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Insurance and infertility

Fertility testing, drugs and treatments are very expensive. A month’s supply of Clomid may cost about $70 but a single round of IVF can average $12,000. Before you start seeking medical advice, it is a good idea to find out what your insurance will cover.

Some states have mandated that health insurance must cover fertility treatments so you will want to check if you live in one of these states. Next, you need to obtain a copy of your health insurance policy and an explanation of benefits. If infertility treatment is not clearly excluded, you may be covered for a portion of the expenses. However, do not make assumptions about your coverage or you may find yourself with a series of hefty bills that you are liable for.

After reading your policy, call your insurance company. Don’t just ask if infertility is covered. Be as detailed as possible. Does your insurance cover diagnostic tests? What type of tests or treatments are covered? Must you see a particular specialist? Do you need prior authorization from the insurance company for procedures? Once they have answered your questions, ask for those answers to be confirmed in writing.

If your insurance does not offer coverage, you might try speaking to your employer. RESOLVE can help you with this.

If your workplace offers a Flexible-Spending Account, find out if this can be used for infertility treatments. You may also want to consider a specific infertility insurance policy. Shop around for different options.

Finally, some clinics offer shared-risk IVF programs, where you pay upfront for a certain number of IVF cycles and a portion of the money is refunded if the treatments are not successful.

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