How To Save Money on IVF
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How To Save Money on IVF

What To Ask Your Insurance Company About Fertility Coverage
Insurance reproduction 101

What To Ask Your Insurance Company About Fertility Coverage

Figuring out what your insurance covers and what you're responsible for paying can be confusing- but it shouldn't be. We're sharing what you should ask your insurance company about during your first conversations about your fertility treatment coverage. 

 

 

1. How much do my benefits cover?

 

Here are the different areas that your insurance provider may coverage- and keep in mind that in-network and out-of-network amounts may differ:

 

  • Co-Pay/Co-Insurance
  • Deductible for treatment
  • The amount of your deductible that you've already met
  • The percentage responsibility after the deductible
  • Yearly dollar maximum
  • Maximum number of treatment attempts
  • Lifetime dollar maximum
  • Medication included in lifetime maximum

 

 

2. What restrictions does my coverage have? 

 

  • You might have some requirements you need to meet before your benefits go into effect- for example, many insurance companies may require that you and your partner have been trying to conceive unassisted for a certain period of time prior to starting treatment.
  • The costs of medication may not be included in your benefit maximum.
  • Your medication may not be covered under your general medical plan or prescription benefits.
  • Your insurance coverage may exclude certain treatments.

 

 

If the costs of your medication are included in your lifetime maximum coverage, you might save more money by paying for your medication out of pocket. Insurance companies are billed at higher rates for the costs of fertility medications because they do not qualify for manufacturer rebates that subsidize the price of medications that patients pay for out of pocket. This means that, if you pay out of pocket, you may pay for some of your medications at a much lower rate, and you can use your lifetime maximum towards other treatments and procedures where the insurance company would be billed the same rate that you would pay out of pocket.

 

 

So, if you anticipate that your total treatment cost may exceed your lifetime maximum, you can save money by paying for medications at a lower rate out of pocket.

 

 

3. Which specific tests, treatments, and procedures does your insurance cover?

 

See the checklist below to keep track of which specific treatments and tests your insurance covers.

Treatment and Tests Coverage Tracker

Use this checklist to keep track of which diagnostic tests, treatments, and procedures your insurance covers.

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Diagnostic Tests

Check off each item if your insurance covers it

* A test on Day 3 of your IVF cycle

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Treatments and Procedures

Have questions about your insurance coverage? Text the Prima team at (718) 230-3535.

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Pro Tip

Connect with our pharmacy team at (718) 230-3535 to talk through your specific circumstances.

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