Does our Insurance Cover Treatment Costs?

The majority of health insurance plans currently do not offer coverage for the treatment of infertility. It is estimated that only 14% of large group plans, 16% of preferred provider organizations (PPOs), and 17% of point-of-service networks and health maintenance organizations (HMOs) routinely cover procedures related to assisted reproductive technologies (ARTs).  For the six million Americans struggling with a medical disorder causing infertility, cost is a significant barrier to care.  The average infertile couple will pay close to $60,000 for a successful delivery using ARTs - well out of reach for many Americans without the benefit of health insurance coverage.

State Laws
13 states have enacted some form of an infertility insurance mandate, although a smaller number are meaningful on a broad scale.  Restrictions on the number of treatment cycles, strict eligibility requirements for coverage, and limited reimbursement policies ensure that many couples, even in states which provide coverage, are still denied access to needed fertility services.  For example:

Coverage Trends
In states where coverage is not mandatory, insurance companies who do choose to offer infertility treatment may be inadvertently penalized.  Couples experiencing infertility problems will overwhelmingly join provider plans with coverage for fertility services, placing a disproportionate financial burden on a limited number of  insurance companies.  Aetna, a major national insurance provider who previously offered coverage for infertility care, recently decided to remove treatment benefits for this reason. Some experts predict that this trend of reduced coverage for infertility will continue in the absence of state or federal mandates.

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