Let’s Get Real about Fertility Treatments and Insurance

Modern Fertility
By Chanel Dubofsky
January 17, 2019

Before I started writing this piece, I did an extremely informal poll, asking people about their experiences getting insurance to cover/reimburse their fertility treatments. Here are a few of their responses.

"It was almost all covered but the meds (which are several thousands a cycle) were a constant battle to get."

"Nothing but the diagnostic testing and a few of the meds was covered. I think the meds were a clerical error, not really covered on purpose."

"It took so much work, but we got some money back. If we had just let the insurance company do their thing, we would not have gotten more than coverage for meds, which was still a significant cost. We were one of the few lucky ones."

"I was so lucky to have great insurance through my org when I did IVF in 2013 and most of one cycle was covered."

"Almost all my meds were covered but the actual embryo transfer was not. My parents helped us pay for it, which is why we call him the baby my parents bought for us."

"In the five years of trying I've never had anything covered. Not meds, not procedures, nada."

If this seems rather incongruous, that's because it is. Figuring out insurance and fertility treatments is seldom straight forward, but don't panic! We're here to make sure you have the information you to need to navigate the complexity.

What expenses are we even talking about?

Check out our piece on the costs of egg freezing and IVF for a deep dive into this. Essentially, there are doctor's appointments to evaluate what's going on, blood tests to assess hormone levels (AMH, FSH, estrogen, etc), and an ultrasound (maybe more than one) to check for things like ovarian cysts and the condition of fallopian tubes, as well to assess your antral follicle count, to measure your ovarian reserve. If you're freezing your eggs, there's hormonal birth control to take, drugs to inject yourself to mature your eggs, the charge for anesthesia when you go into the clinic for the retrieval, and the retrieval itself. Then there's your rent for the egg storage. Doing more than one cycle to retrieve more eggs? Factor that into the finances.

If you're following up that egg retrieval with IVF or IUI instead of putting those eggs on ice, there's the fertilization of the retrieved egg, an embryologist who monitors the embryo, injections to prep the uterine lining for receiving that embryo, and the transfer itself. (These costs are going to vary if you're using donor eggs and/or donor sperm.) Again, consider the possibility of multiple rounds of IVF or IUI when you're thinking about these treatments.

So what fertility expenses will my insurance cover?

It depends on what plan you have. Insurance companies have medical boards, and that's who determines whether or not a service should be covered. "Fertility coverage is highly variable and depends on what services the employer has selected," says Dr. Eve C. Feinberg, a reproductive endocrinologist specializing in infertility at Northwestern Medical Group. "This can range from absolutely no coverage, to coverage for diagnostic testing to discover the reason for infertility, to full coverage including therapies such as in-vitro fertilization. Insurance companies perceive childbearing as ‘elective’ and do not offer routine coverage." (Mammograms and pap smears are examples of medically necessary procedures covered by insurance.)

"As a reproductive endocrinologist and fertility specialist, I couldn’t disagree more," says OB/GYN and reproductive endocrinologist Dr. Daniel Kort of Neway Fertility. "Infertility is like many other diseases with effective treatment options and the potential for a cure." He adds that while proactive fertility testing - that's testing that assesses whether or not you might have fertility challenges in the future - also isn't covered, he feels that it should be. "The biggest problem with fertility testing is that despite advanced testing methods, it is nearly impossible to determine who will conceive and who won’t conceive based on testing alone. However, with the advancement of fertility preservation techniques, women, men, and couples with abnormal (or normal!) fertility testing can take decisive action based on their results."

There is some good news - if you live in one of these 16 states, there are laws in place that require insurance coverage for infertility treatments. This doesn't make coverage free, however; if you have private insurance, you're still responsible for copays. Coverage is also only available once you've proved that you meet the criteria for infertility: you've been unable to conceive after trying via timed, unprotected sex for 12 months, or, if you're over 35, for six months, or if you've been unable to carry a pregnancy resulting in a live birth after a year. If you live in one of the 16 states, make sure to investigate the nuances of the plan. California, for example, requires group insurers to offer coverage of infertility treatments (except IVF), but individual employers can choose if they want to offer diagnostic testing, medication, surgery, and Gamete Intrafallopian Transfer (that's when eggs are removed from ovaries, combined with sperm, and placed into the fallopian tubes, where they're fertilized) as part of their employee benefit package. Religious organizations can opt out of this coverage.

Additionally, there are five states which legislate that insurance plans must cover treatments for folks whose infertility is medically-induced, i.e. if you had chemotherapy and it impacted your reproductive system.

What does this mean for my fertility future?

Like we said before, don't panic. First of all, there are options for financing infertility treatments if your insurance won't cover it. FertilityIQ is a great source for learning about options for financing treatments without insurance. Dr. Eve Feinberg is the President and Founder of the Kevin J. Lederer Life Foundation, a not-for-profit that provides financial assistance to individuals and couples in Illinois, Indiana, and Wisconsin to assist with the cost of infertility treatment or adoption. "There are also over 50 private foundations in the United States that offer financial assistance to individuals and couples struggling with infertility," she told Modern Fertility. Many fertility clinics, such as Neway Fertility, where Dr. Daniel Kort practices, have financial counselors who guide patients through the process of managing funding.

You can get out in front of the fertility treatment v. insurance debacle. For some tips on how, we turned to Caitlin Ardrey, Modern Fertility's Head of Operations, who knows a thing or two (or one million) about insurance. Call your insurance company's billing department to learn about how your benefits work. "Don't try to draw parallels between your benefits and those of your friends," says Ardrey. "Understand your own benefits, that's the most important thing."

Talk to your employer (and/or your HR rep) about what your plan covers, what it doesn't, and what could potentially be covered if it isn't already. If employees make it clear that a plan that covers fertility treatments is desirable, it could impact decisions about picking insurance providers in the future, since that could both attract and retain female employees. Discussing fertility treatments at work, as well as with your friends, also destigmatizes infertility and allows for folks to talk about their experiences, instead of perpetuating silence and shame.

And finally, Modern Fertility was born (pun intended) for this. We want you to get information about your fertility now, while kids are still a hypothetical. You can use your Flexible Spending Account (FSA) or your Health Savings Account (HSA) to pay for a Modern Fertility test kit. You get test results you can talk about with your healthcare provider, so you can start strategizing ASAP), plus access to our weekly webinar, an invite to the Modern Women community, and the opportunity to chat with a fertility nurse who's an expert in fertility hormones. You deserve to feel powerful and informed when making decisions about your health and your future, and we're here to help make it happen.

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