As soon as you realize getting pregnant may be a problem, it’s time to start thinking about how to pay for the treatments. Infertility treatments are very expensive. Unfortunately, insurance companies often refuse to pay for infertility because it’s not considered medically necessary.
Lack of money to pay for treatments is one of the most common reasons couples discontinue treatment. This is heartbreaking for the couple. Doctors have been charged with fraud for attempting to help patients. They have been known to bill for other procedures in an attempt to collect money for infertility treatments.
Only a few states mandate coverage for some diagnosis and treatment of infertility. These states are: Arkansas, California, Connecticut, Hawaii, Illinois, Maryland, Massachusetts, Montana, New Jersey, New York, Ohio, Rhode Island, Texas and West Virginia. The requirements vary by state. Find out the law in your state to take advantage of the maximum coverage.
Find out what your insurance company will and will not cover. Some will cover diagnostic testing and medications, but not assisted reproductive technology. Other companies will cover nothing related to infertility. When I was trying to get pregnant with my first child, our insurance covered diagnostic testing, medications and artificial insemination with the husband as the donor. No other treatments were covered. It’s important to get the most from your coverage, so you will need to come up with less money.
Couples cover the gap in a variety of ways. Some use savings or take a loan on the 401K plan at work. Other couples may take on part time work and save for the treatments. Some have taken out home equity loans to fund expensive treatments. You need to sit down with your spouse to determine a budget and figure out how much you can afford and are willing to spend to get pregnant.
In the meantime, advocacy groups are trying to help infertile couples. Information on this can be found through the advocacy group RESOLVE. These groups are trying to get each state to pass legislation requiring insurance companies to cover infertility treatments. In addition, they continue to lobby the federal government to pass national legislation.
Court cases have been brought against insurance companies. The results have been mixed and several are still pending. The argument is that having children qualifies as a “major life event” under the American’s With Disabilities Act (ADA). To deny coverage is considered discrimination under ADA, according to the argument. The outcome of these cases may be more funding available in the future for infertile couples to achieve the dream of having a child.