Insurance and In Vitro Fertilization

The intimidating cost of in vitro fertilization and other infertility treatments can be an obstacle for many patients.  The good news is that there have been recent legislative proposals in America that would increase the number of people who qualify for insurance coverage with these procedures.  The Family Building Act of 2005 would require insurance coverage of infertility treatments (including up to 4 IVF attempts) by all health plans that also cover obstetrical benefits.  While approval of this bill is still pending, the future seems brighter for those who could otherwise not afford infertility treatment.  In fact, some states currently have provisions in place to require infertility care within medical benefits.

Fourteen states already have laws that require insurers to either cover or offer to cover some form of infertility diagnosis and treatment. These states are Arkansas, California, Connecticut, Hawaii, Illinois, Maryland, Massachusetts, Montana, New Jersey, New York, Ohio, Rhode Island, Texas and West Virginia. Unfortunately, the laws fluctuate greatly in their range of what is and is not required to be covered. You should call your state's Insurance Commissioner's office to determine the specific requirements in your state.

When considering the process of in vitro fertilization, your first step should be to consult your health plan administrator to review your benefits.  You may find that your current coverage already includes some form assistance.  In this case it is likely they offer provisional treatment options that require verification of your infertility.  It is also common for insurance providers to have a mandatory treatment cycle.  This means that you will be limited to certain providers and treatment options in a specific schedule.  If you complete the treatment cycle in its entirety without success, then you can be approved for further methods of treatment.  In the case of in vitro fertilization, it is typically one the last approved options for the patient because of its high cost and lower success rate.

Even if your insurance provider offers coverage for in vitro fertilization, you should still plan to budget your finances.  The complexity of this procedure could leave several elements of treatment outside of your coverage.  Lab testing, cryopreservation, and genetic consulting are some examples of elements that may not be deemed “required treatment” by your insurance provider.  Furthermore, you can expect a number of co-payments associated with the entire process.  Each visit to the office and subsequent treatment could have a varying range of cost and co-payment.  There are also a few procedures that could be considered surgery, which usually carriers a high co-payment.  The bottom line is to make sure you aware of your benefits before seeking treatment.  Otherwise you could be billed unexpectedly for thousands of dollars.