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5 questions to ask your health insurer about infertility treatment Posted: January 9th, 2012

By Susan Ladika

If you're struggling with infertility issues, the huge variations in what health insurance policies cover mean you need a thorough understanding of your own policy before you seek treatment. Otherwise, you could wind up paying thousands or tens of thousands of dollars out of your own pocket.

The Centers for Disease Control and Prevention reports that more than 7 million women have infertility issues.

Despite that fact, just 15 states require that all health insurance covers infertility treatment. Requirements vary among the states that mandate coverage.

Before you make any concrete decisions as to how to proceed, call your health insurance provider and determine what your policy provides.

But before you dial the phone, make a list of the most important questions you want to ask, such as:

Does my state mandate coverage of infertility treatment?

Currently, Arkansas, California, Connecticut, Hawaii, Illinois, Louisiana, Maryland, Massachusetts, Montana, New Jersey, New York, Ohio, Rhode Island, Texas and West Virginia all require coverage.

But even among those states, there are variations. California, New York and Louisiana, for example, exclude coverage for in vitro fertilization (IVF).

Is diagnostic testing covered?

Most policies cover a standard series of tests to determine why you can't conceive.

Even if diagnostic testing is covered, it doesn't guarantee you can get help. Some policies cover the diagnostic phase, but not the treatment phase.

If my policy covers treatment, what is included?

Infertility treatment can be costly. According to the American Society for Reproductive Medicine, the average cost of an IVF cycle is $12,400.

Treatment coverage is all over the map. One health insurance policy may not include coverage. Meanwhile, another policy may cover assisted reproductive technology, in which eggs are removed from a woman, fertilized and then placed in the womb.

If my health insurance policy includes treatment, can I still face limits?

You may find that your policy includes an age limit. There also may be limits on the number of IVF attempts you are allowed, or you may face a financial cap.

Are medications covered by my health insurance policy?

IVF medications cost an average of $3,000 to $5,000 per cycle, according to RESOLVE: the National Fertility Association.

You may find that certain drugs are excluded, or there may be co-pay requirements or limits as to how much your insurer will pay. Because of the policy differences, you could still have large out-of-pocket costs.