23 Sep Know Your Fertility Coverage
Employers and health insurance companies have come a long way when it comes to providing fertility treatment coverage. That said, there is still much they can do to make family-building more financially equitable for all.
5 Steps to Learn More About Your Fertility Coverage
Fertility testing and treatments can be pricey, so the more you know about your fertility coverage, the better you’ll be able to budget. The good news is that regardless of coverage, reputable and experienced fertility centers offer various financing and treatment discounts to help make their services more affordable.
Here are five steps you should take to verify fertility coverage options before making your first appointment. Have you already scheduled your first appointment? That’s okay too. It’s still worth your time to investigate and let our office know what you uncover. We’re happy to provide you with estimated costs for your evaluation and treatment before starting the process.
1. Review your health insurance policy’s infertility coverage
Do you have a copy of your insurance coverage on hand or tucked away in a file drawer. Get it out and scan the headings and subheadings for information on infertility coverage. Most policies cover some level of infertility testing and diagnostic screenings but may not cover fertility treatments at all. Others provide exceptional coverage for infertility testing and screening procedures and fertility treatment(s) for identified infertility factors.
If you don’t have a copy of your policy, go online and print one or contact the insurer’s customer service department and request one. Whatever is stated in writing always supersedes any information you receive verbally, so keep that in mind.
2. Speak directly with an insurance carrier representative
Not surprisingly, printed health insurance policies often include “legalese” that leaves your head spinning. Speaking directly with a representative may be your best shot at getting the answers about what your policy does and does cover.
That said, keep in mind the reminder we stated above. Your written policy is the “law,” and you may be misinformed or misled by the words of a well-meaning representative. Therefore, always refer back to the policy and get clarification or something in writing if what they say differs from what you understand or read from your printed policy documents.
A group of people just like you were entirely frustrated and dismayed at the discrepancy between insurance providers’ support of general health and reproductive issues and the complete discounting of individuals and couples with infertility diagnoses. Progyny is the result of their outrage and desire to change things.
With at least 12% of the American population struggling with infertility and the increasing number of individuals choosing to be single parents, Progyny’s vision has never been more important. First, speak to your employer or the HR department and ask if they offer Progyny coverage. If not, ask them to look into providing Progyny coverage to current and future employees. Then, direct them to Progyny’s Page for Employers and see what happens.
Progyny partners with some of the best fertility centers in the nation, which means it’s a win-win for Progyny patients when it comes to the most affordable fertility coverage and increased success rates.
4. Provide a copy of your coverage to your fertility specialist
Fertility coverage varies in terms of what is covered, how many times a particular service is covered, and the total amount allotted for specific testing and treatment procedures. Providing a copy of your coverage to the office helps us help you as we work through what is covered and what isn’t.
For example, your policy may pay for primary infertility screening but may not cover some of the lesser-used imaging diagnostics testing used to identify suspected infertility factors. Examples of testing/diagnostics that aren’t typically covered include immune studies, such as embryotoxicity assay and natural killer-cell phenotype, and comprehensive semen analysis with ultra-specific morphology. In other cases, a policy may cover oral or injectable fertility medications, but not the IUI or IVF procedures that follow those treatments.
Other common limitations related to fertility coverage include:
- Limits on which procedures are covered
- Maximum per-service coverage, regardless of what your fertility center charges
- Limits on the number of treatments (like coverage for three IUI cycles and only one IVF cycle)
Finally, some policies have “lifetime” dollar amounts that apply to fertility coverage. These lifetime reimbursements may seem like a lot, but they disappear quickly within a cycle or two of treatment.
We can help you identify what’s what to help you plan accordingly. But, ultimately, know that you will be responsible for all medical billing, regardless of what you understand to be true from your policy.
5. Look into medication coverage
We mentioned above that some policies cover fertility medications but not the actual fertility treatment procedures. The opposite can also be true.
We’ve had clients with fertility coverage that pays for a portion or all of their IVF cycle but not the medications to support egg retrieval. While fertility medications aren’t as pricey as treatments, they add up – especially if you participate in multiple fertility treatment cycles before getting pregnant. So, look for drug discount programs available to patients through their fertility center or third-party carriers. We work with reputable pharmacies and will give you a referral.