skip to Main Content

Why it Pays to Understand Your Insurance Benefits

Understand your Infertility Insurance BenefitsYou’re starting fertility treatment. Hooray! Taking charge of your reproductive health is an empowering feeling, but it can also be confusing at times – specifically, when you think about the cost of your full course of fertility therapy.

Learn your insurance policy’s infertility insurance benefits

That huge stack of papers you received from your insurer outlining your health benefits is intimidating. And if you’ve flipped through that packet and insurance terms start swimming before your eyes, it is tempting to toss the packet aside and just call your doctor’s office for direction.

Know your Infertility InsuranceBut wait! Scary as that packet is, it is your responsibility to know what’s included. Your doctor’s office deals with several insurers which all carry multiple policy levels, so its staff may not be able to answer questions about your specific policy. Instead, pull that packet out of the trash and flip to the table of contents to find the right page for infertility treatment. Grab some coffee to focus on what’s outlined there, or call your insurance company to ask one of their representatives to talk to you about your fertility coverage.

Moreover, even if you knew about your benefits last year, some policies may have changed for 2016, so checking through the details of your policy is always a good idea.

What to expect from your health insurance

Make sure you have a pen, paper, and around half an hour to make this phone call. These aren’t usually quick conversations, and insurance companies handle thousands of calls every day, so be prepared to wait on hold for a while.

Have a list of questions prepared. A few starter questions include:

  • What is my deductible?
  • Do I have coverage for infertility treatment? How much?
  • Will I be covered for diagnostic treatment?
  • Which labs should handle my blood tests, and how much of those tests will be covered?
  • Will any of my fertility medications be covered? How much?
  • What is my lifelong coverage for egg retrievals?
  • Does my insurance cover fresh and frozen embryo transfers?
  • Will my insurance cover embryo cryopreservation (freezing)? Or embryo storage? If so, for how long?

Once you begin your fertility treatment and understand the path ahead, you may have more specific questions that you need to ask about your infertility insurance, such as coverage for egg donation (anonymous, known, or via an egg donor agency), coverage for a gestational carrier, or any benefits for genetic testing of embryos. You may require surgery to remove blockages, fibroids or polyps in your reproductive tract which could have been discovered through fertility treatment, but may be covered under a different portion of your plan.

Single patients and same-sex couples

Infertility is the condition ascribed to the inability to get and stay pregnant after 12 months of trying. But that only refers to heterosexual couples. Same sex couples or single women may want to start a family, so fertility treatment is needed, but does not necessarily indicate infertility. In this case, your list of questions to your insurer will be different. You may need to ask:

  • What is my coverage for donor sperm?
  • How many IUIs (intrauterine inseminations, or artificial inseminations) am I covered for?
  • Will I have coverage for IVF? At what point?
  • Will I need to undergo full diagnostic treatment to access my IUI benefits?
  • Am I covered for egg freezing? Frozen egg storage?

The insurance norms

Infertility Insurance for testingIn New Jersey, infertility coverage is mandatory for companies that provide health insurance benefits for more than 50 employees, per the NJ Family Building Act. (There are some loopholes and restrictions, though, so it is still wise to check your policy.) Generally, these benefits cover diagnostic treatment, four IUIs and then four egg retrievals for IVF. This coverage may also include medications, embryo storage, ICSI or assisted hatching.

Every insurer has its preferred phlebotomy labs (usually LabCorp or Quest). At the Center for Advanced Reproductive Medicine & Fertility, we have an onsite LabCorp phlebotomist who will draw your blood and send it to the appropriate lab. If you have QualCare insurance, however, it is a good idea to call your insurer and ask where your blood should be drawn. Often, this is at a hospital such as JFK Medical Center in Edison (a short drive from our main office) so you don’t receive a steep and unexpected medical bill.

Unfortunately, it is common for insurers to provide minimal, if any infertility coverage. Most plans purchased through the Healthcare Marketplace, for instance, do not cover infertility at all. Our Center provides patients without infertility coverage and without IVF benefits an affordable cash-pay option of a $6300 IVF program. In addition, we can refer patients to for financing options.

Finally, once your doctor has established a treatment plan, you can schedule a consultation with one of our financial experts. Send your infertility insurance policy coverage and you can meet with our expert one-on-one to discuss the most cost-effective course of action according to your available benefits.

Not knowing your infertility insurance coverage could cost you

Medical bills beyond infertility insurance coverageMost people don’t like to pore over insurance documents, but nobody likes a surprise medical bill. Not knowing and understanding your insurance coverage could lead you to making a costly mistake during the course of your treatment, which can limit your options in the future.

Take full advantage of your health insurance coverage by calling today! Then contact us to request an appointment. See you soon!


Leave a Reply

Your email address will not be published. Required fields are marked *

Back To Top