Health Insurance
There are no easy answers when it comes to insurance questions. Your health insurance is the obvious answer to addressing the medical needs you are experiencing. However, you may run into many problems with your medical insurance.
Insurance BasicsChances are, your health insurance is employer-based, meaning it is provided as a benefit through either your or your spouse's employer. What your particular health insurance covers is not up to you; the employer determines your health insurance coverage. You may still have some choices, however.
It is very important that you let your employer know what coverage you want or need. Your employer may even be willing to add coverage for fertility treatments if they know that there is a demand. It is worth looking into it.
Just because you work at the same company and have the same insurance carrier as another employee, it does not mean that you have the same coverage. Always be sure to read your policy before determining what your specific insurance covers.
Reading your policy is just the beginning. Most of the time when you sign up for your health insurance you are given a summary of benefits. While this is a nice and tidy document, it is not your actual coverage list. If you would like to see your coverage in full detail, it is your right. Ask your human resources department to see the contract that they have with the health insurance carrier. You will want to read the sections that might particularly pertain to the treatment of infertility. Look at exclusions of coverage, as well as at limitations of coverage and of benefits. This might even include monetary limits on how much the insurance will spend on fertility treatments. If need be, ask for help with this document as you need to be able to understand it in detail.
State LawsA few states have a mandated insurance coverage for infertility treatment. However, that is not as promising as it seems. The majority of these states actually have a mandate that encourages employers to offer the services, but does not require coverage. This means that insurance companies in the state have to
In states where coverage is mandatory, you have a much better chance of getting coverage. States that have a mandate to cover means that employers must provide insurance to cover the cost of infertility treatment in every premium, not as a separate expense. The states that have mandates to cover are Hawaii, Illinois, Louisiana, Maryland, Massachusetts, Montana, New Jersey, New York, Ohio, Rhode Island, and West Virginia.
One loophole that many women can take advantage of is that you do not necessarily have to live in the state that has a mandate. If the company you work for is headquartered in a state that has mandatory infertility treatment coverage, even if it's not the state where you work and live, your health insurance is most likely provided through the state with the mandate. In this case, you'll be able to get the coverage too.
Many times even when your health insurance covers infertility testing or procedures, there are exclusions or other problems with actually using the insurance. You may find that your insurance will only pay for certain procedures, like repairing your fallopian tubes, but not for in vitro fertilization.
Some fertility patients have gotten wise to the games insurance companies play! Be sure to have your care provider use diagnosis codes that do not reflect infertility as a diagnosis; rather they should list the disease, like endometriosis or anovulation, instead of infertility secondary to anovulation. This is one way to get all or part of your treatments covered.
Perhaps you are one of the lucky ones with great coverage, but you find that your insurance has a cap on it. This means that your coverage might be for anything, but only up to a certain amount. After that, you're on your own.
