Does Insurance Cover Infertility Treatments?

 Does Insurance Cover Infertility Treatments?

Did you know that 1 in every 8 women will face infertility? Infertility is a frustrating, emotional struggle.

It can make you feel as though you have no control, but there is something you can do. You can see a doctor. If you are considering infertility treatment, you probably have a lot of questions. The first being “does insurance cover infertility treatments?”. 

Insurance Coverage for Infertility Treatments

When shopping for insurance coverage, most people focus on maternity and newborn care. These are often considered essential benefits, but infertility care is often not considered. Whether your insurance will cover infertility treatment or now greatly varies.

 Some plans cover IVF but not the accompanying injections required. Other plans may cover both, and still some plans cover limited attempts at certain treatments. And of course, there are some plans that offer no coverage for infertility treatment. 

Infertility doesn’t just affect women. Men will need to check if their plan covers a semen analysis and male infertility care. Both partners need to be evaluated because the issue could lie with either, or both. 

Where to Begin

First, you should speak to your OB-GYN. He/she can order diagnostic tests to check hormone levels, analyze semen, and more. The results of these preliminary tests will determine what medical problems, like PCOS or endometriosis, may be hindering your fertility.

Your gynecologist can also help you track your menstrual cycles and advise you on the best time to have intercourse during ovulation. He/she can also prescribe ovulation-stimulating drugs to help you conceive. 

Typically, couples start with the least invasive methods, which are offered by your OB-GYN. This tends to be less expensive than an infertility specialist and depending on your insurance plan, you may find that you pay less out of pocket as well. You should also be sure to check that the medication your doctor prescribes is covered by your plan. Sometimes a plan may cover one type of ovulation medication but not another. 

Lastly, men with abnormal semen results are often referred to a urologist. This specialist can offer a diagnosis, prescribe medication, suggest surgical solutions and more.  

Choosing an Infertility Specialist

If your OB-GYN’s efforts are not successful, the next step is to see an infertility specialist, also known as a reproductive endocrinologist.

Your gynecologist can point you in the right direction. If you are not satisfied with your OB-GY’s recommendations, you can check out Fertility IQ. This is a database with patient reviews of infertility doctors. 

Make sure that the doctor you choose is in your insurance plan’s network. Your plan may have additional requirements for people seeking infertility care, so we encourage people to speak to representative from their insurance company.

How Many Cycles of Treatment Will Be Covered? 

While some people respond very well to a certain treatment, other people may not respond at all. It’s hard to not be discouraged when a cycle of infertility treatment fails. However, it is important to know how many cycles your insurance will cover before you begin treatment.

For example, some plans may only cover IVF after you have undergone a certain number of other treatments. Also, doctors usually encourage up to six rounds of IUI, but your insurance may only cover three.

Understanding how many attempts insurance will cover and which benefits are available to you is crucial.  This may be a huge factor in deciding which treatment you pursue. 

Surrogacy and Adoption Coverage

If fertility treatment does not work out for you, you may choose to pursue surrogacy or adoption. If you plan to have a gestational surrogate (a woman who will be implanted with your eggs or donor’s eggs) your insurance may cover the retrieval and fertilization of your eggs.

It’s also important to note that most plans do not cover services received by the surrogate. Therefore, her out-of-pocket health care costs may be your responsibility, depending on your surrogacy agreement. 

If you are considering adoption, check to see if your insurance plan or your employer offers reimbursement for adoption expenses. Also, if you have a Health Savings Account, adoption costs are an eligible expense. 

Fertility Treatments Near MeWhile fertility treatment does seem daunting, it is possible. If you would like to learn more about infertility treatment, please contact Fair Oaks Women’s Center today!

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