Insurance and Your Fertility Treatments: What you Need to Know

Insurance Coverage and Your Fertility Treatments: What You Need to Know

Your fertility plan should eliminate as much stress as possible, and making sure you have the best insurance coverage to meet your needs ahead of time can ease a lot of worry and tension, helping you to focus on your health and relaxation. But finding insurance coverage for fertility treatments is challenging, and understanding the ins and outs of what is covered – and what services are excluded – can be confusing and frustrating.

Plans exist, but you must look at the details.

While there are a few HMOs that offer coverage for fertility treatments, the majority of plans are PPOs. RHWC has contracts with many PPO plans, but we do not contract with any HMO plans at this time.

PPOs, or Preferred Provider Organizations, differ from HMOs and EPOs in a few ways. PPOs offer a wider range of doctors, more flexibility to see doctors outside of the network, and referrals are often not needed for specialists.

However, not all PPO policies will offer testing and treatment coverage, so it’s important to check the details of your policy. These insurance plans are only offered through employers, and employers are also the ones to decide what coverage they wish to offer, and whether they choose to offer coverage for fertility services to their employees.

Find out what coverage you currently have.

Your first step in looking at your coverage options is to see if you currently have a PPO-type plan that offers coverage for fertility services, and if not, to see if your company offers one you can switch to that will offer the coverage you need. 

Speak to your HR representative, or your Insurance provider to confirm what type of policy you have. Ask if your current plan offers coverage for fertility treatments, and if so, which ones. Get as much detail as you can on which procedures are covered, including any co-pays required.

Watch out for exclusions!

Confirming that you have a PPO plan in place and coverage for fertility treatments is only the first step in making sure you are covered. A policy may state that they offer coverage, but there may be a long list of “exclusions” for services that are not covered. 

Request a full list of the exclusions as well as the services offered. That will give you specific information on exactly which tests, treatments and medications are covered and which are not.

Before you switch plans, call the insurance company to confirm.

If you learn that your company offers a PPO plan that you think offers the right coverage, be sure to call the insurance company yourself to verify that RHWC is contracted with your new plan. We’re currently contracted with Aetna, Anthem Blue Cross, Blue Shield of CA, Cigna, HealthNet, United HealthCare, and we work with Meritain, and Health Plan Services – supplemental policies through Kaiser that offer coverage to their employees.

Once your new plan is effective, we’ll also confirm.

Once your new plan is effective, we’ll be able to call the new insurance company and will confirm that we’re contracted with your policy and what services are covered. We also handle direct billing and payments for you.

Your health and well-being are our top concern at Reproductive Health & Wellness Center, and we’re here for you at every step in your journey. If you have any further questions about insurance that we can assist with, or if you’d like to schedule a consultation to learn more about our services, please call us at (949) 516-0606.

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