Although most health insurance policies do not cover egg freezing, some do if it is done for medical reasons. The federal Access to Infertility Treatment and Care Act filed a bill in May 2018 to require fertility preservation insurance coverage. The bill aims to help people who are undergoing fertility preservation operations like egg freezing as a result of medically essential procedures like cancer treatment.
Moreover, some aspects of the procedure, like as a physician consultation, ultrasounds, bloodwork, and ovarian reserve tests, may be reimbursed by a variety of insurance providers.
In the United States, only 16 states compel insurance companies to cover infertility diagnosis and treatment. You might be surprised to learn that leading corporations like Google, Facebook, and Apple provide egg freezing to their employees as a workplace benefit.
It is recommended that you study your insurance policy or contact your insurance carrier to have the coverage explained to you.
Is Egg Freezing Worth the Cost?
According to a Yale Medicine study, egg freezing only increases your chances of having a baby by 3-5 percent. Doctors, on the other hand, frequently collect numerous eggs, increasing the chances of a late pregnancy.
Women who are thinking of freezing their eggs should take their time. Choose this surgery after a long discussion with your doctor and without any pressure.
You should also think about your reproductive goals, your health, and the total expenditures. The woman’s age and overall health play a role in her success. The older you get, the less likely you are to become pregnant with a frozen egg.
Alternatives to Pay for Egg Freezing
Is egg freezing covered by your insurance? If that isn’t the case, don’t give up! Other funding alternatives are available to you.
Consult your financial counselor to see if there are any other options. Many fertility clinics also offer egg freezing as a payment alternative. You can also use crowdsourcing and borrow from a friend or family member.
To summarize, egg freezing is a viable option if your health objectives and money allow it.
Which insurance company covers egg freezing?
Blue Cross and Red Crescent Societies Blue Shield is one of the major insurance companies in the United States, and their customers are currently covered for egg freezing.
Does Blue Cross Blue Shield MA cover egg freezing?
During a covered cycle of IVF, egg cryopreservation will be covered for members who have surplus (supernumerary) eggs that cannot be fertilized (i.e. no sperm can be produced on the day of egg retrieval or there are too few sperm for the number of eggs retrieved on the day of egg retrieval).
Is egg freezing worth it?
To calculate the cost-per-percentage-point, we divided the total expected cost of two rounds of egg freezing plus the requisite years of storage by a woman’s % chance of having a baby in the future.
As shown in the graph below, freezing eggs sooner rather than later increases a woman’s chances of having a child later in life. However, you’ll get the most bang for your buck if you use those eggs to try to conceive after your natural fertility has drastically reduced.
Can I buy insurance to cover IVF?
California, unlike some other states in the US, does not require your health insurer to cover in vitro fertilization. While this is disheartening, there are health insurance plans in California that cover IVF fees on a voluntary basis. Employers who want to provide additional perks to their employees, on the other hand, pay for these advantages. As a result, in California, IVF health insurance is only offered through employer-sponsored health insurance plans and cannot be purchased through individual health insurance.
Individual Health Plan Coverage
So far, we are not aware of any individual health plans available on the ACA marketplace in California that cover in-vitro fertilization. This is unsurprising, given that coverage of in vitro fertilization would raise the cost of health insurance. Advanced fertility services are rarely covered by low-cost health insurance. While only a small percentage of members with fertility issues would be affected, the bulk of other insured members will benefit from cheaper monthly costs. If you live in California, your sole option for obtaining individual coverage for in vitro fertilization is to relocate to a state where fertility services are required to be covered by all insurance policies. Another option is to show that IVF is medically essential, such as in the case of a serious genetic disease. In most cases, low sperm count or obstructed fallopian tubes will disqualify you from those exclusions. One of our patients, a fragile X carrier, was able to convince the California Department of Insurance that advanced fertility procedures, including implantation genetic diagnosis, were medically necessary, forcing the insurance company to pay for them.
Employer sponsored health coverage
The ideal circumstance is to work for a company that offers these perks. Only affluent California firms, such as Google, Apple, Facebook, Tesla, and Warner Bros., are thought to provide health insurance with IVF coverage in California. Not everyone will be able to find work with those businesses. Corporations like Starbucks, on the other hand, may provide fertility coverage to their employees, and acquiring a job there may be easier than at the other companies mentioned. Benefits may be restricted to a higher-level employee group in some circumstances, but each organization sets its own policies. Prior to starting work, phone the HR department to confirm your position’s health insurance benefits.
Kaiser insurance will be available to a large number of Californians. Kaiser Permanente is used by several companies to provide health insurance to its employees. Unfortunately, Kaiser insurance plans purchased on an individual basis do not include fertility coverage; however, many members with employer-sponsored plans do. We’ve created a particular page to Kaiser Permanente members’ fertility coverage due to the significant number of Kaiser Permanente members in California.
