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There’s no one-size-fits-all answer when it comes to insurance coverage for fertility treatment. Variables including insurer, coverage plan, where the insured person lives, and even where the insurer is headquartered all factor into what’s covered. Navigating the complexities is challenging, but not impossible.

The Reproductive Care Centre provides tips on how to make the most of your insurance plan’s open enrollment period including things to look out for and tips to make this potentially overwhelming process totally manageable.

Where to Start
Health insurance companies typically have several different policies, each of which may vary in what fertility treatments they cover.  We do our best to verify coverage for our patients, but it can get complicated since most insurance companies have many different policies and varying degrees of coverage. You are your best advocate; understanding exactly what your specific insurance policy covers can help avoid unnecessary issues. The following steps may be beneficial as you review your covered benefits and gather information:

  • Get to know your policy inside and out.
  • Reach out to your health insurance company to determine which fertility treatments they cover, and which they don’t.
  • Each time you call your health insurance company take detailed notes just in case you need to refer back to them later. It’s also a good idea to jot down the date and name of the representative you speak with.
  • Ask for details on which procedures and drugs are covered.
  • Check to see if there is an age restriction or maximum lifetime benefit.
  • Ask if you need a referral, and how to get one.
  • Find out if you need to use a specific clinic to get coverage.
  • We can’t stress enough how important it is to ask questions and document the answers you receive. The more documentation you have, the easier life will be if you find yourself disputing anything later on down the road.

What’s Typically Covered?
As mentioned, it really is different for everyone. Two people may have the same health insurance company, but find out that different things are covered depending on a host of variables. That said, many insurance carriers cover diagnostic testing until an infertility diagnosis is confirmed. The most common diagnostic testing procedures include consultation, initial ultrasound, initial blood work, semen analysis, and Hysterosalpingogram (HSG). Certain carriers may also provide some level of coverage for treatment.

Some employers offer multiple insurance carriers. If this is the case where you work, you may want to consider exhausting your infertility coverage with one health insurance company and then switching to another carrier’s plan. Before you do so, check to see if previous infertility treatments will affect your new coverage in any way.

How We Can Help
Our dedicated financial counselors are here to help you maximize your insurance coverage. We understand how complicated it can get, and are available to answer your questions, coach you on the best way to work with your carrier, and provide guidance throughout the process.

We want you to make the most of every opportunity available to you in your quest to have a baby, and understand the insurance piece of the puzzle is one of the most complicated. If you’d like more information, please call us at 905-816-9822 to schedule a consultation at The Reproductive Care Centre. Our financial counselors are available to help you make sense of your policy, so you can optimize your coverage and reimbursement options.