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Book NowFertility Treatment & Insurance: What You Need to Know
Insurance benefits for fertility treatments vary widely depending on your plan and provider. Before beginning treatment, it’s essential to contact your insurance company and fully understand what your coverage includes. Fertility treatment is a collaborative effort, and understanding your insurance benefits should involve coordination between you, your fertility clinic, and your insurance company.
Understanding Infertility Insurance Coverage & Benefits
Each insurance plan is unique, and it’s impossible to cover every possible scenario for fertility treatment. To get specific information about your plan, it’s crucial to contact your insurance provider before starting treatment. This process should involve clear communication between you, your fertility clinic, and your insurance company to ensure you fully understand what is covered.
To assist you in this process, we’ve compiled a list of important questions to ask your insurance company when speaking with a member services representative. Your insurance company’s contact information can typically be found on your health insurance card.
Questions to Ask Your Insurance Company About Fertility Coverage
- Does my insurance cover infertility testing, such as lab work, ultrasounds, and andrology services?
- Does my insurance cover fertility treatments like artificial insemination or In Vitro Fertilization (IVF)?
- Are physician, hospital, and laboratory charges related to fertility treatment covered?
- What is my copayment for an infertility specialist visit?
- What are my copayments or deductibles for hospital charges related to fertility treatment?
- Does my insurance cover fertility medications, including both oral and injectable medications?
- Is there a specific laboratory or pharmacy I must use to be covered under my insurance plan?
Importance of Pre-Authorization
When working with your insurance company, it’s essential to ensure you have the necessary pre-authorizations before beginning any fertility treatment. Insurance authorizations can take up to six weeks, so be mindful of rushing into treatment or procedures without receiving an authorization number. This step is critical to avoid unexpected financial responsibilities.
Fertility Coverage in California
California law requires insurers to offer infertility benefits as an optional rider to employers when they purchase their annual insurance plans. If your current employer doesn’t offer infertility coverage, this could be an area where you can advocate for change. Make your voice heard through your HR department, requesting that infertility benefits be added to the package during future benefits discussions.
What If You Don’t Have Fertility Insurance Coverage?
If your insurance plan does not include fertility coverage, there are still options available. At San Diego Fertility Center, we offer discounted cash packages for various treatment options. We also accept major credit cards, including Visa, Mastercard, Discover, and American Express, to help make fertility care more accessible.
Fertility Insurance FAQs
If your employer offers infertility benefits, they will be covered by insurance. The specifics of coverage depend on the benefits purchased by your employer. At San Diego Fertility Center, we will perform a complete benefit check and review your coverage during your financial consultation.
The cost varies depending on the type of treatment needed. San Diego Fertility Center offers various discounted cash packages, and we also provide a success guarantee program for some treatments.
Your financial responsibility depends on the benefits your employer purchased as part of your insurance plan. We will verify your insurance benefits before your appointment and help you understand both your coverage and out-of-pocket costs during your financial consultation.
We are a contracted provider with many major insurance companies and some smaller providers through third-party arrangements.
There are currently no individual insurance plans that cover infertility benefits. Most coverage is obtained through employer group plans. Ask your employer if you can pay a higher premium to add infertility coverage as an option.
If your insurance requires pre-authorization, you’ll need to get a referral from your primary care physician or OB/GYN for the initial fertility consultation. After that, our office will handle any future pre-authorizations for treatment.
No, if your plan requires pre-authorization, you must obtain it before starting treatment. Retroactive authorizations are typically only issued in emergency situations, and infertility is not considered an emergency.
Infertility coverage is often considered a “rider” to basic health insurance plans. To manage costs, employers may offer fertility coverage with higher copayments or coinsurance compared to standard medical coverage.
Advocate for Infertility Coverage at Your Workplace
Many patients are unaware that their employer, not the insurance company, decides what benefits are included in their health insurance plan. If your employer doesn’t currently offer infertility coverage, you can advocate for change by speaking with your HR department.
You can also raise your voice on a national level by contacting your U.S. Senator. The advocacy organization RESOLVE offers resources for advocating for infertility coverage, including sample letters you can send to your legislators.
Explore Your Coverage
Navigating fertility treatment and insurance can be complicated, but understanding your coverage is essential to avoid unexpected financial burdens. By asking the right questions and coordinating with your fertility clinic and insurance provider, you can ensure a smoother process as you embark on your fertility journey.
For more information on fertility treatment options and insurance coverage, contact San Diego Fertility Center or visit our website for additional resources.