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Navigating nuances of fertility and health insurance

Understanding fertility and health insurance

Our Connecticut fertility center knows there is no “one-size-fits-all” answer to fertility treatment, and the same can be said about fertility and health insurance. Plans can be confusing, and we want to empower you by knowing your coverage.

Where to start in understanding your insurance benefits

Review your policy, and if you have an employer-based plan, talk to your health care benefits administrator. Familiarizing yourself can better set expectations before starting your fertility journey at our Connecticut fertility center.

Coverage is different for everyone. Plans vary greatly from person to person. Fertility benefits may but be limited to diagnostic testing, not treatment. Other plans might cover forms of treatment, such as IVF, but not important IVF medications.

Here are some fertility and health insurance basics:

  • Know your deductible. This is the amount of money you must pay yearly to cover expenses before insurance pays.
  • Understand your copayment. This is the amount you pay to share in your medical costs after meeting your deductible.
  • Submitted isn’t always covered. Just because a claim is submitted on your behalf, it is not a given that it is covered.
  • Know your cap. Be aware of caps (limits) on coverage, which might be annual or for a lifetime. Some policies also limit the number of cycles of a procedure they will cover.
  • Understand coverage. In some plans, coverage for fertility benefits is tied to your primary health insurance, but in other cases, fertility benefits are “carved out.” If it is carved out, benefits are managed by a secondary plan or network, meaning it is a different company than your primary health insurance. If this applies, ensure you have enrolled in that program before your appointment.
  • Is a referral needed? If your insurance requires a referral to see us since we offer specialized care, you must first talk to your primary care provider (PCP). When you reach out, ask your physician to contact your insurance company for a referral before seeing us.
  • Information matters. Don’t forget your insurance card and ID for your first appointment!

We are here to help

Our Connecticut fertility center wants to support and serve as a resource to help patients understand fertility and health insurance. Our dedicated staff is happy to assist you. Contact us for more information about our fertility services.