Does My Insurance Cover Infertility Treatments?
nderstanding infertility insurance coverage and benefits involves many details, but where to begin? Help guide research with your insurance provider by turning to the questions on this page. Whether you are a new patient or a current patient with new insurance, we encourage you to take a moment and confirm coverage for your diagnosis and infertility treatment with your provider.
Please keep in mind that these questions serve as a helpful guide rather than a guarantee of insurance coverage and benefits. Before taking care of any payments, it is important to submit your claims for review with your provider. Our Financial Services team can help you work through any questions that come to mind.
1. Is the physician/Shady Grove Fertility location listed as an in-network participating provider?
2. Do I need a PCP referral to be seen by the doctor?
3. Will my visit require insurance authorization?
4. Do I have coverage for testing to diagnose the cause of infertility under diagnosis code Z31.41?
5. Do I have coverage for treatment of infertility under diagnosis code N97.9?
a. If yes, what is my co-pay/co-insurance for diagnostic office visits?
b. Is pre-authorization required for diagnostic testing (lab or radiology)?
a. Do I have coverage for artificial insemination (IUI) (CPT codes 58322, 58323, Z31.89)?
b. Do I have coverage for in vitro fertilization (IVF) (CPT codes 58970, 58974, Z31.83)?
c. Does this plan require a prior authorization before treatment begins?
d. Are there age limits in order to access these benefits?
e. Am I required to try certain treatments (such as IUI) before moving onto more intensive options (such as IVF)?
f. Does my plan cover any genetic testing, such as preimplantation genetic screening (PGS) or preimplantation genetic diagnosis (PGD)?
g. Does my plan cover cryopreservation of eggs and/or embryos?
h. Are there other specific criteria that must be met prior to accessing this coverage?
i. If yes, what is my co-pay/co-insurance?
a. If so, how much is it and how much is remaining?
b. Are there any cycle attempt limitations for IUI or IVF? (Example: 3 attempts per lifetime)
8. Is pre-authorization required for any of the following:
a. Oral/injectible fertility medications?
b. Obstetrical/medical sonograms performed in the office?
10. What is my coverage for "specialty injectible" medications for infertility? (examples: Ovidrel, Gonal–F, Bravelle, Follistim)