Will Insurance Cover My Fertility Treatment? Questions to Ask Your Provider in 2020
2020 has been a year of ups and downs. Okay, mostly downs.
And finding out you are in need of fertility treatment in the midst of it all pretty much seems like a final blow.
People don’t plan on having trouble… in fact, we usually try our hardest to prevent "surprises," assuming everything is perfectly fine. So, finding out that you are going to need some assistance might be shocking, devastating, and heartbreaking.
Then your clinic shows you the price list of your different options.
Did you know that one cycle of IVF can cost somewhere between $12,850 and $24,250?
Surely your health insurance will cover your treatment needs, right? Eh… maybe. Unfortunately, not many health insurance plans cover fertility needs, which results in you either paying out of pocket, seeking grants or loans, or halting your treatment altogether. We at RMA of Connecticut hate seeing patients stress over the financials of their fertility when we wish they could focus all their energy into their end goal: having a baby.
But that’s why you’re here reading this blog. Even in the chaos of 2020, you want to take control of your future. We 100% support that and are going to help you figure all this out.
How Do I Pay for Fertility Treatment?
We’ve written a series of blogs lately that have covered everything you need to know about open-enrollment and ways to pay for treatment outside of health insurance. Let’s review those options…
Have some money saved up for something unexpected? This might be the moment you use that surplus.
Paying out-of-pocket is not an option for many people. Grants are a great way to help supplement the costs of fertility treatments – you might even find some that pay for it all, top-to-bottom, medicine-to-procedure. Be mindful that grants typically have stipulations… you must use “this” fertility clinic, you must live in “that” state, etc.
Medical loans are another option – these are essentially out-of-pocket, as you’ll ultimately end up having to pay the loan back, plus interest. These might be a better option than just swiping your credit card every bill, since you can negotiate a predetermined interest rate and payback period.
Often times, a fertility clinic will have financial options that either discount their services, or assist you in paying over a particular amount of time.
Want a free ebook on financing your fertility journey?
And then there’s the option for which we all hope…
Health Insurance & Fertility Coverage:
Wouldn’t this be dreamy?! Sometimes health insurance companies will cover partial or full fertility treatment. Some include a stipend for medication, some give you a lifetime monetary allotment… the coverages vary. So that begs the question…
Will Insurance Cover My Fertility Treatment?
Will your health insurance cover your fertility costs? Below, we dive into how you can find out if your provider offers this benefit or not.
First off, ask the obvious:
● Does my current plan cover infertility?
If your insurance policy DOES NOT cover infertility, head straight to your employer (the Human Resources representative) with these questions…
● Is there another plan I can switch to that does include infertility? Make sure to understand the grace period before using the fertility benefits… some insurance companies require a certain amount of time to pass before dipping into some benefits, like infertility.
● Are there any company-based policies that would supplement my fertility journey? Some employers offer fertility supplementation separate from their health insurance. You may need to purchase a rider to your current plan or a separate package through another provider.
● Are there any other company policies I could take advantage of to assist my lifestyle as I seek fertility treatment? Maybe you have no opportunity for fertility treatment supplementation, but there’s a possibility they could help you in other ways! Think: a more flexible work schedule, more paid time off, etc.
If your insurance policy DOES cover infertility…
● Do I need to use a particular clinic? Some insurance companies will only cover your treatment if it's administered by certain clinics. Typically, the preferred clinics are ones that report to SART (Society for Reproductive Technologies), a third party information source with clinic statistics, and/or are Centers of Excellence.
● How do you define infertility to be granted coverage? Some plans require a particular amount of time of trying-to-conceive or other health issues before allowing access to the extended coverage.
● Is all the fertility testing covered? Fertility testing must be done before any treatments are started. Is your HSG, saline sonogram, and genetic testing covered? You should ask about those specifically.
● What specific fertility treatments do you cover? Some insurances will not cover anything more than ovulation-inducing medication. Some will cover the entire gamut of procedures. Make sure to get a detailed list!
● Do you cover fertility medications? And a follow up: Will I need to use a specific pharmacy?
● Do I have any yearly or lifetime maximums on procedures or spend? Some plans place a cap on treatments in a given amount of time. For example, your lifetime allotment might be 3 IUIs and 1 IVF cycle, or 1 IVF cycle a year, etc. Some plans will not put a cap on the type of procedures but will instead grant you a certain monetary stipend to be used on fertility needs in a given amount of time. For example, you could be given a $25,000 lifetime allotment. Getting this answer will hopefully answer several of your other questions, like “how many rounds of IVF am I allowed?” or “what specific treatments do you cover?”
● Is there a particular order to the procedures that I’m required to follow? Meaning, will I need to do something less invasive like an IUI before IVF, or can I choose to do IVF first?
● Will I have a co-pay for office visits? And will all visits have the same co-pay, regardless of the purpose? You'll be in the office quite a bit having bloodwork done, an ultrasound, or diagnostic testing, or simply a chat with a doctor. Is it all the same co-pay?
● Do you cover pre-implantation genetic testing?
● Should I need ICSI in an IVF cycle, is that covered? ICSI is a more focused fertilization method (manually placing a single sperm inside an egg) that requires more intensive work by the embryologist.
● Do you cover cryopreservation? You might need to freeze your eggs or embryos.
● How should we communicate from this point forward? Will you correspond directly with the clinic or will you be contacting me with any and all results, approvals, or denials?
● What happens if I make it through my allotted coverage? Is there an additional package I could purchase?
● Do I have a deductible to work through before my fertility coverage is paid for? Ask about all the office visits you'll have and if those payments can apply to your deductible, should you have one.
In addition to the questions above, here are a few basic IUI and IVF insurance codes to ask about:
IUI: 58322, 58323, 89260, 89261, S4042
IVF: 58970 58974
Make sure that by the time you get off the phone with your insurance representative that you are feeling comfortable and understand everything they’ve said. You can also request to get the policy in writing.
2020 is the Time to be Your Biggest Advocate
It’s incredibly important you do everything you can to understand your coverage and give your family building dreams a chance to come true. With open-enrollment coming up, now is a great time to get on the phone and ask these necessary questions. Be your best advocate, and let’s start the journey now. Let's turn 2020 around!
Are you ready to speak to someone about your financial options?
About Virginia Hamilton Furnari
Virginia Hamilton Furnari is RMA of Connecticut’s Brand Specialist and has a background in writing, marketing, and content production. In addition to helping mold the RMA of CT brand through blogs, videos, and events, she is also a patient and has undergone many fertility treatments. Given her professional and personal involvement in the fertility community, she has immersed her mind, body, and soul in family-building education.