Understanding fertility insurance
We have included some general information about types of insurance and steps you may take to ensure you receive the optimal benefit provided by your insurance policy. Some plans cover diagnostic procedures only, others cover diagnostic procedures and treatment.
There are two main categories of insurance policies.
Private indemnity generally has a deductible. You may see any doctor of your choice. These policies usually pay a percentage, sometimes 80% to 100% reimbursement once the deductible is met, with the patient being responsible for the remaining percentage.
Preferred Provider Organization (PPO)
The other popular type of insurance policy is a preferred provider organization (PPO). Services are rendered by a network of physicians who are under contract with the insurance company. A deductible must be paid by the patient before insurance benefits begin. Those benefits are reimbursed by the insurance company based on their usual and customary fees. Patient responsibility with these types of policies is usually a percentage of the usual and customary fees.
It is important for you to know what your coverage provides for. Some helpful steps you may take would be:
- Obtain a copy of the contract and/or the summary plan description. The plan usually lists what services are included and which are excluded.
- If you would like to request information from your insurance company about your fertility coverage, we have provided a form letter that you may use as a guide, print and mail to your insurance company. Download sample letter.
- It is also important for you to determine what your exclusions are. “Infertility services excluded” can mean that neither diagnostic nor treatment services will be covered.
- “Infertility covered, but no artificial insemination, IVF covered” usually means that diagnostic procedures, surgery, or monitoring of medication may be covered.
The physician will process all claims that need to be filed directly, but if you must submit on your own, please request documentation and attach to your claim. Since there are many services and therefore visits that may be incurred during the course of an infertility evaluation, it is important to keep all of your explanation of benefits, (EOB) and all receipts and documents from your insurance company.