This article from CNN covers one woman’s struggle with IVF and discusses the issue of insurance coverage (or lack thereof) of fertility treatments for couples struggling to conceive in the United States.
Since the 1980s, 15 states have passed laws that require insurers to either cover or offer coverage for infertility diagnosis and treatment. In the remaining states, including our state of North Carolina, coverage depends on what insurance plan you have. There is a vast difference in insurance plans; some offer lifetime limits in the tens of thousands of dollars, allowing women to do multiple rounds of In Vitro Fertilization (IVF) if needed. Others may not cover IVF, but will cover another type of less-expensive treatment called Intrauterine Insemination (IUI). Others may not cover IVF or IUI, but will cover costs of injectable hormone medications and/or ultrasound monitoring visits, both of which are used in many of our treatment protocols.
How do I know what my insurance covers? We encourage you to call your insurance coverage and ask if you have coverage for fertility treatment. I say ‘treatment’ because insurance companies differentiate between fertility diagnostic procedures and fertility treatment. Most insurance companies offer excellent coverage for fertility diagnosis, meaning, undergoing bloodwork, imaging studies, and semen analyses to figure out what the cause of infertility is for a couple. Once the fertility diagnostic work-up has been completed and treatment is recommended, then it is very important to find out your insurance company’s coverage of the specific treatment you need based on your physician’s advice.
How do I know what each treatment will cost? This is where our office comes in. At Carolina Conceptions, we have dedicated Financial Coordinators to help you navigate your insurance and tell you exactly what insurance will cover, and what price you can anticipate paying per cycle if you do not have full coverage. If you do not have full coverage, the cost of the treatment varies by treatment type. In general, most couples do not actually need IVF, and are able to successfully conceive with less expensive treatments. Treatment cycles involving timed intercourse are the least expensive, followed next in price by IUI cycles, and finally, IVF cycles are the most expensive treatment. Treatment cycles using pills to stimulate egg growth are less expensive than hormone injections to stimulate egg growth. Physicians at Carolina Conceptions will start with the least invasive, least expensive form of fertility treatment that is appropriate for each couple’s individual case.
What companies offer the best insurance for fertility coverage? The top companies that we see offer excellent fertility coverage are: 1) large national companies with offices in the Triangle, and 2) Pharmaceutical and Technology companies. If you work for a company in Research Triangle Park, the odds are high that you probably have excellent coverage for IVF and even egg freezing. If you do not work for one of these types of companies, don’t despair, you likely have coverage for some fertility treatment, and our Financial Coordinators at Carolina Conceptions can help you figure that out.
Bottom Line: Insurance companies almost always cover an infertility consultation with one of our physicians, as well as the work-up that is involved to seek out the cause of a couple’s infertility. I would encourage patients to not let fear of cost of treatments prevent them from coming in to find out why they are having trouble conceiving. Most couples are successful with our less expensive treatments, and are so relieved to hear that they will not need to spend the expensive prices that they may have thought they would have to pay. To make an appointment with one of our 4 board-certified infertility physicians, please call (919) 782-5911.