Understanding Insurance for Fertility Treatment Costs
Rhode Island, Massachusetts and Connecticut are three of only 15 states in the country that have fertility insurance mandates, which means that the state’s law requires insurance providers to cover fertility treatment costs for men and women, if they meet certain restrictions. Despite these regulations, insurance benefits vary widely from plan to plan, adding complexity to the already challenging situation of paying for fertility care.
It is ultimately the patient’s responsibility to identify what an insurance plan will or will not cover before starting treatment. But we know it can be difficult to predict what your expenses will be and what information you will need from your insurance provider, especially if it is your first time pursuing infertility treatment. Below, we’ve compiled resources for understanding your insurance benefits and paying for fertility treatment costs.
If you are currently a patient with Women & Infants’ Fertility Center, you can also contact our financial counseling department at (401) 441-5336 with specific questions.
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Paying for fertility treatment costs
Dr. Lynae Brayboy of Women & Infants’ Fertility Center gives a brief overview of what to expect when working with insurance providers to pay for fertility treatment at our center.
Fertility treatment costs & insurance FAQ
Do I need to get a referral for my insurance to cover treatment?
This should always be your first question to your insurance company if you’re planning to see a fertility specialist. If your insurance does require a referral, you will need to request one from your OB/GYN or primary care provider in order to have your first appointment covered by insurance. All referrals can either be submitted through our website or faxed using our referral form to (401) 453-7598.
Does insurance cover IVF?
The Rhode Island insurance mandate states that insurance must provide coverage for medically necessary expenses for the diagnosis and treatment of infertility, which can include in vitro fertilization (IVF). But, the amount of coverage can vary from plan to plan. In some cases, there may be limits on the number of IVF cycles or a required diagnosis before treatment.
Does mandated infertility insurance coverage apply to everyone?
Rhode Island law specifically states that this mandate only extends to married individuals between the age of 25 to 42. If your age falls outside of this range or if you’re unmarried, there is a possibility that your insurance will not cover any of your costs.
Massachusetts and Connecticut state laws are different than Rhode Island’s. If your insurance is through an employer in one of these states, make sure to inquire about any limitations or requirements.
Will Medicaid cover fertility treatment procedures or testing?
Medicaid does not provide the same level of coverage that many other insurance plans do. Unless you have a diagnosis of polycystic ovary syndrome (PCOS) or uterine fibroids, Medicaid plans do not cover the cost of a consultation with a reproductive endocrinologist. Medicaid does not cover any other procedures or diagnostic testing.
How can I pay for IVF if insurance won’t cover all of my costs?
We offer loans and affordable IVF programs through ARC Fertility Financing that can help patients whose insurance will not cover their costs for IVF, or if they have high expenses even after coverage. Programs offered by ARC allow you to bundle your costs, including medications, so you only need to make one monthly payment.
For women looking to preserve their fertility before cancer or other medical treatments, fertility treatment costs can sometimes make starting a family feel out of reach. Women & Infants offers the Compassionate Gift Program to assist those who can’t afford fertility preservation services. Donate Today
Can a previous diagnosis or medical treatment affect which costs insurance will cover?
In some cases, a person’s medical history can greatly impact what will or will not be covered by insurance. For example, if you had a voluntary tubal ligation, your insurance may not cover your fertility treatment costs. We recommend that patients disclose past procedures and diagnoses to their insurance providers before treatment. This will allow you to better understand your true coverage so you’re not surprised by unexpected expenses.
How can Women & Infants’ Fertility Center help me with my insurance benefits and treatment costs?
While we always recommend speaking directly with your insurance company to understand your benefits and financial responsibility, we also provide financial counselors to help you navigate the complexities of paying for fertility treatment. Our staff can help explain the costs associated with your treatment plan, including what your insurance will likely cover and what you will need to pay out of pocket.
Many insurance policies require authorizations before starting an IVF cycle or certain medications. We will submit this authorization to your insurance company on your behalf. Please note that authorizations can take up to 15 business days to be approved, so it’s important to check with your insurance in advance of your anticipated treatment start date.
What resources are available to help me learn more about infertility insurance coverage?
The best first step to understanding your insurance coverage is to review your plan details on your insurer’s website. Most insurers also offer a member services department that you can call for additional details on your plan.
If your healthcare benefits are through an employer, you may also be able to speak to your employee benefits specialist or human resources department.
RESOLVE New England, a nonprofit organization that offers support and education to those experiencing infertility, has a number of online resources to assist you in understanding health insurance plan types and coverage.
Members of the RESOLVE organization can also speak to an insurance advocate for free during scheduled appointment times.
Questions to ask your insurance provider
Before you make your first appointment at Women & Infants’ Fertility Center, we recommend you ask your insurance provider the following questions. These can greatly assist you and our financial counseling department in understanding your coverage.
- Does my insurance run on a plan year or calendar year?
- Do I have infertility treatment coverage?
- Do I need a referral to see a reproductive endocrinologist?
- Are there any limitations or caps to my coverage?
- Does my plan include IVF coverage?
- How much is my coinsurance for various services and office visits?
- What is my deductible?
- What is my out-of-pocket maximum?
- Does my insurance cover medication costs?
- Does my plan limit which pharmacies I can order medication from?