If you are fortunate enough to have an insurer that covers infertility treatments the next question will be for exactly what are we covered? This is important to know given the complexity of insurance in general and specifically the fuzziness and uniqueness of infertility insurance. Whatever you do please be sure and get a written commitment from your insurer prior to undergoing any treatment. This will eliminate the insurer’s ability to deny your claim.
To say that coverage varies is an understatement. In some states that mandate coverage the coverage is mandated only for a correctable medical condition and does not cover medications. Some states cover just about everything. In most situations what will happen is your specialist will start with the simplest treatments and work their way up the ladder. Good news is that many insurers cover the lower cost options such as Intra Uterine Insemination. The following states mandate coverage: Arkansas, California, Connecticut, Hawaii, Illinois, Maryland, Louisiana, Massachusetts, Montana, New Jersey, New York, Ohio, Rhode Island, Texas and West Virginia.
What if you live elsewhere? What can you expect? Some good news is that the diagnostics of the situation is covered by most insurers. This is most likely due to the fact that it is not expensive to find out that you are infertile. There may be a medical condition particularly with women that has a side effect of infertility. If a woman has irregular menstrual cycles that cause irregularity and discomfort and contribute to infertility. Is fixing the condition an infertility treatment or medically necessary for the health of the patient? If denied coverage in the situation, make a case with the insurer and appeal the claim. You have a valid argument that the treatment was not just for infertility.
An excellent yet expensive ART (Assisted Reproductive Technology) is In Vitro Fertilization. This is covered in some of the mandated states. There typically will be restrictions as to the number of cycles covered. Also please be sure and know whether the necessary medications will be covered. The medications can be one-third of the cost of treatment per cycle.
Medications are frequently covered by insurance. If you are able to successfully achieve pregnancy through the use of fertility drugs you may be in luck.
Alternative types of insurance can be pursued. Many In Vitro clinics offer “money back guarantees” and shared risk programs. These programs typically offer a refund if pregnancy is not achieved. Be cautious however and be certain that you know the exact terms. The clinic may consider a pregnancy that reaches the second trimester as successful even if it does not result in a live birth.