Road to fertility

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How to get IVF Covered by Insurance with Current Insurance Plans

how to get ivf covered by insurance

When you are given any kind of diagnosis that impacts your fertility or if your doctor is recommending in vitro fertilization to have a child, it can feel overwhelming or stressful. If you’re concerned about affording treatment or wondering how to get IVF covered by insurance, it can add to that stress, which isn’t helpful. Below, we hope to arm you with some advice, data and information so that you can look into advocating for yourself in how to get IVF covered by insurance.

How to get IVF Covered When Your Insurance is Through Your Employer

If you have insurance through your job, you should take comfort in the fact that in 2006, a survey by Mercer Health and Benefits and commissioned by RESOLVE – The National Infertility Association – found that 65 percent of employers offered infertility treatment in response to employees requesting IVF and/or fertility coverage. This means that taking the step of at least asking could be all you need to get the ball rolling.

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If you know of other employees that may be in a similar situation as you, that could also help. Going to your Human Resources representative and speaking to them about how getting IVF covered by insurance would mean, according to this infographic created by RESOLVE, increasing feelings of company loyalty among employees may be helpful. Introduction of fertility coverage would also help workers miss less work due to infertility treatment, and employees would recommend the company as not only a great place to work but also view it as “family friendly”. If employees know that they have fertility benefits, they would have reduced stress and worry,  as they wouldn’t have to wonder how they are going to pay for the IVF treatment they need. If your manager, Human Resources representative or other person in charge of making decisions about your benefits saw it as a long-term investment, they may consider adding IVF to their benefits package.

How to get IVF Covered by Calling Your Insurance Company Directly

If you are reaching out directly to the insurance company, review the fine print. If you know IVF isn’t covered, call them and ask for either an Exemption of Benefits or a formal form that’s the equivalent where you can request how to get IVF covered by insurance.

You can also request any documentation from your doctor supporting why IVF is medically necessary for you to have a family (including any diagnostic codes, tests, etc. explaining why your reproductive endocrinologist is recommending in vitro fertilization).

Also, similar to the above, you can provide evidence as to why it would be in their best interest to offer coverage. One example is that according to National Institutes of Health, patients who have access to IVF coverage will actually save insurance companies money in the long run. This is because they tend to have more singleton pregnancies (meaning they are only pregnant with one baby). When you have limited access to fertility benefits, you may transfer more than one embryo, which can mean having a high-risk twin or triplet pregnancy, or even having NICU costs as there is a risk for premature delivery and/or preterm labor.

Making the Most of the Benefits You Have

While you advocate for yourself on how to get IVF covered by insurance, there are things you can do to help in the interim:

  • Speak to your accountant about whether any money you’ve spent previously can be filed under “medical” when you file your taxes.
  • You can look into whether or not your Flexible Spending Account (FSA) or your Healthcare Savings Account (HSA) can be used towards IVF.
  • Ask your doctor and/or clinic if there are any IVF clinical trials that you qualify for that may cover either the cycle or any of the medication.
  • Speak to your doctor about whether or not they recommend Pre-implantation Genetic Testing for Aneuploidy (PGS), which can help increase the chances of having a healthy baby and decrease your chances of a miscarriage, or an Endometrial Receptivity Analysis (ERA), which is a genetic test that takes a sample of your endometrial lining to determine which day would be the best day to transfer an embryo following an IVF cycle. If you’re paying out of pocket, both of these tests can help increase the chance of a successful outcome of your IVF cycle.

Fertility and finances can be overwhelming but there are so many resources and studies that you can arm yourself with to make your case for why access to IVF treatment can benefit not just you but the insurance companies that provide it. Advocating for yourself may even help you feel empowered, as you could potentially be helping future patients get the care they need. Hopefully, with persistence and support, you will not only get the coverage you need but the family you desire.

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1 comment

25 March, 2019 6:11 pm

Do you participate with insurance companies? If so, do you participate with BCBS?