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Making Sense of Fertility Coverage in 2013

Your goal is to become pregnant in the New Year. At Texas Fertility Center, we resolve to help you navigate your insurance company’s call center maze and complex insurance forms that will hopefully result in your being able to maximize your coverage for infertility diagnosis and treatment. Investigating and understanding your insurance plan takes patience, even perseverance, but as someone experiencing the pain and frustration of infertility, you have a lot of practice with these attributes.

 First, verify infertility coverage. 

Fortunately, the State of Texas requires that insurers at least offer your employer the option to purchase coverage for infertility diagnostic testing and treatment. Each policy differs in what is and isn’t covered, so it’s important to ask your insurance provider to ‘predetermine’ or ‘preauthorize’ fertility coverage. A written list that specifies covered tests, and the approved order of testing, will help you avoid any surprises at the billing desk.

If you are denied coverage, don’t give up. A tweak to a single word in a pre-determination request can mean the difference between ‘yes’ and ‘no.’ Ask us for assistance in resubmitting an infertility pre-determination request.

Stand up for your rights by backing the Family Act. 

You are not alone. TFC business office associates have many years of experience in helping patients understand and maximize insurance benefits. In fact, our founding physicians advocate for infertility awareness and insurance coverage, here in Austin and in Washington D.C. TFC supports The Family Act, or the Infertility Tax Credit, a bill that would create a tax credit for over $13,000 of out-of-pocket costs associated with infertility medical treatment. Contact your Congressman, and watch for updates when Congress reconvenes in 2013.

Formulate a fertility coverage plan with these questions provided by Fertility LifeLines™. 

  • What is the definition of fertility in your insurance contract?
  • What coverage is listed?
  • What procedures require preauthorization?
  • Are there restrictions on the type of healthcare provider that can perform fertility services?
  • What limits, if any, apply to your coverage (in terms of treatment cycles, procedures, months in therapy, etc.)?
  • Is fertility drug coverage included in your plan?
  • If so, are infertility drugs covered under the pharmacy benefit or medical benefit?
  • Are there 30-day drug prescription limits for infertility drugs?

The TFC business office staff pledges to do our part to ensure that you attain the maximum benefits that you are entitled to.  Our practice also offers our patients access to shared risk programs, fertility drug discounts, and financing options. Contact us at Texas Fertility Center to discuss your financial options and make a plan for a fertile New Year.


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