Are Fertility Treatments Covered by Insurance?

Pregnancy is already expensive on its own, and adding fertility treatments to the mix does not make matters easier. You know you want to have a family, but you may be unsure of how you can afford to make it happen.

We believe that cost should never be a barrier to trying for the family you want. But before you go down that road, you should have a basic understanding of what you could be looking at financially. One of the first questions you may have is “are fertility treatments covered by insurance?”

Unfortunately, as is often the case with matters involving health insurance, there is not a hard and fast yes or no answer to this question. Though it can be discouraging to ask a question only to get an answer starting with the caveat that “it depends.” But let’s look at some of the ways insurance can help you pay for fertility treatments depending on your coverage and where you live. And then, we can explore some other options for financing fertility treatments if your coverage is insufficient.

State Requirements

Whether or not your insurance will cover your fertility treatments can depend on several factors, including what state you live in. Certain states have requirements for what insurance companies must cover. Currently, only 16 states have laws pertaining to infertility insurance coverage. Fortunately, California is one of them.

According to the California Health & Safety Code, group insurers are required to offer coverage for infertility treatments, with the exception of IVF. If insurance is through an employer, the employer can determine whether or not to include plans that offer infertility coverage as part of their employee health benefits packages.

All group insurance must offer plans that include infertility coverage, but coverage in all plans is not required. The things that many plans offering infertility coverage are often limited to include diagnosis, diagnostic testing, medication, and Gamete Intrafallopian Transfer (GIFT).

To qualify infertility coverage, you must meet certain requirements in regards to your diagnosis of infertility. Infertility is defined as “the presence of a demonstrated condition recognized by a physician and surgeon as the cause of infertility or the inability to conceive a pregnancy or carry a pregnancy to a live birth after a year or more of regular sexual relations with contraception.”

Exceptions to the law exist. IVF treatments are not included in coverage, which is a big exception for many couples who may need that particular treatment. Along with employers who self-insure, religious organizations are exempt from the law if they do not wish to offer coverage.

Other Ways to Finance Fertility Treatments

In addition to state laws, individual policies and plans make a difference as to what your insurance will or will not cover. And it can vary from patient to patient. Usually, insurance can offset fertility treatment costs when coverage is available, but may not cover everything. As has been mentioned before, IVF is not required to be included in the coverage.

We have more details about what is required to qualify for infertility coverage on our pricing and affordability page. There you can also find a list of insurance plans that Laurel Fertility Care accepts.

If you do not have coverage, or still need assistance paying for your fertility treatments, we work with programs that provide financial alternatives. These programs include:

With all of these things in mind, Laurel Fertility Care will work with you and take all of your needs, including your budget, into consideration when coming up with a care plan that’s right for you. Our finance specialist is here to guide you through making these important decisions because we want your dream family to be within your reach, no matter your financial situation.

If you want to learn more and begin the process, call 415-673-9199 or request an appointment online.