After the initial shock or disappointment or [insert emotion here] wears off, many couples are faced with some very important and often expensive decisions. The cost of infertility is very wide ranging; from just taking Clomid and using timed intercourse ($10 with a prescription) to to full on in vitro fertilization (IVF) running in the $15,000+ range. The ray of sunshine, for some, is that insurance providers cover infertility. For many others, insurance doesn’t cover anything and forces couples to foot the entire cost of infertility treatment.
Navigating the Cost of Infertility
We are “lucky” as we live in Illinois, a state with a mandate for insurance companies to cover the cost of infertility treatment. There are lots of details involved with that, and that’s probably another post for another time, but even though it’s a requirement, it’s still pretty difficult to navigate. There are tons of rules, exemptions, required tests, and so on and so forth. Here’s our guide on making the most of your insurance coverage (if available) and minimizing your out-of-pocket spending.
Call your insurance company or ask HR for your insurance contract
Doing this will let you know if you are covered at all, and if you are, how many procedures and/or what the maximum coverage amount is. You’ll read scary things like “lifetime max,” “limit one assisted reproductive treatment (ART),” or “maximum $10,000 covered,” but knowing what you are up against is huge. Fertility Centers of Illinois put together some great questions to ask about procedures/treatments and medication coverage.
Consult a Reproductive Endocrinologist BEFORE Any Treatment
This is perhaps the most important piece of the puzzle. Since some insurance plans cover the cost of infertility treatments differently, you don’t want to accidentally waste a cycle or dollar spend on someone who isn’t trained specifically in infertility. The worst scenario: you use insurance to pay for an IUI that costs roughly $300 with cash and you have a one-time limit on ART. If it doesn’t work and you have to use IVF, you may have just wasted $10,000.
Use your Clinic’s Billing Office!
These people are a great resource. They can pre-verify your coverage and tell you exactly what you can and cannot do with insurance. They know all the billing codes and the steps to getting covered. And if there are any tests you need to do prior to treatment, they’ll tell you that, too!
An often overlooked piece of the process is the monitoring. Going to the RE’s office every morning for an ultrasound and bloodwork can get pricey. Sometimes, though, your insurance will cover that even if they don’t cover the cost of infertility. It’s usually coded as a diagnostic test instead of infertility treatment. So make sure you ask the billing office about that bit, as well.
Insurance Covers Dollars Spent vs. Number of Procedures?
Don’t use insurance to get your medication. Medicine is FAR more expensive when purchased through insurance and has less workarounds than treatment. Plus, there are tons of resources for the costly medications. Discount programs, cash discounts, donated medication, and much more are available. Any clinic worth their salt will have a detailed list of where you can go for affordable medication.
In the same token, if you are covered per procedure, make sure you save the big ones. Pay for the cheaper treatments out of pocket. If you get pregnant, you can submit the bills to insurance on your own! And if you don’t, you still have treatment available for the big stuff. Knowing your coverage is the best way to navigate the cost of infertility.
Ask for Discounts
It never hurts to ask! Especially if you are paying cash, most clinics offer a discount on treatments and services. 10% here and there will really help out in the long term.
Be Your Own Advocate!
You are in charge. Always remember that. You are paying your clinic and you are paying your insurance company. If you don’t like what’s going on, put your foot down. Demand explanation. Get it in writing. Call and wait on hold for hours to talk to an insurance rep. I don’t even want to think about how many hours I spent on the phone, but it was certainly worth it at the end of the day.
Infertility is a Journey
It’s not easy. It’s not fun. But having the right tools can make it much, much more bearable. From a financial standpoint, the cost of infertility can vary widely depending on who you talk to. So just make sure you document everything. Keep track of everything. As you end the journey, positive or negative outcome, you’ll know you did everything you could to make sure you got the best possible experience.