After meeting with your doctor, you will hopefully have a better understanding of your infertility diagnosis and a possible treatment plan. The next challenge you may face is the cost of your treatment.
Given the structure of the U.S. healthcare system, insurance coverage for infertility treatments varies from state to state and insurance plan to insurance plan. If you are lucky enough to have some type of health insurance, please read on to learn how you can make the most of your coverage.
If you do not have a plan that currently offers coverage for infertility treatments, please proceed to Steps 3 and 4 on the Path to Empowerment to learn how you can work with your Employer and Legislators to enhance their insurance plan coverage.
Dealing with a complicated health insurance policy or company can be aggravating and time-consuming. In infertility, it can be especially frustrating as you are constantly aware of the weeks, months, and years that may go by as you work to build your family. There are ways you can improve your chances of success, when appealing a claim denial or avoiding unexpected bills for treatments you thought were covered. Please use the checklist below to understand how you can prepare for your visit and guide you through the advocacy process with your insurer.
Use this handy checklist for Communicating with Your Insurance Provider (pdf here)
It is very common, especially in infertility, to receive notification that you will be denied coverage for treatment. Insurance companies know that a large percentage of their customers who are denied, will never file an appeal. The checklist above offers some background on general strategies for communicating with your insurance company. However, given the appeals process is a frustration so many patients encounter, further information is provided in the Appeals Guide below.
Insurance Appeals Guide (click for link to 1 page PDF checklist file for users to print)
In addition to dealing with the physical and emotional challenges of infertility, many cannot bear to take on the administrative and bureaucratic hurdles to appeal a denied claim, but it is possible to win appeals. Using the tools from this site and other resources, educate yourself, be patient, and persevere in your path to empowerment.
Appealing a denied insurance claim, will not only help you, but could provide benefits to others in the future as companies may be persuaded to change their guidelines and denial practices. Participating in this appeal process can create a change for you and others.
Melissa and Dan: A Success Story
“Like more and more Americans these days, Dan and I got married relatively late in life (he was 44, I was 39). Given our ages, we were eager to start a family and never really thought it would be much of a problem. But after several months of trying unsuccessfully to get pregnant, we visited a doctor and were diagnosed with male factor infertility. We are fortunate to have a medical insurance and after gaining pre-authorization from the insurance company we began our treatment, confidently expecting our costs to be paid for. To our surprise, after our first round of treatment and thousands of dollars, worth of medical bills – the insurance company denied our claims.
We appealed this inexplicable decision through the company’s usual channels. We even had our doctor submit a letter on our behalf and participate in a review with the insurance company. Still – no success. Increasingly desperate, we sought legal counsel and were directed to FWR. Fighting a bureaucratic goliath like an insurance company can be can be a frustrating and demoralizing endeavor but FWR gave us the strength and guidance we needed. The information and tools they offered helped us realize that we had powerful allies on our side and led us through the process of getting the government to investigate our claim. Within 10 days of filing a complaint with the state, the insurance company reversed its decision and is now paying our medical expenses. Without FWR, we would still be battling our insurance company which would create additional stress in our dream to start a family. With their help, we’re back on the path toward achieving one of our most important life goals.”
When communicating with employers, insurers and legislators, it is critical to share facts which support your argument that it is affordable for you to receive family building benefits, including the diagnosis and treatment of Infertility. Fertility Within Reach is happy to provide you with the following which provides supporting facts and sources to best prepare you:
Resources to Support all Conversations