infertility insurance

December 17, 2012 by Aaron 1 Comment

State Mandated IVF Insurance Coverage

state legislature relating to infertility — Do you live in a state that has laws forcing insurance companies to cover infertility treatments such as IVF?

Infertility, usually defined as being unable to conceive after one year of unprotected sex is a common affliction. An affliction that affects approximately 1 and 8 couples in the US alone. In order to combat their fertility problems couples turn to doctors for treatments such as in vitro fertilization (IVF), where the women’s eggs are surgically removed, fertilized with the designated sperm in the laboratory and then the resulting embryos are transferred back into the uterus; or intrauterine insemination (IUI), where the partner’s or, in some cases, the donor sperm is processed and injected into the uterus during ovulation.
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State Infertility Laws

There are approximately 15 states that have passed legislation addressing the issue of insurance companies covering infertility treatments. I have summarized the states with their individual infertility legislative below. Be aware that each state has their own definition of infertility, which you must meet in order to qualify for any benefits. It is also common to allow certain religious organizations and/or employers to be exempt from having to provide infertility coverage.

Arkansas: require health insurance companies to cover services and procedures performed at properly licensed facilities; the Arkansas Comprehensive Health Insurance Pool shall not be used for any infertility related procedures.

California: requires health insurance to offer insurance coverage for the treatment of infertility, but not IVF.

Connecticut: requires that health insurance provide coverage for medically necessary expenses in the diagnosis and treatment of infertility, including in vitro fertilization procedures, Except where such coverage would go against the religious beliefs of an employer or individual.

Hawaii: require all accident and health insurance policies that provide pregnancy-related benefits to also include a one-time only benefit for outpatient expenses arising from in vitro fertilization procedures.

Illinois: requires certain insurance policies that provide pregnancy-related benefits to provide coverage for the diagnosis and treatment of infertility, including in vitro fertilization (IVF). Coverage is limited to four completed egg retrievals( IVF cycles), except if a live birth follows a completed IVF cycle, then two more IVF cycles are covered.

Louisiana: prohibits the exclusion of coverage for the diagnosis and treatment of a medical condition otherwise covered by the policy, contract, or plan, solely because the condition results in infertility. The law does not require insurers to cover fertility drugs, in vitro fertilization or other assisted reproductive techniques, reversal of a tubal litigation, a vasectomy, or any other method of sterilization.

Maryland: Infertility coverage is required for all insurance policies, with several conditions regulating when the coverage kicks in, and stipulates the insurer may impose a maximum lifetime benefit of $100k or three IVF cycles. Small businesses with under 50 employees, or certain religious organizations are exempt from having to provide IVF coverage.

Massachusetts: require general insurance policies, non-profit hospital service corporations, medical service corporations and health maintenance organizations that provide pregnancy-related benefits to also provide coverage for the diagnosis and treatment of infertility, including in vitro fertilization.

Montana: revises certain requirements of Montana’s Comprehensive Health Association, the state’s high-risk pool, and clarifies that covered expenses do not include charges for artificial insemination or treatment for infertility. They also requires health maintenance organizations to provide basic health services on a prepaid basis, which include infertility services. Other insurers are exempt from having to provide the coverage.

Minnesota:specifies that medical assistance shall not provide coverage for fertility drugs when specifically used to enhance fertility.

New Jersey: require health insurers to provide coverage for medically necessary expenses incurred in diagnosis and treatment of infertility, including medications, surgery, in vitro fertilization, embryo transfer, artificial insemination, gamete intrafallopian transfer, zygote intrafallopian transfer, intracytoplasmic sperm injection and four completed egg retrievals per lifetime of the covered person. The law includes some restrictions as well as a religious exemption for employers that provide health coverage to fewer than 50 employees.

New York: prohibit individual and group health insurance policies from excluding coverage for hospital care, surgical care and medical care for diagnosis and treatment of correctable medical conditions otherwise covered by the policy solely because the medical condition results in infertility. The laws exclude coverage for in vitro fertilization.

