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  • Writer's pictureAhsan Malyk

What Health Insurance Covers IVF?

A common question from prospective parents is, "Does insurance cover IVF?" You might be surprised to hear that your existing health plan can include insurance coverage for fertility treatments, and many plans cover your initial consultation and testing. The copayment for a patient's office visit with a specialist is covered by insurance.

The Aspire Houston Reproductive Institute works with you to reduce the initial consultation cost if you don't have insurance or your plan doesn't cover fertility treatment. Before the initial consultation, our insurance and billing department will check your coverage once you've scheduled your first appointment with a doctor.

Before your first appointment as a new patient, several insurance companies require authorization and/or a reference from your primary care doctor. You will have the chance to sit down with one of our Aspire HFI financial advisors to go over your circumstances in more depth after your appointment.

Regular insurance companies we work with include:

  • Blue Cross Blue Shield

  • Aetna

  • Healthcare companies

  • Cigna

  • First Health

  • Great West

  • HealthSmart

  • Humana

  • Mhealth

  • United Healthcare

  • Uniformed Services Family Wellness

Insurance Coverage for IVF? Questions to Ask Your Employer or Insurance Company

We are aware of how crucial insurance is to your fertility therapy. Every patient has the chance to talk with an Aspire HFI financial consultant after their initial physician visit, and they will be available to you for the duration of your treatment with us. We've offered a list of crucial inquiries to make when speaking with your employer or insurance provider directly for patients who would want to do so:

  • Describe any benefits I might have from an infertility diagnostic test.

  • Do infertility treatments have an age limit?

  • Do we require any kind of recommendation or previous authorization in order to consult a specialist?

  • Exist any intrauterine insemination (IUI), in vitro fertilization (IVF), or intracytoplasmic sperm injection (ICSI) plan restrictions, such as lifetime maximums or set limits?

  • Are there any limitations on rounds of frozen embryo transfer?

  • Do I have access to medical coverage? Is this distinct from or in addition to my existing limitations?

  • Are procedures involving donor sperm and/or donor eggs covered?

  • Are there advantages to genetic testing?

  • Is there a waiting period before I may begin therapy with you?

  • Do I have coverage for ancillary services like ultrasounds and blood tests if I don't have coverage for the core procedure?

  • Can you formalize these advantages in writing?

IVF and other reproductive procedures

Who is eligible for IVF therapy?

IVF treatment helps infertile people conceive and have a child. It could be a combination of both male and female infertility problems inhibiting conception.

When a woman is under 35 years old and a couple tries regularly unprotected intercourse for a period of 12 months without success, it is said that they are experiencing infertility. Or, if the woman is 35 years of age or older and the couple has tried regular, unprotected sex for six months without success.

To ascertain the reason for infertility, a specialist will often perform a few diagnostic tests. Some couples may be able to conceive a baby by continuing to try naturally (with or without medication) or through less intrusive therapies; not all couples will need IVF therapy. The best course of action is to go over your IVF choices with your doctor.

Rebate for Pre-IVF Fertility Testing

Who is eligible to get the rebate for pre-IVF fertility testing?

If you want to receive the rebate, you have to:

  • be a female (eligible fertility tests may be for a man or a woman, but only women can submit an application for the rebate)

  • have been recommended by a general practitioner or a specialist for qualifying fertility tests.

  • possess a receipt for an out-of-pocket expense for one of the subsequent pre-IVF reproductive tests:

  • AMH test, pelvic ultrasound, and sperm analysis are all used to determine ovulation.

Ask your fertility specialist to: prior to applying:

To be sure you qualify for the rebate, check the Pre-IVF Fertility Testing Rebate checklist and bring the Pre-IVF Fertility Testing Rebate form] with you.

You must show one receipt for an eligible test as evidence of your out-of-pocket costs.

Both male and female tests are eligible for the rebate. However, if the intended parent's partner or donor has given consent, the woman seeking a pregnancy must file the claim on their behalf.

Even if the receipt you provide is for less, the full $500 rebate is still available. The rebate is only available to women once. In addition to Medicare and any other available rebates from private health insurance, the rebate is offered.

Please be aware that the rebate will decrease from $500 to $250 as of January 1, 2023, to reflect the current out-of-pocket costs for pre-IVF fertility testing.

Can I make a claim for exams I had before, during, or after IVF?

The reimbursement is not accessible for in-cycle IVF operations or post-IVF exams because it is a pre-IVF rebate. But if you've already started IVF treatment, it's likely that you underwent one of the qualifying pre-IVF diagnostic tests before starting IVF therapy, and you might want to claim for this.

Are men also eligible for the reimbursement, or is it just for women?

The reimbursement applies to tests that apply to both men and women. However, the woman who wants to get pregnant must file the claim on her own own, the behalf of her partner's, or the donor's, body.

This makes sure that the partnership can only submit one application for the rebate in order to have a kid. The woman is the best candidate to obtain the reimbursement because it applies to the widest variety of relationships, including same-sex unions and circumstances in which a surrogate is used.

Are spouses of the same gender qualified for the rebate?

Yes. The rebate is available to anyone thinking about IVF treatment who has paid out-of-pocket medical expenses for fertility testing.

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