Plan rules for IVF coverage
Even if your health insurance supports in vitro fertilization, there are frequently conditions that must be met before treatment can begin. In most circumstances, you’ll need to go through numerous rounds of intrauterine inseminations before you can use your IVF coverage (typically between 3-6). However, if your sperm quality is low or your fallopian tubes are blocked, you may be able to proceed to in vitro fertilization right away. Some insurance companies will recognize advanced reproductive age as a reason for IVF treatment right away.
Should I freeze my eggs at 25?
“When should I think about freezing eggs?” Between the ages of 25 and 35 is the optimal time to consider egg freezing. Even if you use your eggs when you’re 40, the eggs you freeze when you’re 25 will still be 25 years old.
Is it worth freezing eggs at 39?
According to the American Society for Reproductive Medicine (ASRM), freezing your eggs is best done in your 20s and early 30s, when your ovarian reserve (the quantity of eggs in your ovaries) is higher and your eggs are healthier. Having your fertility hormones analyzed (for example, with Modern Fertility!) can reveal a lot about the condition of your ovarian reserve and help you determine if egg freezing is right for you, with the support of your doctor. However, egg freezing is not advised for persons over the age of 38.
At what age should a woman freeze her eggs?
Egg freezing was no longer considered experimental by the American Society for Reproductive Medicine in 2012. They also claimed that egg freezing is a morally acceptable fertility method. Pregnancy rates as well as the health of delivered kids have now been demonstrated to be a safe and feasible alternative as a result of additional scientific developments.
While no fertility preservation approach is guaranteed to work 100 percent of the time, the chances of oocyte cryopreservation working rise with the timing of the treatment. Women should freeze their eggs before the age of 35, or at the very least before the age of 40, due to the natural decline in fertility with age.
Contacting a doctor is the initial step for anyone interested in this surgery. By starting a conversation about fertility options, women can better assess if egg freezing is the best option for them.
Does insurance cover fertility testing?
Services linked to infertility testing are frequently (but not always) covered by health insurance programs. Many insurance plans, on the other hand, state that after a diagnosis has been made, they will no longer pay for fertility-related therapies. This is most likely owing to the fact that diagnostic testing is quite inexpensive for them.
When it comes to test coverage, there may be some murky areas. For instance, a lady who is attempting to conceive has heavy periods and excruciating menstrual pains. The fertility center performs a hysteroscopy on her to evaluate the matter. Regardless of the test’s results, the insurance company may pay in full or deny payment, claiming that infertility is not covered. Was the test performed because she was bleeding and in agony, or because she was infertile? What if that was done for every single one of them? It can be a little difficult and complicated at times.
Infertility treatment and insurance
Treatment for infertility is far less typically covered by insurance than testing. When there is coverage for infertility treatment outside of a state required condition (see below), it is fairly typical to exclude IVF or have a lifetime maximum benefit.
We frequently see health insurance plans with a lifetime maximum of $10,000 to $25,000 on the market. The insurance company’s potential costs are so limited. In other circumstances, insurance will cover testing and treatment up to and including intrauterine inseminations, but not IVF. The “monitoring” of IVF ovarian stimulation (blood and ultrasound tests) is occasionally reimbursed, but not all of the (expensive) IVF codes are.
State insurance mandates for infertility and IVF services
There are now 15 states with some form of infertility mandate. In terms of what is covered how many IVF rounds, for example the mandates are significantly varied. Some of the mandates are somewhat extensive, while others are not. Other states’ mandates are not explored in detail here.
Does Blue Shield HMO cover IVF?
When infertility services are defined as a benefit under the member’s Blue Shield Health Plan, they are covered. In the treatment of infertility and induced fertilization, procedures must follow accepted medical practice.
Does PPO cover IVF?
Infertility testing and treatment are covered by many insurance plans. It can be time consuming and frustrating to figure out how insurance works. This condition generally worsens when coping with infertility. Each insurance carrier may offer infertility benefits, however these benefits may vary based on the group contract or the medical group chosen by the individual. Because of this amount of complexity, it’s tough to make broad assertions regarding your potential benefits. You can start your own investigation into the potential benefits you may have by using some of the recommendations provided on this page.
It’s crucial to recognize a few key characteristics while analyzing your infertility benefits. Diagnostic tests, therapy, and drugs may be covered by insurance benefits. Some or all of these alternatives may be covered by your insurance policy. Insurance companies frequently pay for diagnostic testing but not therapy. Because you will be paying for your treatment out of pocket, you should choose a facility that has transparent pricing to avoid any surprises. You’ll also want to know if any co-payments are required, as well as if your benefits are subject to any restrictions. We’ve put together a list of questions to ask your insurance company.
- Do I have diagnostic infertility coverage so that the doctor can figure out why I’m having trouble becoming pregnant?
- Is a referral required for an initial consultation with Dr. (name of your regular doctor)?
- Do I have in vitro fertilization (IVF) coverage? If so, does it cover the following items:
- Does my insurance cover office visits if my policy doesn’t cover infertility treatment?
- IVF coverage in California infertility insurance: are there any plans that cover IVF?
