'How Can I Afford Fertility Treatment?'

July 01, 2013 | By: Wendy Schillings, MD, FACOG When an individual is looking into their options for fertility treatment, one of the main factors that they look into is how much is it going to cost. There are 15 states that require employers to cover some parts, if not all, fertility treatment for their employees. Some states, such as New Jersey, have a state law that requires employers with more than 50 employees to provide fertility treatment coverage. Unfortunately, that is not the case in Pennsylvania. Resolve has recently issued a scorecard by state for infertility coverage. Most often your insurance policy correlates to the state where your company is headquartered, not where you live.

However, you shouldn’t give up your hope of ever having a family. Before making an appointment with a fertility clinic, call your insurance company and find out what fertility benefits you may or may not have. If your policy does not provide fertility treatment coverage, ask the representative if your policy covers you up until the point when you are provided with an infertility diagnosis. This last part makes a HUGE difference; because approximately 95 percent of insurance policies cover diagnostic testing, as well as your first visit to the fertility specialist. During the call, with your insurance company, you will also want to ask them if your policy covers any type of fertility medication. There are insurance policies that do not cover fertility treatment but do cover the cost of fertility medication. Whenever you talk to your insurance company make sure to write down the date you called them, the information they provided you, the representative’s name and also the tracking number for the call. This will help if you ever have to refer back to the information. 

If you have coverage for services up to diagnosis, don’t hesitate; make an appointment with a fertility specialist. Before you make your appointment, call the fertility clinic to make sure that they participate with your insurance company. It is important to understand the differences in practices offering fertility services. General Ob/Gyns can diagnose and treat basic infertility but see a wide range of patients with multiple gynecologic and obstetric issues. Board Certified Reproductive Endocrinologists and Infertility (REI) doctors have subspecialty training in infertility which allows them to offer more advanced fertility treatments and often more rapid ability to complete the diagnostic workup. Many practices have dedicated financial counselors.

It is important to know that many times, during the testing process, issues are found that are easily treated and may allow you to become pregnant without having to receive any actual fertility treatment. During your first visit or two with the fertility physician, you should receive a full evaluation of your fertility and preconception health. You will receive diagnostic testing which may involve an ultrasound, blood work/laboratory testing, and various other diagnostic tests. By analyzing all of this information, your physician will be able to discuss with you any treatment options you may have.

After all the testing is completed and it is determined that you will need to utilize fertility treatment to build your family, don’t give up. You still have options. If your physician recommends Invitro Fertilization (IVF), there are many programs available that offer patients discounted treatment cycles, bundled treatment plans, or even plans where you may receive a refund if you are not successful in having a baby. It is important to understand what is and is not covered by each program as they are all different. You will want to know how much you may need to pay for the treatment cycle outside of the program cost.

If your physician recommends an Intra-uterine Insemination cycle (IUI). The cost for this cycle is usually less than and IVF cycle. However, you will still want to completely understand what is and is not included in the IUI cycle costs and treatment success rates. Typically, there no bundled treatment plans or refund programs are available for IUI cycles. However, some clinics do offer discounted cycles for patients with no insurance coverage.

The majority of fertility treatment cycles involve the use of medication. This medication cost could vary from a few dollars to a few thousand dollars. Since you called your insurance company previously, you will know if you have coverage for fertility medication or not. If you do not have medication coverage, the fertility clinic staff should be able to help you figure out where you can purchase your medication at the lowest price and if there are any discount programs or discount cards available.

In the end, if your only option is fertility treatment and you decide to proceed, you will need to take a look at your personal finances. There are multiple loan programs which are designed specifically for medical treatments. There are companies that you can utilize to have a fundraiser to pay for your treatment and even foundations that provide grants for treatment coverage.

The most important thing any patient can do is to completely research their options. An informed consumer is the best type of consumer.