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The National Infertility Association, also known as RESOLVE, has defined infertility as

“A disease or condition that results in the abnormal functioning of the male or female reproductive system interfering with the ability to achieve a pregnancy or of a woman to carry a pregnancy to live birth.”

According to the organization, 6.1 million couples in the United States struggle with infertility, this represents 1 in every 10 couples!

Many of these couples are spending their hard-earned money and savings to pay for treatment to achieve their dreams of having a family. Other couples are able to take advantage of their health insurance to pay for some of the costs associated with fertility treatment. A fortunate few have health insurance with complete fertility treatment coverage. Whichever situation you might be in, it is important to know your options.

 

Paying for treatment

The Affordable Care Act was signed by President Obama in 2010. The ACA was designed to provide better quality and increase affordability for health insurance. Unfortunately, the Act did not require infertility coverage, leaving couples with the same struggles to pay for treatment as before.

Every state has different laws referring to fertility coverage and whether insurers are obligated to have a level of coverage or not. Currently, 15 states—Arkansas, California, Connecticut, Hawaii, Illinois, Louisiana, Maryland, Massachusetts, Montana, New Jersey, New York, Ohio, Rhode Island, Texas, and West Virginia—require insurance companies to offer some sort of coverage for fertility treatment to their enrollees. Other states have no mandate for insurers to offer coverage, leaving minimal options for couples in need of fertility treatments.

It’s best to review the laws in your state regarding fertility treatment to know your options and to determine if it is possible to find a plan that will benefit you and your needs for treatment. For information, visit www.reproductivefacts.org.

 

Additional benefits from your company

In recent years, large companies like Apple and Facebook have announced that they were going to offer fertility preservation treatments to their female employees. Other large companies are also beginning to offer some form of coverage for treatments associated with infertility, and some companies offer medical insurance with plans to cover all infertility treatments up to a certain amount specified. Even if you are in a state where coverage for IVF is not mandated, employers like these can still offer fertility treatment coverage in their medical insurance plans.

 

Know your options

Know your plan and know your options. All medical insurance plans vary in coverage. Understanding the details of the fertility benefit your plan offers can make all the difference. There may be options for you within your current medical coverage that allow for some aspects of treatment to be billed to your insurance. For example, some insurance providers may cover diagnostic procedures or labs used in diagnosing a medical condition or abnormality associated with failures to conceive or carry a pregnancy. Such procedures and labs can help in identifying a need for fertility treatment as well.

Additionally, fertility treatment can be deemed medically necessary resulting in some form of insurance coverage. For example, there are insurers that require a certain number of artificial insemination cycles (IUI), better known to insurance companies as ovulation induction cycles. If these cycles fail to produce a pregnancy after a certain number of attempts, then the insurance company will cover the full cost or portion of the cost of an IVF cycle.

 

Taking the first step

In regards to treatment involving Assisted Reproduction Technology, such as IVF, your first step should be to schedule an initial consultation with a Fertility Specialist. The Specialist can also order diagnostic testing such as hormone tests, or a semen analysis to identify underlying factors associated with troubles conceiving. Additionally, a Fertility Specialist can advise a course of action and treatment plan moving forward.

During the first appointment, the costs of treatment can be outlined. Some practices, like mine at the HRC Fertility, Orange County, California, offer a financial consultation at the time of the initial appointment to review your options for paying for the treatments. This includes a review of your resources, including your insurance benefits. It can be very informative and really help you understand the costs and your payment options.

If you do not have insurance or your insurance has minimal or no fertility coverage, there are some other financial options for you. For example, www.CAPEXmd.com offers loans for fertility treatments. Savings programs such as an HSA or FSA (sometimes offered by your employer) can be beneficial in paying for fertility treatment. HSA’s and FSA’s allow you to pay for medical treatment with pre-tax money. Consulting with your personal financial planner can be a wealth of information for you in understanding your options and abilities in funding your fertility treatment.

Dealing with the financial aspects of fertility treatment can be stressful for any couple. The added stress can also contribute to troubles with trying to conceive. Setting financial goals and understanding your insurance ahead of time will help in alleviating stress associated with funding your fertility treatment, and in the long run, will help you focus on what is truly important…achieving your goal of having the family you have always dreamed of.

Jane Frederick, MD
Practicing in California since 1990, Dr. Jane Frederick is an internationally noted specialist in Reproductive Endocrinology and Infertility. She is the Medical Director of HRC Fertility in Orange County, where she developed a diverse clinical practice in reproductive surgery, IVF, and the genetic screening of embryos. Dr. Frederick is board certified in both Reproductive Endocrinology/Infertility and Obstetrics/Gynecology from the University of Southern California. A renowned speaker, Dr. Frederick has educated medical colleagues in the area of fertility preservation, and age and reproductive issues with numerous publications. She has held many posts with organizations active in the advancement of reproductive medicine including the Pacific Coast Reproductive Society (Past President), and the American Society of Reproductive Medicine. Dr. Frederick has received a variety of honors for her outstanding work in the field, and recently ranked among the top 10% in the nation from U.S. News and World Report.

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