Health insurance coverage for fertility treatment is limited and can be complex to navigate. Knowing the details of your policy and the right questions to ask your insurance carrier is important before starting treatment.
Understanding your fertility insurance benefits
Due to the nuances within each private healthcare insurance plan, it is our patients’ responsibility to know their insurance benefits, coverage and limitations.
While our staff can assist you in navigating your insurance coverage, we can’t guarantee what treatments will be covered and to what degree.
For this reason, each patient must take the lead in determining his or her own fertility treatment insurance coverage.
The three levels of fertility health insurance benefits
- No coverage. Unfortunately, most insurance plans fall into this category as many do not offer fertility treatment benefits. If patients do not have coverage under their insurance plan, they are expected to pay at their appointment for any services rendered.
- Diagnostic testing only. With this level, an insurance plan may cover a new patient consultation and possibly cover some of the costs for fertility testing to diagnose the cause of infertility in women or men. Fertility treatment, however, is not covered.
- Diagnostic testing and limited treatment. In these circumstances, insurance will cover diagnostic testing, as well as cover some methods of infertility treatment such as artificial insemination. The extent of coverage varies widely by plan and employer. Understanding your individual policy will help you anticipate whether a particular service with us is covered.
An important note on medical coding for fertility
Medical coding is how procedures, services, equipment use, and diagnoses are converted to a universal alphanumeric code specific to the medical industry. It is how we document a patient’s visit, and it is also how an insurer evaluates what to cover and how to pay the medical provider.
Our physicians are specialists in reproductive endocrinology and infertility. That means most, if not all, visits are coded as procreative management, infertility or fertility. This can affect insurance coverage and benefits; the codes we use are very specific and cannot be changed or altered by our staff.
Be prepared with this fertility insurance checklist
- Check with your insurance carrier to determine whether your policy requires you to have a written referral from a referring physician or an authorization number directly from your insurance carrier (see questions to ask below).
- Review your policy to determine specific (if any) insurance benefits for fertility treatment.
- Bring your insurance card and identification to every visit.
- Review finance options (our team is available to discuss these options with you).
- Plan to pay for services not covered by insurance (copayments, deductibles, noncovered services, etc.) at time of service. All self-pay fees are collected at time of service unless a treatment deposit has been paid in advance.
Common questions to ask an insurance provider
Prior to treatment, contact your insurance company to better understand your fertility insurance plan benefits. To facilitate the conversation be sure to have insurance information on hand before calling and ask the following questions.
- What infertility benefits are included in my policy (new patient consultation, diagnostic testing, treatment, other)?
- Is this limited to diagnostic testing or are treatments or medications included?
- Am I required to have a referral or preauthorization for coverage?
- What are the exclusions?
- Are there limitations or caps to benefits, such as lifetime or yearly maximums on coverage?
- Are benefits available out-of-network?
Progyny fertility benefits through your employer
Dallas IVF has partnered with Progyny, which works with employers to offer comprehensive fertility benefits to their employees. Want to know if your company offers Progyny fertility coverage? Check with your human resources team or contact [email protected] to find out.