Infertility Treatment and Health Insurance: What Patients Should Know By Sonja Kristiansen, MD on May 29, 2018

A woman talking with her doctorIn the majority of the United States, you may not receive any medical insurance coverage whatsoever to cover a treatment for infertility. Thankfully Texas is one of 15 states in America that has laws on the books requiring insurance providers to provide coverage for select infertility treatments.

The fertility specialists at our Houston, TX practice would like to cover some of the basics when it comes to insurance coverage from in vitro fertilization (IVF). This broad overview will help you understand the requirements for coverage from insurance providers so you can prepare for the process, or perhaps consider alternatives.

Texas State Law on Fertility Treatment and Insurance

The statute in question reads as follows:

Tex. Insurance Code Ann. § 1366.001 et seq. (1987, 2003) requires that all health insurers offer and make available coverage for services and benefits for expenses incurred or prepaid for outpatient expenses that may arise from in vitro fertilization procedures. In order to qualify for in vitro fertilization services, the couple must have a history of infertility for at least five years or have specified medical conditions resulting in infertility. The law includes exemptions for religious employers.

How Much of a Fertility Procedure Will Be Covered by Insurance?

This can vary from insurance provider to insurance providers, and based on the policy that you have. For some people, IVF may only involve a small co-pay. Most insurance providers will at least cover the initial consultation with a fertility specialist as well as infertility diagnosis. The infertility treatment itself may be partially covered or fully covered, but it can vary.

It’s important that you check with your insurance provider directly to find out how much coverage is offered and for what services.

What Is Required to Qualify for Insurance Coverage?

As you’ll notice with the above state law, to qualify for insurance coverage, a couple must have experienced infertility or at least five years or suffer from a medical condition of some kind that results in infertility. Other kinds of issues affecting fertility may not be covered under your policy.

Again, it is of the utmost importance that you contact your insurance provider directly with any questions about your coverage. This will help you plan ahead and know what is required of you.

Helping You with Documentation

While we may not be able to help directly with any disputes with your insurance provider, we can help you gather the documentation you need to have your claim approved. This may include a letter or notes from medical professionals and other sorts of paperwork of filings. Feel free to speak with us about your needs. We will be more than happy to lend assistance however we can.

Discussing Additional Payment Options or Arrangements

Five years can be a long time to wait for some couples. If you’re in your mid-30s, five years can mean an increased risk of birth defects or unsuccessful pregnancy. There are also other plans in life one may have had that could be thrown off by a five-year wait to start a family.

These realities of life are why we offer patients various payment plans and financing options. While you may not have insurance coverage for a fertility procedure, monthly installments can make starting a family a reality for you without breaking the bank.

Contact Houston Fertility Center

For more information about your options for treating infertility, be sure to contact the team at Houston Fertility Center. We will be more than happy to go over these matters in greater detail and offer insight into your best options for care.

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Dr. Sonja Kristiansen

Houston Fertility Center

Dr. Sonja Kristiansen is the founder and Medical Director of Houston Fertility Center. She is a board-certified Reproductive Endocrinologist Infertility (REI) specialist who is proud to help hopeful parents fulfill their dreams of having children. Our center is affiliated with the:

  • American College of Obstetricians and Gynecologists
  • American Society for Reproductive Medicine
  • Texas Medical Association

We provide convenient care for patients from greater Houston and visitors from out of town. For more information about our services, contact our office online or call (713) 225-5375 today.

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