Some insurance companies will only supply you with information if you give them the correct billing codes, sometimes known as CPT codes. The following are some of the most commonly used CPT codes.
Davis Fertility Center, Inc. has arrangements with a number of insurance companies in California. The contract conditions are frequently specific to the medical group to which you’ve been allocated, as well as any employer-specific contract inclusions/exclusions that may be applied to your benefits. Using the questions listed above, you should contact your insurance carrier for more information. We’ll also check with your insurance company to see if your benefits are still valid. The clinic may tell you something completely different, so it’s always a good idea to double-check your own coverage.
The clinic staff will do a benefit verification and discuss the results with you. Based on the information gathered, we can attempt to provide you with acceptable treatment service estimates. We won’t be able to provide you an accurate treatment estimate because every contract is different, and we won’t know the amount the insurer will pay until after the claims are submitted in most circumstances. While this can be aggravating, you can contact your insurance company and ask for further information. The clinic and its employees are not responsible for determining the benefits covered by your plan, and they are unable to continue to question or debate coverage with individual health plans. Any additional questions should be referred to your insurance carrier. We will try our best to offer you with the most accurate estimate possible.
Terri Perez leads our team of insurance consultants. Terri has extensive experience engaging with insurance companies from a variety of perspectives. She has experience working with medical practices, hospitals, insurance companies, and medical groups. Her knowledge has aided our clinic and patients in making the most of their medical insurance benefits. Terri has met with local insurance providers and offered instruction and training on infertility treatments in a number of instances. Compare this to some clinics’ policies, which require you to pay for services in advance and bill your insurance on your own if your insurance benefits are not accepted by the clinic. This quickly turns into a nightmare, and you are unlikely to get the full advantage. Our skilled billing staff at California IVF: Davis Fertility Center, Inc. works hard to make the most of your insurance coverage.
We work with each patient to help them get the most out of their treatment. We go so far as to verify insurance coverage, explain benefits (which many patients enjoy because this is normally not done for them), secure authorizations, and walk the patient through the entire process. Many of the patients who come from other hospitals express their appreciation for this service. They claim they’ve never experienced service like this before. They’re also taken aback when they learn about our low cash prices for non-covered treatments.
When insurance coverage is not an option for your treatments, we provide transparent, easy-to-understand pricing. We don’t like surprises, so we’ll do everything we can to make sure you’re aware of the price of any therapies we propose. Pricing for services not covered by insurance may be less than what your insurance estimate indicates. This is primarily due to the substantial costs associated with processing and filing insurance claims. The savings from early payments are passed on to the patients.
With so many abbreviations, health insurance might be difficult to comprehend. We work with HMOs, PPOs, and EPOs on a contract basis. All insurance plan participants who have the option of using a non-contracted provider are welcome to use our services. The majority of health plans do not cover infertility treatment, thus whether a member visits a contracted physician or not is irrelevant.
The acronym HMO stands for Health Maintenance Organization. Patients in an HMO are normally forced to see a provider from the HMO’s network of doctors. Patients will need permission from their primary care manager if specialty care is required outside or outside of the network (PCM). Often, your OBGYN can make a reference request to your PCM.
PPO stands for Preferred Provider Organization. Without the involvement of the primary care manager, a PPO will frequently allow self-referral to a specialist. Co-payments for these types of policies are frequently substantially greater. If a network specialist isn’t available in the PPO network, the plan will normally cover an out-of-network provider.
Employer-driven contract (EPO). The health plan provided to Sutter employees is the best example of an EPO. Sutter is in charge of its own health plan and insurance coverage. Sutter EPO recipients have a deal with California IVF as a provider.
Davis Fertility Center, Inc. is a member of the Sutter Physicians Alliance (SPA), Sutter Independent Physicians (SPA), and Sutter Specialty Network, among other Sutter networks (SSN).
Patients with HMO plans managed by Medical Groups that are not contracted with our institution can apply to be transferred to any of the Sutter Medical Groups in Northern California. This can be accomplished by calling their insurance company and requesting that their Primary Medical Group be changed to the Sutter Medical Group (PMG). If you submit your request before the 15th of the month, the modification will take effect on the 1st of the following month. We’d be delighted to help you with this.
Here’s where you can find out about military discounts and Tricare coverage for infertility treatments, IVF, and other infertility services.
Insurance companies must provide infertility insurance coverage for diagnosis and treatment of infertility under California infertility health insurance rules. Insurance firms in California are not required to provide health insurance coverage, but they must provide the choice of infertility benefits. Employers are not obligated to incorporate infertility insurance in their employee benefits packages. Individuals may request the addition of infertility testing and treatment coverage, which is normally at an additional cost. Lockout periods may apply to prevent people from signing up for benefits and using them without first waiting a certain amount of time. Every health plan is unique, and even policies from the same insurance company can differ across two employers. Use our list of Infertility Insurance Questions to Ask Your Insurance Carrier as a starting point for a conversation with your human resources manager or insurance broker.