Health Insurance Coverage for Infertility in California


Insurance coverage is a growing monster in our world today. In 2010 the CDC (Center for Disease control and Prevention) found that 22.3% of adults from age 18-64 are uninsured. The monster is in its full rage when it comes to infertility coverage in California. Although more and more insurances are starting to cover the basics of infertility treatment, California is still a long way from becoming a mandated state for full infertility coverage.

What is the basic coverage for infertility services? We are finding the basic infertility coverage covers diagnostic services. This may include the following infertility services: the initial consult and follicular ultrasound, lab panels, semen analysis, and uterine cavity screening procedures. If you have an HMO policy, authorization is required by the plan.

Once you start a plan of treatment such as Artificial Insemination (IUI) or In vitro fertilization (IVF) coverage is limited and/or has restrictions. Insurance plans may require a patient to undergo a number of IUI cycles prior to authorizing an IVF cycle. In some cases insurance provide an IVF benefit, but limit the lifetime maximum to $2,000, which in most cases will not cover a full IVF cycle. This information is a crucial piece when figuring out your out of pocket costs for treatment.

What questions you should ask your insurance plan? The financial staff at most infertility clinics will know the specific questions to ask your insurance company to obtain the most accurate and detailed information. They are your best resource for assisting you in verifying your coverage. In many cases, insurance representatives don’t automatically provide you detailed infertility coverage; you have to dig for this information. Remember, simply verifying coverage is not a guarantee of coverage. Here are some questions to guide you in obtaining the most accurate information about your infertility coverage.

• Is infertility an exclusion on my policy?

• Is infertility a covered benefit on my policy? More specifically diagnostic services, artificial insemination, invitro fertilization. What is my co-ins and deductible?

• What is the lifetime or cycle maximum for infertility on my plan? What amount has been met out of my lifetime or cycle maximum?

• To get the more complex coverage–Do I have coverage for Donor services, Cryopreservation, Storage, Embryo Biopsy (PGD).

• Do I need to register with an infertility program; do I need authorization for my services?

• Lastly, get a reference number and name of the representative to document your call.

*Remember to provide your insurance company with your physicians full name and TAX ID# (if available) to ensure they are a participating provider with your insurance plan.

Infertility services may be costly and your insurance coverage may be limited. It is always recommended to speak with the financial coordinator at your infertility clinic prior to starting any treatment. Most are available to answer questions even if you are not an established patient, take advantage of these helpful resources. It is best to understand the full financial picture of your infertility treatment to avoid unforeseen out of pocket costs.

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