The FCLV team is here to help you understand insurance coverage for fertility care
Understanding insurance coverage for fertility care can feel just as confusing as making sense of an infertility diagnosis. You may see unfamiliar terms as you try to unravel the specific criteria for coverage. The good news is the benefits and authorizations team at our Las Vegas infertility center can demystify the world of insurance.
A quick look at the basics of coverage for fertility testing and treatment
Just like no two patients are the same, no two insurance plans are identical. Our fertility doctors are here to provide personalized fertility care, while our benefits and authorizations team can help you make sense of your insurance coverage.
When it comes to fertility insurance benefits, most health insurance policies fall into one of four categories:
No coverage. Some policies won’t cover any fertility testing or treatment. However, most plans will cover the diagnosis and treatment of underlying conditions that can cause infertility. For example, these plans often cover medical (but not fertility) treatment for conditions such as polycystic ovary syndrome (PCOS) or endometriosis.
Coverage for testing. Certain insurance policies cover fertility testing, but not fertility treatment. However, the coverage can vary. A policy may cover all diagnostic services, regardless of when your doctor performs them, or it may only cover what occurs during your first visit.
Coverage for testing and limited treatment. Some types of insurance coverage pay for fertility testing and limited fertility treatments. As an example, this type of policy may cover artificial insemination (IUI), but not more advanced options such as in vitro fertilization (IVF).
Full infertility insurance coverage. Although it is rare, some lucky patients have coverage for fertility testing and treatments including intrauterine insemination (IUI) and IVF. However, it’s common for even these policies to limit the number of cycles they will cover or place a lifetime dollar limit on fertility treatment.
Are fertility medications covered by fertility insurance benefits?
Fertility medications play an important role in almost every treatment cycle at our Las Vegas infertility center. Because these medications are highly specialized, they can be expensive without insurance coverage.
To determine if you have coverage for fertility medications, you’ll want to pay close attention to the language of your policy. If your policy covers medications, it may only include coverage for certain types. For example, your plan may only cover oral medications, such as Clomid, and not injectable medications.
If your insurance coverage for fertility care does not cover the fertility medications you need, our team can help you find fertility discount programs to make your care more affordable.
Does insurance cover IUI and IVF?
Some insurance plans cover IUI and IVF. However, determining whether you have coverage for these treatments requires a close look at your policy’s wording. Even if your policy mentions that it does cover one or both of these fertility treatments, it can still have coverage limitations.
- A limit on the number of IUI or IVF cycles your plan will cover
- A lifetime dollar limit for use on fertility treatment
Additionally, plans that cover IVF may not cover add-on services, such as genetic testing, or even the cost of all fertility medications.
Does insurance cover egg donor IVF or surrogacy?
Typically, insurance coverage for fertility does not cover egg donor IVF or surrogacy. However, our benefits and authorizations team will work hard to make sure you can make the most of the fertility coverage you do have.
Does insurance cover Ovation Fertility IVF and andrology lab services?
The Ovation® Fertility IVF and andrology lab is now contracted with UnitedHealthcare and UMR insurance. Coverage is dependent on the individual insurance plan and can cover fertility testing and even fertility treatment.
Questions to ask your employer about insurance coverage for fertility care
Knowledge is power, so you want to know as much as you can about your insurance coverage before beginning treatment with us. To help you learn more about your fertility insurance benefits, we recommend asking your employer’s HR department some questions.
- Does my health plan include fertility insurance benefits? If so, do they include fertility testing and fertility treatment?
- Do you offer other insurance plans with infertility coverage? If yes, what is the difference in premium cost?
- When am I allowed to change plans?
- Does a preexisting condition restriction apply? If so, how long do I have to wait before starting treatment?
You’ll also want to ask your employer about specific employer-offered fertility benefits from providers such as Progyny, Maven and Carrot.
Questions to ask your insurance company about fertility coverage
The HR department at your place of work isn’t the only place that can provide information about your insurance coverage for fertility. Your insurance company also has a wealth of helpful information.
When you call member services, you can get more specific information about your policy by asking several questions.
- Do I have coverage for diagnostic testing for infertility services?
- Does my plan cover fertility treatment? If so, what type of treatment does my plan cover?
- Are fertility medications covered by my plan? If so, which ones? Oral or injectable medications?
- Do I have a lifetime maximum benefit or a maximum benefit per calendar year?
- Is medication included in my lifetime maximum benefit limit?
You might feel intimidated by the thought of reaching out to your insurance company, but just remember that they are there to help you. Additionally, our Las Vegas infertility center can help you work with your insurer.
A note about referrals and authorizations
Some plans may require you to obtain a referral and authorization before your first fertility appointment. This is a very important step because your insurance will not reimburse your visit without them. Without reimbursement, you will be responsible for the entire cost of your appointment.
If you have questions, our benefits and authorizations team is here to provide the answers you need. Additionally, we will work closely with your provider to ensure you make the most of the fertility insurance benefits that your policy offers.
Contact us if you would like to learn more about making the most of your insurance coverage to receive fertility care from The Fertility Center of Las Vegas.
