OHSU

Insurance Help for Fertility Patients

UNDERSTANDING AND USING YOUR INSURANCE FOR FERTILITY SERVICES

We understand that insurance coverage can be limited when it comes to infertility. That’s why we check to see what your insurance covers before your initial consultation. Currently in the states of Arkansas, Hawaii, Illinois, Maryland, Massachusetts, Montana, New Jersey, New York, Ohio, Rhode Island and West Virginia insurance companies are required by law to provide infertility benefits (although the limitations of coverage do vary). In Oregon, if your health insurance is through your employer, it is the employer’s choice as to whether they purchase a Rider that covers an infertility diagnosis and treatment benefits. Therefore, we encourage you to contact both your insurance carrier, as well as your employer’s Human Resource Department. They can give you a detailed explanation of your benefits and other options that may be available to you.

 

Common Questions to ask your Insurance Carrier:

  • What are my current infertility benefits?

  • What are the exclusions?

  • Do I have Out-of-Network Benefits (including for the Andrology Lab)?  Can I request a gap exception?

  • What types of treatments are covered?

    • Intrauterine Insemination – Artificial Insemination
    • IVF, GIFT, ZIFT
    • ICSI (Intracytoplasmic Sperm Injection)
    • Cryopreservation of Eggs/Embryos
    • Donor related costs
  • Are there medical criteria and age restrictions?

  • Do I need a referral or pre-authorization for any of the procedures?

  • Are there limitations or maximum benefit levels regarding infertility treatments?

Common Questions to ask your Employer:

  • Is infertility covered by my current health plan?

  • Are there other plans provided by the company that have infertility coverage?  Am I able to change plans?

  • What are the restrictions to the plans or waiting periods, if any?

We can help if you have limited or no infertility insurance coverage. We are contracted with two companies that provide opportunities for financing and refundable options at reduced rates.

  • ARC provides a range of both non-refundable and refundable options. ARCs Affordable Payment Plan can also be used for medical services and fertility drugs.

  • Attain IVF through IntegraMed offers a refundable option of 3 fresh IVF cycles with 3 frozen IVF cycles. For patients that qualify, Attain guarantees that you take home a baby or get 70 percent of your money back.

 

Our Financial Counselor is able to assist you with financial matters throughout your treatment cycle.

He will verify your eligibility and benefits before your initial consultation and estimate your out-of-pocket expenses. He is available to meet with you to review your insurance coverage, financing options and payment schedules after a treatment plan is selected. During a treatment cycle, he will request authorizations from insurance companies for visits, diagnostic testing and procedures, as needed.

If you have any questions or concerns regarding financial issues related to your treatment please call us at 503-418-4500.