Answering the Most Common Questions About Infertility Insurance

If you’re considering infertility treatments or taking steps to freeze your eggs, then you’ve probably heard that procedures can be costly—and that is true for most clinics. However, there are several ways to mitigate costs so that you can grow your family without breaking the bank, and one of those is insurance.

Figuring out if infertility treatments are covered by insurance is rarely simple. Insurance coverage can vary greatly; some procedures might be covered by one policy but not another, there is no across-the-board answer as to whether a procedure will be covered or not, it all comes down to individual insurance policies.

There are several questions about infertility insurance that we can answer though. Here are a few of the most common ones we get asked by patients at Arizona Center for Reproductive Endocrinology & Infertility.

What expenses does insurance usually cover?
This is the big question, isn’t it? What is covered by your insurance depends on your policy.

Coverage is actually determined by the medical board of your insurance company, and their decisions will be based on the policy you or your employer have selected. Coverage is only granted once you’ve proven that you meet the criteria for infertility—and this can differ from state to state.

Typically, insurance might cover: expenses related to diagnostic testing only, full coverage of all services, a combination of testing and treatments, or absolutely nothing. Even with coverage, you still might be responsible for copays and any labs performed in the clinic.

How do I find out what my benefits are, in relation to fertility coverage?
If you’re wondering what treatments may or may not be covered by your insurance, the best way to find out is to call your company’s HR representative or your insurance company’s billing department to find out the details of your benefits.

You can also check out your Explanation of Benefits (EOB) for information on what your policy covers; you’ll get this document after your provider submits a claim. Typically, an EOB includes the types of services you received, who performed them, and their costs; the amount your insurance did and did not pay; and the out-of-pocket expenses you still owe. While an EOB is more useful after the fact, paying attention to this will give you an idea of what you can expect to owe in the future.

What costs should I expect, if I don’t end up having any insurance coverage?
We’ve answered this question in the past (to read the post, click here).

The services you will end up paying for (either through insurance or out-of-pocket) will depend on the cause of infertility and the treatments you decide to pursue. They may include:

  • Doctor’s appointments
  • Blood tests
  • Ultrasounds
  • Hormonal medications, including injections
  • Retrieval and fertilization procedures
  • The egg transfer process

The costs will vary depending on whether you’re using a donor, surrogate, or your own gametes, or sex cells (sperm/egg). And it’s important to note, that it may take multiple cycles of a procedure for pregnancy to occur.

How can I make fertility treatment costs more manageable?
At AZCREI, our entire team does our best to help reduce the financial burden of the infertility tests and procedures. Not every woman or couple will need expensive treatments and fairly often, when infertility is medically-induced, we can help find a way to get insurance to cover treatments (even if it’s outside of our offices). We’ll always work with you to help you find ways to pay for treatments, and when insurance coverage isn’t available, we offer several packages and payment plans to make the costs of treatments more feasible.

We never want insurance coverage to be a factor in your ability to grow your family. For more information on what starting a family may cost you and to explore your options, visit us online or call 520-326-0001.