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Insurance Coverage for Infertility Treatment - RSMC

We do recognize that the type and amount of insurance coverage can impact your decision with respect to fertility treatment. Understanding insurance coverage and costs can be overwhelming. Insurance coverage for infertility treatment varies by insurance company. Many companies cover diagnostic procedures such as: consultations, the initial ultrasound, initial blood work, and semen analysis. Some may provide coverage for treatment. If you are considering infertility treatments, we suggest looking at each policy to ensure that you are maximizing your coverage for treatment.

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Insurance Coverage for Infertility Treatment - RSMC

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  1. Insurance Coverage

  2. We do recognize that the type and amount of insurance coverage can impact your decision with respect to fertility treatment. Understanding insurance coverage and costs can be overwhelming. Insurance coverage for infertility treatment varies by insurance company. Many companies cover diagnostic procedures such as: consultations, the initial ultrasound, initial blood work, and semen analysis. Some may provide coverage for treatment. It is also important not to assume that because an insurance policy may cover your fertility treatment, there will be no costs. Many benefits have a “cap” at a certain amount. This means that a provider will pay up to a certain amount towards services, but anything more will be out of pocket. It is also possible that the process is reversed. First a patient will pay a certain amount before any benefits kick in. We always recommend reaching out to your carrier to go over your benefits. Insurance Coverage

  3. Many employers have multiple options for insurance coverage. If you are considering infertility treatments, we suggest looking at each policy to ensure that you are maximizing your coverage for treatment. Reproductive Sciences Medical Center is both an “in network” and “out of network” specialty facility and accepts PPO insurance only. The “in network” insurance providers we accept are Blue Cross, Blue Shield, and United Healthcare. Additionally, the “out of network” providers we accept are Aetna, Anthem, Blue Cross Blue Shield, Cigna, Tricare, and United Healthcare. Accepted Insurance Plans

  4. This depends whether or not infertility has been purchased as a benefit. Some insurance providers may cover a portion of treatment if it is a medical necessity. Benefits vary by insurance policy. We always encourage our patients to reach out to their provider for an explanation of coverage. Will my health insurance pay for any infertility treatment?

  5. RSMC accepts both “in network” and “out of network” PPO insurance only. We accept “in network insurance from Blue Cross, Blue Shield and United Healthcare. We also accept “out of network” insurance from Aetna, Anthem, Blue Cross Blue Shield, Cigna, Tricare, and United Healthcare. What type of health insurance do you accept?

  6. Following your initial consultation, your physician will outline a treatment plan and the associated costs. Costs will vary depending on what type of treatment is recommended. Without health insurance there are additional rate plans available as well as several financing options. Contact our office for more details. If I don’t have health insurance coverage, how much will the treatment cost?

  7. Couples often find out that an infertility diagnosis and certain treatments are covered by their insurance. However, IVF and others may be excluded. California is one of 13 states with an infertility mandate in place. This is a “soft” mandate, which gives employers the option to offer infertility benefits. Since it is not required, not many employers will purchase the coverage. Since your employer makes the final decisions about health insurance, it might be a good idea to speak with your Human Resources representative to find out what it would take to have infertility treatments included in your benefits package. What if my company does not provide fertility benefits?

  8. Typically, PPO insurance does not require pre-authorization for an initial consultation. If your insurance requires a pre-authorization to see a specialist, then you must get a referral from you OB/GYN to see a fertility specialist. Pre-authorizations may also be needed for any testing, ultrasounds, or blood work. Your assistance in coordinating authorizations is important in order to protect you from the surprise of becoming financially responsible if they do not pay. Do I need pre-authorization from my insurance to start the process?

  9. Here are some important questions to ensure that you have the right coverage for treatment: • Does my insurance cover diagnostic evaluation for infertility (lab work, ultrasound, etc.)? • Do they cover physician, hospital, and lab charges? • Is treatment for infertility such as IUI or IVF covered? • What is my co-payment? • Are injectable or oral medications covered (Clomid, Lupron, etc.)? • Do I need to use a specific contracted pharmacy? • Do I need to us a specific contracted laboratory? What are some important questions to ask my insurance carrier?

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