Fertility Insurance & Benefits at Boca Fertility
Understanding coverage options for your fertility journey
Fertility insurance plays a crucial role in supporting individuals and couples on their journey to parenthood. Insurance offerings encompass a range of medical services and offer financial assistance that may cover some of the costs associated with fertility treatments and related procedures. It’s important to discuss your fertility coverage options with your insurance provider to determine the potential investment involved in your treatment plan
Types of fertility insurance coverage
Fertility insurance refers to coverage provided by health insurance plans for various fertility treatments, diagnostic procedures, and associated medical services. However, fertility coverage varies widely depending on the insurance plan, employer policies, and geographical location.
Coverage Components
Diagnostic Testing
Some insurance plans cover diagnostic tests aimed at identifying the causes of infertility, such as blood tests, ultrasounds, hysterosalpingograms (HSG), and semen analysis. Plans that include diagnostic testing benefits may also cover diagnostic surgical procedures, such as hysteroscopy or laparoscopy.
Treatments and Procedures
Some plans provide partial or complete coverage for fertility treatments, including medications, intrauterine insemination (IUI), and in vitro fertilization (IVF). Coverage for fertility-related treatments varies widely based on your insurance package or benefits plan, so it is important to review your policies thoroughly to determine specific inclusions.
Prescription Medications
Coverage may extend to fertility-related prescription medications, which are a significant part of many fertility treatment plans. You may ask specific questions about which medications are covered (e.g. Clomiphene, Gonal-f or Follistim), as coverage may vary among insurance providers.
Fertility insurance considerations
Coverage variability
Fertility coverage varies widely among insurance plans. Some plans offer comprehensive coverage, while others may cover only specific procedures or medications.
Employer policies
Employer-sponsored health insurance plans may or may not include fertility coverage. It’s important to review your plan’s benefits and discuss options with your HR department.
Geographical differences
Coverage requirements and regulations related to fertility benefits vary by state and country. Our patient experience specialists will be able to provide additional insight on coverage regulations specific to Florida.
Questions to ask about fertility insurance
Understanding your fertility insurance coverage and benefits options is essential to maximizing the cost efficiency of your treatment program. Here are some questions you can ask your employer and insurance provider to get additional clarification on your level of coverage.
For your employer:
- Are there fertility insurance benefits in my health plan? Is there any treatment benefit?
- Is there any other plan that has infertility coverage? If so, what is the cost difference?
- Can I change plans? If so, when?
- If a pre-existing condition restriction applies, what is the waiting period before I can start treatment?
For your insurance provider:
- Is there coverage for diagnostic testing?
- Is there coverage for treatment of infertility? If yes, which of the following is covered:
- Intrauterine insemination (IUI)?
- In vitro fertilization (IVF)? Number of cycles allowed?
- Embryo freezing?
- Frozen embryo transfer cycle?
- Are prescription fertility medications covered?
- Is there a lifetime maximum benefit?
- Is there a maximum benefit per calendar year?
- Is the medication benefit included in the calculation of the lifetime maximum limit?
Be sure to keep record of your information so that you can easily refer back to your coverage inclusions when discussing the financial aspects of your fertility journey with your fertility care team.
What if I don’t have fertility insurance?
We understand that minimizing the expenses of building your family is an important aspect of your fertility journey. If you do not currently carry fertility insurance coverage, there are various alternatives to consider.
Financing Options
We offer various fertility loan and financing options through our partners at CapexMD and Lending Club. Explore and learn more about your options for Fertility Financing.
FSAs and HSAs
Flexible Spending Accounts (FSAs) and Health Savings Accounts (HSAs) are accounts that allow you to set aside pre-tax funds for medical expenses, including fertility treatments.
Third-Party Programs
Some employers partner with third-party programs to offer fertility benefits, even if they are not included in the standard health insurance plan.
FAQs about fertility insurance
What is your billing policy?
Boca Fertility will bill your insurance for covered charges incurred in our office. Your deductible and copayment are due at the time of your visit. We accept cash, MasterCard, Visa, or Discover. Patients paying cash should note that we do not keep change in our office.
How can I verify my insurance benefits?
Boca Fertility verifies your insurance benefits with your insurance company prior to your appointment. Please be advised that it is only an estimation of benefits. It is not guaranteed by the insurance company and is subject to change by your insurance’s approval. You will be responsible for all charges not paid by your insurance company. We will do everything in our power to appeal an unpaid charge, however you are responsible for payment for your services rendered.
How do I know which services are covered?
Some services provided by our office may be non-covered. If we have been informed that the service is not covered you will be responsible for payment in full at the time of the visit. Otherwise, we will file the claim and bill you if it is denied. Many insurance policies do not cover infertility; therefore, your expenses at our clinic may or may not be covered. Check with your insurance provider for more detail on your policy’s inclusions and coverage options.
What happens if my coverage expires or I change plans?
If your insurance coverage is terminated or you switch policies, it is your responsibility to let us know prior to receiving further services.
My insurance company is asking for a copy of my records. Can you help?
It is possible at some point your insurance company may request a copy of your records to determine if your treatment is for a non-covered or pre-existing condition. Unfortunately, this is a matter we have no control over. We cannot withhold or alter records.
Are fertility surgeries and procedures covered?
For surgery, ovulation induction therapy, and in vitro fertilization, we will bill your insurance; subject to verification of coverage and pre-payment of your expected out-of-pocket expenses. You will be billed for all charges not paid by your insurance.