Insurance Information for Infertility Treatment
Many insurance companies provide coverage for testing and treatment of infertility. Understanding how insurance works can be very frustrating and time consuming. When dealing with infertility, this problem usually gets worse. Each insurance carrier may have programs with infertility benefits, but these benefits can be modified depending on the group contract or an individuals selected medical group. Because of this level of complexity, it is impossible to make any generalized statements about what benefits you may have. With some of the tips provided on this page, you can begin your own investigation into the potential benefits you may have.
When you are evaluating your infertility benefits, it is important to understand several important distinctions. Insurance benefits may cover diagnostic testing, treatment, or medications. Your policy may cover some or all of these options. It is very common for insurance companies to cover
diagnostic testing but not treatment. Treatment costs will be paid out of pocket so you will want to select a clinic with straight forward pricing to avoid any hidden costs to you. You will also want to understand if there are any co-payments that must be made and if there are any limitations to your benefits. We have prepared a list of questions that you should ask your insurance provider.
- Do I have diagnostic infertility coverage to allow the doctor to find the cause of infertility?
Do I need a referral to visit Dr. (name your regular doctor) for an initial consultation?
Some insurance companies can only give you information if you provide them with the appropriate billing codes, called CPT codes. Some of the most common CPT codes are listed below.
IVF vitro fertilization (IVF)
Intrauterine embryo transfer 58974