Infertility Insurance Coverage

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Infertility treatment can be very expensive. According to national infertility association RESOLVE, as of 2010, each in-vitro fertilization (IVF) cycle in the US cost an average of $8158 plus $3000 to $5000 for medication. The American Association of Reproductive Medicine puts the cost of IVF even higher, saying it averages out to $12,400. Medical insurance can ease this financial burden, but which plans cover infertility?

The National Conference of State Legislature says that since the 1980s, 14 states—Arkansas, California, Connecticut, Hawaii, Illinois, Maryland, Massachusetts, Montana, New Jersey, New York, Ohio, Rhode Island, Texas and West Virginia—now have laws in place that say insurance companies must either cover or offer additional coverage for infertility diagnosis and treatment. Twelve states’ laws mandate that insurance companies must cover infertility treatment. California and Texas law requires that insurers offer infertility treatment coverage. Most of these 14 states include IVF as one of the procedures they must cover, but California and New York’s laws say they don’t have to include this treatment in their coverage.

One reason insurance companies may not want to cover fertility treatment is that it can lead to multiple births, which have a higher prematurity rate than the births of single babies. A study showed that in 2007, 8.2 percent of all newborn babies were less than 5.5 pounds, which is medically regarded as low birthweight – indicating a great deal of these babies were premature. This is the highest percentage of low-birthweight babies since the 1970s. Premature babies cost healthcare providers much more than full-term infants, hence insurance companies’ reluctance to cover procedures that might lead to more pre-term births.

Before seeing a fertility specialist, it’s wise to get preauthorization of coverage from your insurance company. Read the fine print and make sure you are aware of exactly what treatments and procedures the company covers. Be mindful of time limits on your coverage, and also ensure you know how many treatment cycles the insurance will pay for. As well as blanket preauthorization, be aware that your insurance company may require preauthorization for specific procedures. Make sure you get that authorization in writing before continuing with treatment.


 
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