First, call your insurance provider and ask them what IS covered in relation to fertility treatment. Many plans will not cover the actual treatment, but WILL cover the diagnosis. In other words, the initial testing could be covered so you can at least get the process started.
For example, if you have fibroids, or endometriosis, insurance may cover those treatments, even if the plan does not cover IVF or IUI.
It is possible that infertility benefits are included in your plan, so it certainly makes sense to at least ask. The worst thing the insurance company can tell you is that nothing is covered.
It is also important to be aware that coverage can be found on both the patient’s insurance as well as your spouse or partner’s plan. Therefore you should always research and explore the possibility with regards to all plans under which you may have coverage.
Many patients are unaware that their spouse’s plan could cover infertility.
Call 2-3 times and ask the same questions. You don’t always get the same answers when calling your insurance company, unfortunately. It all depends on whom you speak to on the other end of the line.
Also, don’t rely only on the doctor’s office to get the answer for you. Their information is only as good as the representative to whom they spoke. Again, you do not always get the same information when you speak to different people. Many times coverage is found on a second inquiry when you re-verify benefits.
You can also talk to your employer’s Human Resource contact person to inquire about benefits. He/she may be more familiar with your plan and can be a good resource.
Ultimately, it’s a good idea to initially get some of the diagnostic testing done beforehand. It’s important that you have an actual diagnosis and plan moving forward. The last thing you want is to worry whether or not you have coverage for a procedure you may not even need. You do not want to jump through all sorts of hoops to get coverage only to find out that it doesn’t cover your particular needs in the end. You should definitely work with your physician and their office staff to be clear on what procedure(s) you will require. Plus, you also need to know in advance what is and is not covered by your insurance plan.
While medications are often not covered in plans that DO include infertility treatment as a benefit, the medication costs will sometimes apply towards your deductible. So be sure to ask.
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