Understanding Infertility Insurance
Unfortunately, infertility coverage is not considered essential for medical care in the state of Texas. Infertility coverage is more common for insurance plans provided by larger employers and seldom an automatic option for individual health insurance policies. When infertility is covered, it is usually an option with different levels of coverage added to the main insurance plan. It is more common for insurance plans to cover the diagnostic part of your evaluation, and not the treatment part. In general, your insurance coverage will fall into one of three categories:
- No infertility benefit: Neither diagnostic procedures nor treatments for infertility are covered. Unfortunately, many patients do fall in this category. We make every effort to offer discounted or package pricing to our self-pay patients, choose testing and treatments wisely to maximize treatment outcome and to minimize the financial burden.
- Infertility coverage for diagnosis, but not for treatment: With this type of coverage, we are allowed to perform tests to find the cause of infertility such as blood hormone tests, sonohystograms and hysterosalpingograms. Some investigational surgeries (laparoscopy, hysteroscopy) may also be covered. Once the explanation for infertility has been identified, no further expenses will be paid towards the subsequent efforts and treatments deemed necessary to become pregnant.
- Comprehensive coverage: This type of coverage will pay to find the cause of your inability to conceive as well as for various levels of treatment depending on the type of plan. Treatments that are covered may include intrauterine insemination with or without accompanying hormone treatment and in vitro fertilization with associated procedures such as intracytoplasmic sperm injection (ICSI) and embryo cryopreservation. Oral and injectable medications may also be covered. Certain limitations may apply such as limits on the number of ovulation induction or IVF cycles, maximum dollar amount that can be spend on infertility treatment per year or per lifetime or combinations of the above. Medications are not always covered.
Certain insurance plans do require you to be referred by a primary care physician prior to your initial consultation. You may need to obtain precertification or authorization from your insurance company prior to the beginning of your treatment. When a referral or precertification is required, it is the patient’s responsibility to obtain the referral or precertification from the primary care physician or precertification/authorization from the insurance company.
Our office can assist you with verification and clarification of your specific infertility benefits. If you have questions about your coverage, please contact us at (972) 301-8668.
Frisco Institute for Reproductive Medicine is contracted with most major insurance plans. Since these agreements with the insurance companies have varying expiration dates, you are encouraged to call our office to verify that we are still contracted with your plan at the time of your appointment. Even if we are not currently contracted with your insurance company, you may still have out of network benefits.
- Accountable/inter Plan Health Group PPO
- Aetna PPO, POS, HMO
- Beechstreet PPO NEXT PPO
- Blue Cross Blue Shield Choice PPO/POS
- Blue Cross Blue Shield HMO (HMO BLUE)
- Cigna PPO
- Cigna Managed Care (HMO, POS, Open Access, Open Access Plus)
- Galaxy Health Network PPO
- Great-West HMO, POS, Open Access, PPO
- Healthcare Partners of East Texas PPO
- HealthSmart North Texas Healthcare Network PPO POS
- Humana PPO
- Multi Plan PPO
- NPPN PPO/ Plan Vista Solutions
- PPO NEXT
- Principal Edge PPO
- Regional Healthcare Alliance PPO
- Texas True Choice PPO
- United Healthcare Select, Select Plus
- United Healthcare Open Access Products (Choice, Choice Plus, Options PPO)
- USA Managed Care Organization PPO