Ohio: requires health maintenance organizations (HMOs) to provide basic health care services, which include infertility services, when medically necessary.

Rhode Island: require any contract, plan or policy of health insurance (individual and group), nonprofit hospital service, nonprofit medical service and health maintenance organization to provide coverage for medically necessary expenses for the diagnosis and treatment of infertility. The also law clarifies that the co-payments for infertility services not exceed 20 percent.

Texas: requires that all health insurers offer and make available coverage for services and benefits for expenses incurred or prepaid for outpatient expenses that may arise from in vitro fertilization procedures. Certain conditions need to be met before infertility coverage is allowed. The law includes exemptions for religious employers.

West Virginia: amends the 1997 law and requires health insurers to cover basic health care services, which include infertility services. Applies to health maintenance organizations (HMOs) only

Each state has different definitions of infertility and you must meet the specific requirement set forth by each state with IVF coverage in order to qualify for the benefit. If you are happen to live in a state that has mandatory insurance coverage for IVF I recommend calling your insurance company for the latest information on what the specific requirements are to qualify for your infertility benefit. For more information on the statues summarized above check out the National Congress of State Legistatures.

Any questions or comments, if so please post them below :)

Cheers!

December 7, 2012 by Aaron Leave a Comment

Paying for IVF: Your Options

Paying for IVF can be emotional and troubling affair

In vitro fertilization (IVF) is a great technique in the infertility MD’s arsenal that has helped countless couple’s conceive over the years. Due to the complexity of the modern IVF process it can also be rather expensive. A single cycle, without any insurance can cost upwards of 30K when you include medications and some auxiliary treatments such as PGD or Donor eggs. I am going to list some of the ways you can pay for the costs of IVF.

Have great insurance (for a lucky few)

This is a great option for a small few. The truth is, the majority of people will not have sufficient insurance to fully cover their fertility treatments. More likely, your insurance will cover some/most of the diagnostic phase of infertility and very little, or none of the actual treatments required to help you get pregnant. The sad fact is that most insurance companies treat any medical intervention to have kids as “elective” treatments, not as a medical necessity. As such, the total price of IVF will likely fall entirely on you to pay for.

Pay Cash

This is a good option for those with large amounts of cash, and/or semi-liquid assets floating around. Chances are the interest rates you would have been earning with those funds were far less than what you might pay with other options. Another advantage is many clinics will be able to negotiate their prices down (usually only applicable if you do not go through your insurance company). If you are doing well enough financially to have this kind of money floating around then you will likely want to put the expenses on your reward cards (see next item) for that extra % back.

Credit Card(s)

Credit cards are great for those who will be able to pay off the balance within a couple months (the earlier the better). Reward cards are the way to go here – giving you the opportunity to earn miles/cash back/ or other rewards on the money you were going to spend anyways. On the down side: credit cards often have high interest rates and the longer you carry a balance the more interest you will end up paying. Introductory offers and balance transfers can also be used to save money. Be aware that opening up new lines of credit, or high % credit card utilization can affect your credit score negatively.

Financing

Getting a loan from a finance company can be the way to go if you don’t have the money to pay for your treatments, but can manage a monthly payment. When you shop around for medical loans be aware that they might have higher %APR than other kinds of loans. If you own your own home consider taking out a line of credit on it, or using some of your equity. You can often lockdown a much more attractive rate than if you went with a medical loan. The IVF clinic you are working with might have a few outfits they recommend so don’t hesitate to ask them.

Friends/Family

I wasn’t going to mention this but asking your friends and family can be a great way to raise some/all the money required for your fertility treatments. Asking others for money can be difficult, at best, and most people don’t like to do it. Thank goodness for the internet! Sites such as Gogetfunding.com or gofundme.com (follow the links for two examples of couples asking for donations for their IVF treatment) take much of the unpleasantness out of the ordeal and make the whole process much easier to manage.

fill in the ________

What is this option? You tell me. I have covered many of the main ways to fund your IVF treatment, but my list is not complete. Did I leave something out? Let us know in the comments!!

