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Understanding Fertility Insurance Coverage

Get help understanding fertility insurance coverage

Navigating the world of fertility insurance benefits can be confusing. Our Austin fertility doctors recommend that you research your benefits thoroughly to help with understanding fertility insurance coverage. In addition to gaining information from insurance websites, your plan booklet and human resources, you can also rely on the team at Texas Fertility Center to help guide you.

The basics of understanding fertility insurance coverage

Most insurance plans will cover infertility diagnostic testing, but it is important to determine whether you have coverage for “diagnosing infertility” or coverage for “up to the diagnosis.”

  • If your insurance plan provides coverage for “diagnosing infertility,” this typically includes coverage for all services performed in the diagnostic process regardless of when they are performed.
  • If your insurance plan provides coverage for “up to the diagnosis,” this is typically coverage for one visit using an infertility diagnosis, but the entire diagnostic process can take more than one visit. In this case, you may want to take advantage of that one visit with our Austin fertility doctors and request to have all testing possible at that initial visit.

Learning about coverage for fertility treatment

Coverage for fertility treatment is less common, which makes understanding fertility insurance coverage more complex. The easiest way to determine whether your insurance plan will cover fertility treatment services is by looking at the wording in the benefit description. If your insurance policy excludes infertility treatment and all related services, it is safe to assume any services performed within your treatment cycle are not covered.

Coverage for infertility treatments, such as intrauterine insemination or in vitro fertilization, is often accompanied by some sort of limitation specific to infertility services. It may include a limitation on your number of attempts using a specific procedure or a maximum amount your insurance policy will pay for fertility treatment. Certain plans will include qualifications you must meet prior to qualifying to use your fertility benefits or limitations that will exclude you from using your insurance benefits, such as a prior sterilization. These types of qualifications and limitations will vary from plan to plan, so our Austin fertility doctors recommend that you research this thoroughly.

When infertility is caused by another underlying medical condition

If your infertility was caused by another underlying medical condition, your insurance provider will consider these medical conditions separate from your infertility benefit. If you are diagnosed with a medical condition, such as endometriosis or a fibroid, your insurance will likely provide coverage for services provided to diagnose and treat these conditions as any other illness.

In some circumstances, your insurance may argue that you would not have been treated for these conditions if you had not been attempting pregnancy. In these types of cases, it is within your right to argue otherwise.

Anytime you have a preexisting clause in your insurance policy, be sure to research your coverage carefully. A preexisting clause will exclude any condition you were previously diagnosed with, within a certain time frame.

Pregnancy is not a preexisting condition

Once you achieve pregnancy, your insurance will provide coverage for your services under your maternity benefit. If maternity coverage is excluded from your policy, your services will not be covered with the exception of a pregnancy complication. Most plans will cover any pregnancy complication, such as a miscarriage or tubal pregnancy. Be sure to carefully research this benefit.

Contact us to learn more about understanding fertility insurance coverage or to schedule an appointment with one of our Austin fertility doctors.