As many as one in eight couples experiences infertility or difficulty conceiving. For some couples, this can be a traumatic experience, and the stress of infertility can cause relationship problems. Additionally, infertility is sometimes caused by serious underlying health concerns. Women who have difficulty conceiving may be interested in pursuing various fertility treatments but might not know whether they’ll be covered under insurance. This is a reasonable fear as insurance policies vary tremendously and not all procedures are always covered by insurance.

Ultimately, the best way to find out whether your insurance policy will cover a specific treatment is simply to ask the company itself. You can also review your policy information to discover any particular exclusions. Nevertheless, certain things are mandated by state laws, and most insurance companies handle some issues in the same way.

What Are Fertility Treatments?

“Fertility treatment” can cover a wide spectrum of diagnostic activities and medical procedures. Depending on the underlying cause of the infertility, treatments may include prescription drugs and hormone therapies in addition to more invasive assisted fertilization treatments. In vitro fertilization, for example, is a procedure where eggs and sperm are collected from the parents and fertilized outside of the woman’s body. The fertilized eggs are then implanted inside the womb. These treatments can sometimes be very costly, and they do come with some risks.

For example, assisted fertilization treatments can often cause multiple births, which sometimes results in premature babies and low birth weights. This in turn can lead to more medical expenses for the family down the line. All the same, fertility treatments are the only option for some couples, and many states have recognized their importance by mandating insurance coverage for these procedures.

Will Insurance Cover Fertility Treatments?

Since the 1980s, more states have begun to make legislation that requires insurance companies to provide coverage for fertility treatments. These laws vary from one state to the next. For example, some states will cover all fertility treatments except for in vitro fertilization; other states cover that procedure as well. California, Louisiana and New York specifically exclude in vitro fertilization from their insurance policies.

Even in states where fertility treatments are covered by insurance, it’s important to realize that the insurance company is only required to offer this coverage. That means it may not be standard in all policies, and you may need to request it specifically or pay a higher premium for that coverage. If you already have insurance without the necessary coverage, you may be forced to wait until the policy term has ended to upgrade the coverage.

Additionally, it’s also important to receive treatment from doctors within your network. You should begin your search by contacting a general practitioner or primary care physician to receive a referral to an in-network gynecologist or other specialist. This will improve your chances of having some or all of your expenses covered by insurance.

What to Do if Insurance Won’t Cover Fertility Treatments

Even if your insurance company excludes coverage for specific fertility treatments, you may still be able to get some of the expenses covered. For example, the insurance company may still pay for diagnostic tests, physical exams and office visits. This would reduce your out-of-pocket expenses substantially. When obtaining healthcare, be sure to ask the receptionist to bill your insurance in a way that will make it clear what procedures were done. Sending an itemized bill to the insurance company is one way to encourage the company to pay for more of your visit.

Additionally, fertility treatment may be covered by insurance if it also treats other health issues. For example, some women are rendered infertile by endometriosis. While the fertility treatments may or may not be covered by insurance, treatments to deal with the endometriosis itself may be paid for by insurance.

Your insurance company may also be willing to work with your doctor on many non-invasive treatments. If you haven’t yet exhausted these options, attempting prescription drugs and hormone therapy might be a wise first step. This carries less risk and expense than assisted fertilization treatment, and it’s more likely to be covered. Of course, if these methods prove ineffective, you may still be required to pay the other expenses out of pocket.

Insurance can be complicated, and dealing with billing issues can be frustrating. By doing your research in advance, you can save yourself from the unwanted surprise of unpaid bills. Take the time to confirm your coverage with your insurance company and discuss your options with your doctor and spouse. This will help you create a treatment plan that will fit your needs regardless of the coverage on your insurance policy.