Infertility Treatments and Insurance Coverage

If you and your partner are struggling with infertility problems and have decided to see a fertility specialist, the cost of procedures including intrauterine insemination and in vitro fertilization may prevent you from getting the treatment you need. While these fertility treatments offer the highest success rates, you do have some affordable alternatives, and some infertility treatments are covered by health insurance.

Here’s what you need to know about covering the costs of fertility treatments:

Health Insurance Coverage for Infertility Procedures

Some health insurance policies do cover a portion of the cost of infertility treatments, while others do not cover anything at all. Thirteen states in the United States mandate insurance coverage of certain infertility treatments, but the majority of states do not require health insurance providers to provide any type of coverage or provisions for treatment.
There are currently two types of mandates for health insurance providers: mandates to offer, and mandates to cover. Mandates to offer require insurance companies to offer policies that cover the costs of infertility diagnosis and infertility treatments. Mandates to cover require insurance companies to cover the cost of certain types of fertility treatments, and many include a higher-than-average monthly premium to help cover the cost of the treatment.
The thirteen states that have mandates to cover fertility treatments are: Arkansas (including the cost of IVF treatments), California, Connecticut, Hawaii, Illinois, Maryland, Massachusetts, Montana, New Jersey, New York, Ohio, Rhode Island, Texas and West Virginia.
Certain states have strict regulations on whether the individual will receive coverage based on ‘medical necessity’, while others set a number of treatments that will be covered. For example, New Jersey law mandates that the insurance company can cover the costs of up to four egg retrievals. Massachusetts law requires HMOs and insurance companies to only cover the costs of treatments that have been deemed medically necessary, such as IVF, ZIFT, GIFT, IUI and sperm or egg retrieval. In Ohio, all treatments that are covered by insurance must be approved as medically necessary.
Some health insurance policies will cover the cost of fertility drug therapy, while others will pay for the diagnosis. It’s important to learn about your state’s mandates, and also speak directly with your health insurance provider to find out exactly what is and isn’t covered under your plan. You can then speak with a fertility specialist to learn about the payment arrangement process, and what types of treatments are available if you want the insurance company to pay for it.

Other Options for Financing Infertility Treatments

Another option for covering the costs of infertility treatments is to apply for patient financing. Patient financing can help you make more affordable payments to cover the cost of drug therapy and other fertility treatments recommended by the fertility clinic.
Some fertility clinics may also offer their own payment plan with a set amount of interest. These payment plans can be set up with monthly and yearly repayment options, making it much easier to manage the total costs of otherwise expensive treatments.
Set up a consultation with a fertility clinic in your area to discuss the latest infertility treatment options and learn about payment options, including insurance coverage.