While times are changing regarding infertility insurance coverage, there is still a long way to go.

Did You Know?

Many states in the US are mandating infertility insurance coverage. In many cases, health insurance providers are required to let employers know coverage is available but they are not under any obligation to provide it. It’s a start at least.

However, many insurance providers hesitate to provide health insurance coverage for infertility, and even if they do, they provide only very limited infertility insurance coverage. This is because most of them are afraid of the costs of the infertility treatments, for each of them is very expensive.

Coming To Terms With Treatment Costs

Infertility treatments may cost from $300 all the way up to $14000. A simple example of this would be the price of insemination, which costs at least $500 per trial, and the In-vitro fertilization cycle which costs up to $14000. These treatments are some of the most common ones, and even to afford these, many couples would have to sacrifice many other things; in the desire of having a child.

What Does Government Law Say?

Many states have given mandates to infertility insurance coverage and have set certain laws for them. Below are some compiled laws that have been in use to govern the infertility insurance coverage:

First, the patient must fulfil the requirement stated in the statutes to be eligible for the infertility insurance coverage. Some of it would include having at least a two-year history of unexplained infertility, or the infertility must be a reason by disorders such as endometriosis, blocked fallopian tubes that are not a result of voluntary sterilization, and the patient’s eggs must be fertilized with her spouse’s sperm.

Secondly, the company that provides health insurance should consider the infertility insurance coverage as mandatory. This is stated in some state laws whereby generally the law requires all insurance companies that cover maternity benefits to cover the cost of in vitro fertilization, infertility diagnosis and treatment, medications and so on.

Understaing Legalities

Some of the treatments that are covered under the laws of the government besides in vitro fertilization are ovulation induction, inter-uterine insemination, embryo transfer, low tube embryo transfer, zygote intra-fallopian transfer, gamete intra-fallopian transfer, artificial insemination, uterine embryo lavage, and intra-cytoplasmic sperm injections.

If you are unsure of your entitlements regarding infertility insurance coverage then it may pay to check the laws of your own state if you reside in the USA or your country’s health insurance obligations. At this stage, there seems a touch of confusion in some of the coverage offerings but at least infertility insurance seems to be heading in the right direction.

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For those after a personal insurance plan, then be careful not to mention that you are specifically looking for infertility insurance. Insurance companies can deny your initial application as it is their right to do. You should be aware that approaching an insurance company for infertility insurance after the condition has been established will generally get your application rejected.

Understanding infertility insurance laws can get very tricky for the average person so gaining some legal counsel if you are going to take on an insurance company would be a wise move. A lawyer specialised in this field knows what laws will work for and against you.

Infertility Insurance Issues State-To-State

Some states have clearly defined laws about infertility insurance. Be aware that there is generally a variation of laws from state to state. The following states up until the publishing of this article had clearly defined infertility insurance laws. This list could well be added to in the future.

- Arkansas: It’s law in Arkansas requiring insurance companies to include vitro fertilization be included in all maternity benefits.

- California: Certain insurance companies under Californian law, not all, are required to offer coverage for infertility diagnosis and treatment. Also employers are not forced by law to provide infertility insurance plans.

- Connecticut: In Connecticut the law requires individual and group health insurance needs to provide infertility insurance for diagnosis and treatment only for the period of one year of unsuccessful trying.

- Hawaii: The situation in Hawaii law is there is a provision  providing infertility insurance that covers a one time only benefits for vitro fertilization.

- Illinois: In Illinois, the law requires insurance companies to cover benefits for infertility diagnosis and treatment.

While the above-mentioned states have varying coverage requirements, it’s important to investigate exactly what qualifying clauses are needed. The reason is because each state is likely to differ when it comes to the qualification process. Be sure you understand completely what level of coverage is being provided by the insurance company. If your medical insurance is through your employer, obtain a copy of the contract and make sure it’s not just a summary. A little time and effort checking the fine print could save you plenty of hassle later on.

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Many health insurers it seem are still coming to terms with the fact infertility is an insurable condition and don’t carry any coverage. If a claim is made and denied, there are several steps you could take before accepting the umpire’s decision.

Recommended Action

- Check the state mandate and make sure that the state you live in has mandates for infertility insurance coverage.

- Be sure to read your insurance contract carefully. The majority of people get their insurance through their employer who in most cases provides just a summary to the employee. If this is your situation, ask for your insurance contract copy as soon as possible. Your employer is required by law to provide you with a copy.

- Check to see if fertility health insurance coverage is not mentioned. This is why it’s important to read contracts carefully. It’s important to make sure if such clauses are included.

- If a clause in the contract stipulates such exclusion, check to see if it excludes treatment only or diagnosis as well. Remember, the insurance company can only deny what they have stipulated in the contract and nothing else besides it.

Why Infertility Health Insurance Coverage May Have Been Denied In The Past

- Infertility is not an illness
- Treatment of infertility does not require medical treatment
- Treatment of infertility is experimental and it may never get any results thus being a never ending process.

It sounds like a large maze of legal jargon to get through and most people tend to retreat into their shells when faced with contracts. If you ever get to a stage of having to appeal a denied claim then it may be well worthwhile seeking legal counsel.

As mentioned earlier, dealing with infertility is tough enough let alone having to sought through legal issues at the same time. Hiring a lawyer, financially permitting, could be a smart move. You should have a right to some sort of infertility health insurance coverage so at least check out what level of legal help is available.

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