Understanding your health insurance even for the most scholarly — can be a daunting and complicated task. The language used in many insurance policies can be very difficult to understand, confusing and vague. Infertility insurance is one type of health coverage offered by insurance providers. The intent of infertility insurance is to help people finance their fertility treatments. In exchange for a monthly premium, insurance providers will supply you with coverage for various infertility procedures.
Depending on the state in which you live, mandated infertility insurance may be available. To see if your state is included in mandated list, contact your state’s insurance commissioner.
Texas state law requires certain insurers that cover pregnancy services to offer coverage for in vitro fertilization (IVF insurance benefits). That means insurers must let employers know this coverage is available. However, the law does not require those insurers to provide the coverage; nor does it force employers to include it in their health plans. The law does not require organizations that are affiliated with religious groups to cover treatment that conflicts with the organization’s religious and ethical beliefs. (Texas Insurance Code, Article 3.51-6).
If you have any questions, one of our financial coordinators can be reached Monday through Friday, 7:30 a.m. – 4:30 p.m. at (713) 465-1211.
Insurance Q & A
How Can We Find Out If We Have Any Infertility Benefits?
Our financial counselors can call your insurance carrier to verify your benefits. We ask specifically which procedures are and are not covered. Make certain that you have a copy of your insurance plan with the listed benefits (insurance company and/or employer to provide). If you would like to know in advance, we have provided customizable letters for you to send to your insurance company and determine your treatment and medication benefits.
What Insurance Plans Cover Insemination and IVF Procedures?
All insurance plans vary depending on what particular plan your employer purchases. Understand that a particular insurance company may cover IVF but that your employer may have decided to not purchase that particular plan.
What Are We Responsible For If Houston IVF Does Not Participate In Our Insurance Plan?
If Houston IVF does not participate with your insurance company you will be responsible for payment at time of service. As a courtesy to you, we will submit all claims and your insurance company will reimburse you according to your policy.
How much of my IVF cycle will insurance cover?
Insurance coverage for infertility treatments such as IVF varies widely between insurance plans. While coverage for IVF is not that common, you should check with your carrier or your employees’ benefits manager. If you do have some level of coverage, our staff will work with you to obtain a predetermination and/or preauthorization from your insurance company before you begin your cycle of treatment.
We’ve been denied coverage. Now what?
If your claim has been denied, you may appeal. In fact, resubmissions are common. The key is to be prepared to address the issues that led to the denial. The more specific information you have, the better you’ll be able to respond to your insurer’s request. Learning how the medical industry codes treatments can also be helpful, since sometimes a denial can be attributed to a simple typo. A few digits can be the difference as to whether or not you’re covered.