Published on November 12, 2007.
Many couples face infertility. This is a very emotional obstacle to overcome. In addition to the mental strength that you’ll need to conjure, you will also need money. Some infertility treatments can be very expensive for most couples. Your intense desire to have children can make infertility treatment seem like more of a necessity than a desire in your life. Many couples who simply can’t afford the treatment that they need, will start to look elsewhere for financial help. This is where the question of insurance comes in.
Insurance coverage for couples seeking infertility treatment may be hard to come by. The first thing you need to do is contact your employer or insurance company for a copy of your insurance coverage contract. Some contracts will specifically exclude infertility treatment as covered by the policy. If not, then you may have a case to get your infertility treatment covered.
Sometimes, there will be a specific list of treatments not covered. Check to see if the actual diagnosis is excluded. Laparoscopic procedures and hysterosalpingograms can be considered diagnostic, especially if you are experiencing abdominal pain or heavy bleeding. If your insurance denies a claim for these procedures and your contract simply excludes infertility treatment, then you have a case to get the procedures covered. Keep in mind that insurance companies are only allowed to deny claims for things that are specifically excluded on the contract.
Meeting with an infertility specialist and getting the diagnostic procedures may be covered by your insurance without question. Once you have been informed of your possible causes of infertility, then a good infertility doctor will consider your insurance coverage when developing treatment recommendations. You can decide with the help of the specialist which routes to take. Do you want to go with an aggressive procedure that may cost you more up front, but can improve your chances of conceiving more quickly? Would you rather go for the cheapest options first and see if any of them work? Either way, it can be expensive and these decisions will ultimately be yours to make.
If you are denied coverage for a procedure or visit that you believe should be covered, then ask your insurance company for contractual proof in writing that the claim is justifiably not covered. If they claim that your infertility treatment or diagnosis is not medically necessary or that infertility is not an illness, then you can still fight it. Keep track of all conversations that you have with your insurance company. Communications should be in writing whenever possible. Many will try to slip through a loophole and deny coverage that you paid for. If it’s not specifically noted as a procedure that is not covered, then it often will be covered by your insurance.
Some states require insurance companies to cover infertility treatments, such as in vitro fertilization (IVF). Keep in mind that there are many exclusions to these state mandates (such as self insured companies and having less than 50 company employees with medical insurance benefits), so check your state mandates to be sure that you know the extent of your insurance coverage. Some insurance companies will ask for documentation from your doctor that you have been infertile for one or two years before they will consider infertility treatment necessary, so make sure that you are working with your doctor early on. If you are running into walls when trying to get your infertility treatment covered, then contact an attorney familiar with insurance claims to help you come up with the best solution.