How to get insurance coverage to pay for IVF: Information and a new forum to get help

July 18, 2013Carole 3 Comments »

In vitro fertilization (IVF) is much more effective than it used to be, delivering rates at average US IVF clinics of greater than 40% take-home-baby rates (CDC data for 2011 reported by SART) and at the best places, over 70% take-home-baby rates for their youngest patients. IVF is being used not just for people struggling with infertility. When combined with genetic testing of preimplantation embryos, it gives prospective fertile parents a way to avoid passing on deadly genetic diseases to their kids. The problem is that all these advances do you absolutely no good if you can’t afford to take advantage of the technology.

If you are just starting down the IVF road, it pays to do your homework.

Step One: First find the best clinic you can get to. The most expensive clinic is not necessarily the best!! I have written a lot of past posts about finding a good clinic. Even if you can afford IVF, wasting your money on a mediocre or poor performing clinic is still a waste of money and a source of unnecessary heartbreak. Some posts to get you started on finding the right clinic:

 Finding your “best fit” IVF program

Advocating for Yourself: Finding a Good IVF Clinic

 How do you know if your IVF clinic is good?

Ten things about IVF you must know

Step Two: If you have medical insurance, understand whether it can be used to cover some aspects of infertility treatment or even the entire IVF cycle.

You might be surprised at what your medical insurance does cover. There is no “usual benefit”; plans are all over the place as to what they will or won’t cover. It is not clear whether the Affordability Care Act (Obamacare) will be a net gain, loss or stay the same regarding insurance coverage for fertility patients. A previous post talks about the effect of Obamacare on access to care for infertility patients. A lot depends on which states you live in. Fifteen states –Arkansas, California, Connecticut, Hawaii, Illinois, Louisiana, Maryland, Massachusetts, Montana, New Jersey, New York, Ohio, Rhode Island, Texas and West Virginia—have passed laws that require insurers to either cover or offer coverage for infertility diagnosis and treatment, which may or may not include IVF. To see a summary of infertility laws pertaining to insurance coverage on a state by state basis, check out this link.

Some medical insurance plans may cover some aspects of infertility treatment, like diagnosis for example, but that’s all. Some may offer diagnosis and low tech treatment, but specifically exclude IVF as a covered treatment.  A previous post, Understanding and Negotiating your Insurance Benefit; has questions for your insurance company and research showing that infertility coverage has advantages for companies too- which is something your HR department may not know. There was a recent uproar in the press when it was revealed that hospitals charge wildly different prices on their ” list price” sheet called the Charge Master. Having had a previous rude awakening about how hospitals come up with IVF fees, agree to ridiculously low insurance rates, and then charge full freight to the uninsured who subsidize everyone else — described in this post — I wasn’t particularly surprised. If you have insurance, you have the best chances of being able to afford IVF. If you have no insurance or don’t understand your insurance coverage, you have the best chance of being screwed.

If you are still trying to get medical insurance for infertility- there are strategies and resources to help you.

As you struggle to figure out your insurance or ask your employer to add insurance to the policy (employers often have the option to do that but employees rarely ask!)- you are not alone. A non-profit organization called Fertility Within Reach is ready and willing to give you lots of assistance in the form of information and education —for free– to help you get your IVF covered.  Read Darren and Vanessa’s story about how they were able to get their employer to offer infertility insurance here.

Recently Fertility Within Reach has teamed up with another infertility support group, Fertile Thoughts, to bring you a forum to ask your insurance questions and hear about others’ experiences in getting infertility care covered.

From the forum: here is one story about someone who had insurance but was still denied coverage and a call to action:

Fertility Within Reach recently helped someone living in a state with a mandate for infertility benefits. Unfortunately, the insurer (HPHC) wrongly denied the patient benefits. They the insurer imposed medical guidelines that went again the state regulations. We coached the patient on how to communicate with to their Division of Insurance. This state government group is now reviewing the medical guidelines of the insurer and will ensure they are complying with state laws and regulations. The action of this one patient is going to make the difference for countless others in her state.

If you believe you have been wrongfully denied insurance benefits, share your story. There are others who have had a similar experience and can help you win your appeal.

So don’t wait. The technology is here. Good clinics are doing really great things. The last hurdle is often insurance, getting it and then getting the most coverage for your insurance dollar. So please, help yourself and use these resources, and reach out to others through this infertility forum to get started.  Good Luck!!



© 2013, Carole. All rights reserved.

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