companies often have a number of policies, each of which may vary in what they pay for infertility treatment. Whether you’re looking for new fertility coverage or figuring out whether your insurance covers IVF and sperm analysis, policies for fertility treatment coverage can be complicated. We attempt to verify coverage for new patients, but you can avoid issues by understanding exactly what fertility treatments your specific insurance policy covers. You may find the following steps helpful as you review your covered fertility benefits and gather information:
- Examine your policy thoroughly. Contact your health insurance company to see which infertility treatments they cover, and which they do not.
- When you call your health insurance company, take notes on their fertility treatment coverage and write down the name of the representative you speak with.
- Ask for details on which fertility procedures and drugs are covered by your insurance policy.
- Ask whether there is an age restriction or maximum lifetime benefit for fertility treatments.
- Ask if your policy requires you to complete a certain number of lower level fertility treatments (ie. IUI) before they will cover IVF.
- Ask if you need a referral and how you can get one.
- Find out if you need to use a particular clinic to get fertility coverage and, if so, get the specifics on that clinic(s).
Many health insurance policies cover procedures used for fertility testing. Your health insurance company may provide coverage for blood tests, a hystersalpingogram (HSG), semen analysis, and initial examinations and consultations.
If your doctor finds the cause of your infertility, your health insurance company may cover procedures to correct it. For example, the cost of surgery to treat pelvic pain or endometriosis, even if it contributes to your infertility, may be covered under general medical treatment.
Conversely, in a situation where SRM does not contract with an individual’s particular health insurance provider, the lack of infertility coverage would require the patient to pay for services out of pocket. In this case, payment would be required at time of service.
Out-of-Network Coverage
As many plans allow for “out-of-network” coverage, you may find that you have some level of fertility coverage even if SRM is not a contracted provider for your insurance. In these cases, we do not bill your health insurance provider directly for fertility treatment.
We will give you an insurance form showing all applicable information required for you to obtain reimbursement for fertility procedures and medication. How much you will be reimbursed by your health insurance provider depends on many factors and can vary widely. Because of its complexity, we recommend that you work with our financial counselors to first determine the level of coverage your health insurance company provides and then evaluate your options.
We Accept these Health Insurance Providers:
- Progyny
- Aetna
- Cigna
- Kaiser Permanente
- First Choice Health Network
- Premera Blue Cross
- Regence Blue Shield
- United Health Care
