Fertility Treatment Insurance Coverage

According to the National Conference of State Legislatures, only 10% of childbearing women in the U.S. receive some form of insurance assistance for fertility treatments. However, this amount does not include those who require an in vitro fertilization (IVF) in order to get pregnant; one of the most expensive procedures that patients can undergo.

It can be a daunting situation when starting a new family comes down to a matter of finances, but tour team is here to alleviate some of your concerns by informing you of how insurance companies manage fertility and what financing options are available to you.

Here are a few things to consider when finding the right coverage:

Why Insurance Providers Do Not Cover Fertility Treatments

Basically, the reason why most insurance providers refuse to cover fertility treatments is because the overall practice is considered to be experimental. Using hormone medications, self-injections, IVF procedures, and egg-freezing creates an idea of experimental medicine that has not changed in the eyes of 21st century healthcare, regardless of the fact that 8 million babies have been born using IVF techniques since the procedure first took place in 1978.

A strong precedent was set among insurance carriers that continues to be upheld even as fertility treatments have become more mainstream and highly successful.

In addition to that stigma, insurance companies tend to neglect major factors that affect not only women, but men, too. For instance, one-third of infertility cases are caused by a female partner, and another third is brought on by the male partner. The remainder of that percentage is made up of joint issues that both partners face. That being said, insurance companies view fertility treatments as a female specific problem, which narrows the scope of understanding and limits their willingness to accommodate those who are at risk.

When this disregard is combined with the idea that fertility treatments are the result of a lifestyle choice, the discussion becomes even more difficult to comprehend. Although insurance companies may never admit it, choosing to undergo fertility treatments or an IVF have largely been considered a luxury afforded to the middle- and upper-class. The image of a career-driven female postponing her plans to start a family assumes the idea that she can automatically afford fertility treatments–when in fact, the demographics that infertility affects are much different than what’s considered mainstream.  

Needless to say, the prevailing notions of fertility treatments that insurance companies have can be a challenge. However, that doesn’t mean that having the family of your dreams is out of reach.

States that Offer Fertility Treatment Insurance

Currently, these are the states that cover or offer insurance coverage for fertility treatments and specific procedures:

  1. Arkansas
  2. California
  3. Connecticut
  4. Hawaii
  5. Illinois
  6. Louisiana
  7. Maryland
  8. Massachusetts
  9. Minnesota
  10. Montana
  11. New Jersey
  12. New York
  13. Ohio
  14. Rhode island
  15. Texas
  16. Utah
  17. West Virginia

The majority of these states have laws in place that require insurance providers to cover fertility treatments, whereas two states, California and Texas, only require insurers to merely offer coverage.

To make matters more difficult, California, Louisiana, and New York, states where fertility treatments and services are among the most competitive in the country, exclude coverage for IVFs, leaving those in need highly vulnerable to financial pressure.

The rules and regulations for these states can be tough to grasp without having a basic knowledge of their stances in the first place, so the best thing you can do to find a manageable plan is to do some research and compare the benefits of the insurance programs that are available to you.

Researching Fertility Insurance Programs

The right fertility insurance program is one that makes your financial responsibility easier to bear. For example, a provider that can cut down the cost of treatments by a substantial percentage, let alone cover the entire expense, will make a huge difference in your overall experience.

Of course, the odds of this become somewhat limited when taking into consideration the state you live in and your employee benefits, but there are ways to use a fertility insurance program to your advantage if you stay diligent.

When determining how useful an insurance program can be, whether it’s provided through yourself or an employer, here some key questions to answer:

  • Is it fully insured or self insured?

Fully insured plans abide by state laws, where as self insured plans abide by federal laws and are not subject to state rulings.

  • Does your employer have plans that are limited to the number of employees?

Employers with less than a certain amount of employees do not have to provide coverage.

  • Was the policy written in a protected state?

Policies must be drafted and implemented in a state with fertility coverage in order for benefits to apply.

Covering these basic questions will assist you with making sure your plan is the most generous. If you discover that your insurance provider will claim responsibility for the costs, then congratulations! This link can give you a breakdown of what your potential costs may be with the help of insurance coverage per state.

Sadly, if you reside in a state where fertility treatments and procedures are not required by law, you may be at the mercy of whatever plans your employer offers, which can most likely result in zero coverage. On the bright side, there are several ways to finance your fertility treatments using credit options and third-party organizations.

Laurel Fertility Care Can Guide You Along the Way

If for some reason your insurance provider can’t give you support, you can trust that Laurel Fertility Care will be your guide to a successful and secure future. Our financial specialist can introduce you to several contracted insurance programs that offer flexible financing options your fertility treatments.

Not to mention, there are many third-party organizations that can lend their expertise and assistance to ensure that you receive significant discounts and competitive prices.

The WINFertility Program is an excellent opportunity that patients can take advantage of to receive the highest quality of treatments and services that will certainly increase their chances of having a successful pregnancy. The best part is that there are no clinical or age requirements to participate, so patients can feel at ease knowing that they are a first priority.

No matter what, Laurel Fertility Care believes in giving you the freedom to have a choice. Overcoming infertility is already a difficult physical and emotional struggle, and we will do whatever we can to eliminate the financial strain.

For more information about our affordability options, please schedule an appointment with us and learn from our team of fertility specialists.