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Insurance

post #1 of 3
Thread Starter 

Does anyone know of a health insurance that covers infertility? I am in California

post #2 of 3

Certain states in the US mandate coverage for IF - I am not sure if California is one of them, I would definitely look into it. The state where we live mandates it, BUT the employer must be based in the state to fall under the mandate. If that is the case, you can petition any insurance company for coverage if they do not offer it. (Usually the doctor's office will help you through the process.) In our case, DH's employer is based in another state without the mandate, so we are not covered. Other than that, theoretically any insurance company will cover IF, I think. From my understanding it is the specific type of coverage plan an employer selects from the insurance company that determines IF coverage. For example, we are covered by Major Insurer X, on an "open access" type plan selected by Employer Y that does not cover anything IF except diagnostics. However, someone else covered by Major Insurer X might work for Employer Z, who has selected a plan with full IF coverage. We don't even have the option of Employer Z's plan because DH's employer has not made it an option. So frustrating. Hoping for you that you are able to access the coverage you need,

post #3 of 3

I'm not in California, so am not sure in regards to specific insurers.  The easiest way to tell is to look at the plan documents, in the exclusions.  How does it word it?  For example, mine excludes Artificial Insemination and In Vitro Fertilization.  Therefore, all the meds, all the bloodwork, ultrasounds, office visits, etc, are all covered.  We have to pay the charge for the actual IVF procedure ourselves.  That's still a lot, don't get me wrong, but it is much much less than having to pay for EVERYTHING.

 

If it states that in the exclusions that there is no coverage for Infertility, then they are excluding the Diagnosis, not the procedure, which means that nothing would be covered (unless your clinic billed it a different way, which depending on what you have and why, at times they can/do).

 

Let me know if you have other questions - I'm pretty knowledgeable when it comes to insurance.

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