Reviewing Your Health Insurance Coverage

If you receive health insurance benefits, a benefit booklet should be provided to you. Review that booklet, which summarizes the contract that exists between your employer and the insurance company. The booklet contains important information regarding your coverage, such as reimbursable and non-reimbursable procedures, deductibles, and coinsurance that apply to your current benefits.

Determining Your Current Infertility Coverage

Your benefit booklet will inform you of the current infertility coverage available to you. The booklet should outline 1) diagnostic infertility services: tests and procedures that allow a physician to determine the cause of your infertility, and 2) infertility treatment, procedures that will assist you in becoming pregnant, such as drug therapy, surgery, intrauterine insemination, or assisted reproductive technologies (ART).

Information regarding infertility coverage may be scattered throughout your benefit booklet. Look for a Covered Benefits section, a Limited Benefits section, and an Exclusion section. Covered Benefits include reimbursable procedures. Limited Benefits will include reimbursable benefits limited by either a number of attempts or a dollar amount. Exclusions or Non-Covered Benefits describe procedures not reimbursed by the plan.

If you review your Exclusion section and do not see any specific exclusions regarding the treatment of infertility, you may be covered. The insurance carrier must clearly define non-covered services or treatments. If a specific procedure is not listed, you can assume it is covered.

You can challenge the contract language, but be aware that the insurance carrier could update the language and change the contract to exclude the procedure that you require. Challenging contract language only offers a short-term solution to lack of treatment coverage. Later on we will discuss approaches to negotiating infertility benefits so everyone gains from the addition of benefits.

We do not advise telephone calls to insurance carriers regarding coverage. The insurance representative may relay unreliable information over the telephone. You may have no recourse if the information proves to be inaccurate. The people who work for insurance carriers do not intentionally give you misinformation. They can only relay to you their best interpretation of your benefits. However, if they are incorrect regarding your coverage questions, you are the one who will bear the financial burden of the misinformation.

Write to your insurance carrier and request written clarification of your benefits regarding any infertility services. Written confirmation, important for any medical procedure, gains particular significance for infertility-related services because these services fall into a gray coverage area and insurance representatives may not know which services their company covers. Written confirmation defines services reimbursed by your insurance carrier for both you and your health care provider. Our letter template provides a sample letter you can send to your insurance carrier regarding benefits. The response to the letter should confirm the infertility coverage currently available to you under your contract.

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