The financial aspect of infertility procedures can be daunting and is one of the biggest concerns for those considering treatment. The key is to have a clear understanding of what the treatment is going to cost, what your insurance is going to cover, and the other financial options that are available. The bright side is that almost 90% of major insurance companies our patients have will cover diagnostic testing until the diagnosis of infertility is confirmed, and approximately 50% of insurance companies will then also cover some, or all, of your infertility treatments at AZARH. In some circumstances, this may even include a donor.
Reviewing Your Plan
Every insurance policy is different, and it is important to thoroughly understand your plan, paying attention to covered benefits, exclusions, and restrictions as they relate to reproductive health services, infertility diagnosis, and treatment. The first step is to request a current covered benefits package or a Summary Plan Description (SPD) from your insurance company. This will have everything in black and white about what is covered for you and your dependents, what services are included and will require a co-payment, the rules for pre-existing conditions, and the circumstance under which your employer can change or terminate a health benefits plan. It is important to note that a medical necessity such as infertility treatment is not the same as a medical benefit. A medical necessity is something that your doctor has decided is necessary, whereas a medical benefit is something that your insurance plan has agreed to cover. In many cases, your fertility doctor may decide that the best possible treatment plan for you is something that is not covered by your insurance policy.
You are your own best advocate for expanded health benefits. If your plan doesn’t appear to cover reproductive services, consider pursuing a different health insurance plan through your employer that may offer coverage for infertility (many employers offer multiple carries of health insurance). If you are infertile & your employer does not currently provide infertility treatment coverage, you can make a formal request for them to do so. In this case, it’s good to get the support of others covered by the work plan who are experiencing similar infertility problems you are. Don’t hesitate to contact the insurance companies directly to get answers and to make sure you have a clear understanding of what is and is not covered.
Speaking with an Expert
Even if you have thoroughly read through your benefits plan (which is no easy task), it is still a good idea to have a financial counselor review your policy. This is where we can help. At AZARH, our team of financial counselors will walk you through the process and help you understand the complex nature of your health insurance policy. We will help you confirm what is covered, answer any questions you may have, and go over other financial options that can help pay for what insurance doesn’t cover.
We understand the emotional toll that infertility can cause, and that the financial obligation is an additional stress to an already stressful situation. You can trust the fertility specialists at AZARH to help you understand your insurance benefits and find the best treatment to build your family. If you would like information about our fertility services or would like to schedule an appointment at our infertility center in the Scottsdale or Phoenix area, please call (480) 946-9900.