Seeking infertility treatment in Los Angeles can be a stressful experience. Because the California infertility mandate is minimal, many insurance providers don’t cover infertility coverage. The only requirement in the mandate is that health insurance providers must offer at least one policy that includes infertility coverage, and make that plan available to everyone without discrimination.
That being said, the mandate does not require providers to include In Vitro Fertilization (IVF) as part of their coverage, nor does it require employers to offer those inclusive plans to employees.
To qualify for infertility treatment under California’s mandate, patients must have a medical condition that causes infertility, as diagnosed by a physician, or be unable to conceive or carry a child to term after one year or more of unprotected sex.
As we enter the open enrollment season for private employers, it might be a good time to look into your options and choose a plan that has the infertility coverage you need. Insurance plans can vary greatly in their requirements and definitions, so doing some research ahead of time is helpful. Before you get started, find out what each policy offers when it comes to infertility testing and treatments.
Here are some helpful questions to ask potential insurance providers about their infertility coverage:
- How do you define “infertility”? For some plans to cover IVF, a couple must have been experiencing infertility for five years or longer.
- What coverage is available for fertility treatment in this plan?
- Is prior authorization necessary for certain fertility treatments?
- Do I need to obtain a referral before I see a fertility doctor (reproductive endocrinologist)?
- Does this insurance policy include coverage for the diagnosis of infertility, such as lab work, office visits, and hysterosalpingogram?
- Does this policy cover fertility drugs? Are any fertility drugs excluded?
- If the policy does not cover IVF, does that mean it won’t cover any of the office visits, lab work or ultrasounds for the non-covered treatment?
- What is the annual or lifetime maximum benefit for infertility treatment?
Knowing the answer to these questions can help you decide which health insurance plan will provide the best infertility coverage and save you the most on out of pocket expenses. Once you choose a plan, you can check to see which fertility doctors in Los Angeles are in-network with your policy.
Reproductive Medicine Associates of Southern California participates with several leading health insurance plans, including:
Prior to your first appointment with one of our physicians at Reproductive Medicine Associates of Southern California, we will collect as much health information as possible, so we can prepare you about the type of treatment that might be right for you.
According to Dr. Thomas Kim, “we want all our patients to know as much as possible about what to expect so that there are no surprises along the way.”
This way, you’ll also be able to check your insurance benefits prior to starting any treatment. At the time of your appointment, you will also meet with our financial advisor, who will work with you to navigate through the insurance maze and find out what your out of pocket expenses will be.
While this process may feel overwhelming at times, asking the right questions will keep you informed and allow you to make the best decisions possible. Choosing the right health insurance policy can keep your infertility treatment options open, and your costs low.
If you have any questions, please reach out to our team today! We’re here to help you in any way that we can.