10 Questions to Ask About Your Insurance Coverage Before Starting Fertility Treatment

Once you realize that getting pregnant is not going to be as easy as you had expected, your thoughts focus on figuring out what is wrong and what to do about it. But before you start looking into treatment, one of the first things you should do is figure out what your health insurance will cover.

Insurance policies can be difficult to understand. There are several places to get help in understanding your coverage: your employer’s human resources (HR) department, your fertility clinic’s financial office, and the customer service department of your health insurance provider. Some states even mandate coverage by employers as part of their health benefits.

But knowing where to ask for help is not enough. You also need to know what questions to ask. Don’t worry; we have you covered. Here is a list of questions to ask before you start treatment.

Remember, it’s important to schedule an appointment in advance to ask your questions. Your HR representative or fertility clinic’s financial office needs adequate time to prepare and to devote time to your questions. If you are inquiring with your fertility clinic, you will first need to provide them with a copy of your evidence of coverage or certificate of insurance. They will likely want to see your full policy, not the summary, so make sure you provide them in advance with the latest copy.

10 Insurance Questions to Ask Before You Start Fertility Treatment

  1. Does my insurance require pre-authorization before fertility treatment begins?
  2. How is “infertility” defined in my policy, and do I meet that definition? For example, how long do I have to have been trying with timed intercourse without getting pregnant before I am eligible? Is there an age limit?
  3. Do I need a referral from my gynecologist or primary care physician before I see a fertility specialist (a reproductive endocrinologist)?
  4. Does my insurance cover the process of diagnosing the cause of my infertility? For example, will it cover the lab work, ultrasound, hysterosalpingogram, semen analysis, etc?
  5. Does my insurance cover treatment for infertility such as intrauterine insemination (IUI), intravaginal culture (IVC), or in vitro fertilization (IVF)?
  6. What is my copayment for services performed at the fertility clinic? Is there a different copayment for fertility-related hospital charges?
  7. What is my deductible for fertility-related services?
  8. What is the annual or lifetime maximum benefit for infertility treatment? Is there a limit on the number of IVF cycles?
  9. Does my insurance cover fertility medications, either oral or injectable? Does my insurance require the use of a specific, contracted pharmacy?
  10. Does my insurance require the use of a specific, contracted laboratory? Will the laboratory charges at my fertility clinic be covered?