Important Information on Dealing with Infertility CostsImportant Information on Dealing with Infertility Costs

By Karol Cardinson

Insurers and infertile couples always seem to be battling over infertility costs. Until infertile couples took on the roles of advocates, few, if any, insurers automatically paid for infertility treatment. In the last several years, however, infertile couples have been successfully lobbying state legislature to pass laws requiring insurers to cover their medical bills.

As of April 2000. Twelve states have enacted infertility insurance legislation: Arkansas, California, Connecticut, Hawaii, Illinois, Maryland, Massachusetts, Montana, New York, Ohio, Rhode island, and Texas. Specific information about legislation for each of these twelve states can be found at the Web site of the American Society for Reproductive Medicine (

If you live in any of these twelve states, you probably have a better chance of having some of the costs reimbursed than if you live elsewhere. But if you do not meet all the requirements set forth under the law (i.e. length of time you've been trying to have a baby, medical condition, or use of your own gametes), the law may work against you. On the other hand, insurance may in fact cover your diagnosis and treatment, even if you live in one of the other thirty-eight states.

The majority of insurance carriers cover between 50 percent and 80 percent of "conventional" infertility treatments. In terms of vitro fertilization, 41 percent of commercial health insurance carriers provide coverage. One in four do so as a standard practice, and the remainder do so on a case-by-case basis.

For lesser, low-tech procedures, most BlueCross and BlueShield plans cover much of the diagnostic testing. As long as the insurance company can justify a treatment as leading up to the diagnosis of an illness or condition, the company will reimburse you for surgeries, blood tests, diagnostic tests (like the HSG or endometrial biopsy), and ultrasound scans.

Insurance companies do not consider infertility to be the illness itself; their argument is that most procedures bypass rather than cure the problem and are "experimental" in nature.

But don't lose hope or make assumptions. There are various ways to find out definitely what, if any, infertility tests and treatments your policy covers. There was a couple, for example that assumed that their insurance would not reimburse them for $700 of out-of-pocket expenses for Lupron during an IVF cycle. The insurer had initially turned down their claim, but the couple resubmitted it, pointing out that the FDA had recently approved Lupron for the treatment of endometriosis, a recognized contributor of infertility. The argument was convincing enough that the insurer reimbursed their $700.

At some point you may decide that "enough is enough". The money crisis may be the straw that breaks the camel's back. Spending your last penny or borrowing money you may never be able to repay may just be more than you can handle. If you are unable to continue treatment because the infertility costs are beyond your means, you are not giving up-you are merely being realistic. - 30525

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