November 15, 2012 by Aaron 1 Comment

Insurance Coverage for Infertility

Is infertility covered by your insurance policy?

This is a very good question that doesn’t have an easy answer. Nonetheless, if you are thinking about seeking medical advice/intervention to help you have a baby then you should know the answer to it. One reason this is so important to know is that coverage for fertility treatments varies widely from policy to policy, and if you aren’t careful you could end up being surprised by some large medical bills.

I want to touch on some basic concepts here for dealing with your insurance company in order to find out what type of coverage you have.

Ask Ask Ask!

This applies to many aspects of life, and is as simple (pretty much) as it sounds. If you don’t know the answers to something then just ask someone who does. Where this can get tricky is knowing who to ask. Our friend Google, or your search engine of choice, is great for finding quick answers to many of life’s little mysteries, but can be woefully inadequate in some queries. For something as specialized as this you are much better off going to the source – your insurance company.

Talking to your insurance company

Now I know just the idea of talking to your insurance company can leave a bad taste in your mouth, but they are the ones who hold all the cards. They know what your benefit is, and more importantly make the final decisions around whether services will be covered under your specific benefit. The best way to get answers from an insurance company is to call the right person. Look for the customer service number on the front/back of your insurance card. If there is a separate # for members, great! Otherwise you may have to fight through some automated systems to get to a real life person.

Quick tip: you can sometimes skip to an operator by pressing “0” or saying ‘customer service’ or ‘operator’ even when those are not given options.

Once you get a real person on the other line there are a few tips to remember:

Don’t hang up until you get an answer you can understand. Lots of insurance companies outsource their call center labor overseas, and the person on the other line may just end up reading a benefit text verbatim back to you. Now if that answers your question, great! Otherwise, make sure you keep asking for clarification on anything you don’t understand until you get a straight answer! This is especially important for infertility related questions, as it can be especially complex.
Don’t be afraid to ask for someone else if the first person you talk to cannot fully answer your question. Some insurance companies have separate divisions related just to infertility and they will be much better equipped to help you with any questions you might have.

Okay so you have someone competent on the line, what now? If you are looking into your broad infertility benefit than ask about that (This is where they will probably just read what is in your insurance benefit booklet back to you). A few things to listen for: The words ‘TOTAL EXCLUSION’ – this means you have no insurance coverage for infertility. If you go to a doctor for advice and or help to get pregnant you will be considered a CASH PAY patient and be responsible for the full amount yourself, often at the time of service. If you hear something along the lines of “..diagnosis of the underlying condition is covered, but any treatments are excluded,” then things are looking up! This means that likely have coverage for the workup (diagnostic phase where the doctors figure out what is really wrong with you so they can recommend the best ways to fix it/best treatments to work around your issue) which can save you lots of money. If you hear “diagnosis and treatment is covered” (lucky you!) keep listening as they will then list limitations to your benefit, often a # of attempts/cycles or a $$ limit.

Don’t forget about the fertility clinic

Another potential resource can be the fertility clinic you are going to be/are receiving services from. They deal with this stuff day in and day out and can be invaluable in helping you with general questions and providing you with procedure and/or diagnosis codes (sometimes required to get more accurate information from your insurance). Remember that at the end of the day the fertility clinic is not making any decisions around what your insurance company does and doesn’t cover, so if you want a definite answer you will have to go to the insurance company yourself. Sadly, sometimes even then you will not be able to get a satisfactory answer.

Was this helpful? I plan on diving much deeper on many of the things I glossed over in this post so stay tuned ;) If you have any comments, alternate strategies that I didn’t mention, or just want to say hi, please do so in the comments below.

Cheers!