- Jennifer "Jay" Palumbo
How To Find Out If Your Insurance Covers IVF
When you know you will need fertility treatment like in vitro fertilization, one of the best first steps is to know and understand your health insurance benefits. Below, we’re going to offer advice on what to look for, how to understand your existing coverage, and your options.
Find Out If You Already Have Coverage
The first step to knowing your coverage and how to get IVF covered by insurance is to request your “Summary of Benefits” to find out if your benefits already include in vitro fertilization. Your summary of benefits may also be referred to as a “Benefits Package” or “Explanation of Benefits.” If your company covers your insurance, you can contact your Human Resources department to get the most up-to-date copy. If you’re self-insured, you can contact your insurance company directly. Once you get a copy, you need to review your benefits to precisely see your coverage. Typically, coverage for fertility treatment falls into one of the following categories:
1. No Fertility Coverage
2. Coverage Only for Diagnostic Testing: Some insurances also may cover some related treatment if there’s a general health condition such as Polycystic Ovarian Syndrome or Endometriosis that happens to impact fertility
3. Coverage for the Diagnosis of Infertility but Not the Treatment: In addition, some insurances may even specify which health care provider you need to be diagnosed by, such as an OB/GYN, Reproductive Endocrinologist, or a fertility clinic
4. Limited Fertility Coverage: You must read this in detail as limited treatment could mean they allow timed fertility cycles with a medication called Clomid, or intrauterine insemination IUI but not IVF
5. Full Coverage: Again, even with full coverage, insurances typically have a limit on how many cycles of IVF you can do, or they have a monetary limit to how much fertility treatment you can do. For example, they may offer $10,000 per lifetime maximum for fertility treatment
While it’s your responsibility to know and understand your benefits, you can speak to your Human Resources department, an insurance company, or, if a fertility doctor is already treating you, most clinics have a financial advisor that can potentially advise you.
If You Have Existing Fertility Benefits
The good news is your insurance offers fertility benefits! Still, you want to make sure that there are no hiccups, and you make every effort to ensure your coverage runs smoothly. How to get IVF covered is to ask for a copy of your IVF coverage in writing or request a written statement confirming coverage from your insurance company.
Next, while undergoing treatment, pay careful attention to your diagnostic code or what is being used to impact your coverage. When you spoke to your insurance company and confirmed how to get IVF covered by insurance, you ideally discussed the diagnostic code necessary to properly process your in vitro fertilization cycle.
If at all possible, speak to your clinic to ensure your paperwork is correct before they submit it to your provider. It’s complicated after claims have already been submitted to try and fix it, and if the wrong diagnostic code is used, it can impact your coverage.
Also, if your insurance company limits the amount of IVF cycles you can have, be certain to clarify what counts as a cycle. For example, should you have a canceled cycle, how would they handle that, and would that count against your maximum lifetime limit?
In addition, if you are of a certain age or have had recurrent pregnancy loss, your reproductive endocrinologist may recommend genetic testing such as PGT-A or preimplantation genetic testing for aneuploidies. Unfortunately, this is typically not covered by insurance and can cost approximately $3,000.
The bottom line is while fertility treatment may be covered, there are additional add ons like PGT-A, endometrial receptivity analysis, or other protocols and tests that may not be.
If You Have Little (to No) Coverage
There are ways you can be a patient advocate for yourself and your own treatment:
● Speak to your clinic about any IVF clinical trials that you may qualify for
● Keep copies of any of the money you’ve spent on fertility treatment or any related doctor’s appointment and ask your accountant if it can be filed under “medical” when you file your taxes for that year
● Investigate if any of your Flexible Spending Account (FSA) or your Healthcare Savings Account (HSA) can be used towards IVF for that year
● Explore fertility financing as an option
Fertility treatment itself can be overwhelming. When you’re trying to figure out how to afford IVF, it can add an extra layer of stress. This is what motivated our founder, Carmela Rea, to create EggFund. We can help you finance your treatment and at least remove that concern from your mind so you can just focus on building your family. Click here to learn more.
What’s important to remember is that you have so many avenues to explore, options you can pursue, and EggFund to help in any way we can, with or without insurance!