Infertility care is expensive. Many insurance companies are now
recognizing their responsibility to cover some of these costs
since infertility does represent "real" pathology. Yet,
insurance companies typically have been reluctant to cover infertility
care. Hopefully, this situation will improve in the near future.
Many couples are surprised that they are still responsible for
many of the services provided by an infertility specialist, even
when their infertility specialist actually "accepts"
their particular insurance plan. The reason for this is that each
insurance plan will only cover certain identifiable services and
if the infertility service provided by your physician is "not
covered" by your insurance plan then responsibility for payment
falls back on you. A large number of insurance plans cover virtually
no advanced infertility services.
The poor coverage of infertility services by managed care contracts
makes it far less important to choose an infertility specialist
who "accepts your insurance."
If you decide to receive medical care from an infertility specialist
who does not accept your insurance plan, you should always ask
you insurance provider whether you are eligible for "out
of network" coverage. If you are eligible (or if you can
convince your provider that your desired physician is the only
doctor in your geographic area that can provide appropriate care
for you), you will often receive a high percentage (70-80%) of
the usual fees that are paid by your insurance.
New infertility practices may discount their fees while they are
growing, and some established infertility practices will try to
attract new infertile couples into their practice by offering
"special deals." One should be cautious when considering
these situations. Generally, finding an infertility specialist
with a proven record of success, considerable clinical experience
in all aspects of infertility care, an emphasis on highly individualized
care, and competitive fees for the geographical area is a reasonable
goal. Board certification in Reproductive Endocrinology and Infertility
is also valuable.
You should always feel free to call your insurance provider and
ask about your infertility coverage. Additionally, you can call
your local infertility center(s) to ask what level of financial
responsibility (burden) you should expect given your particular
situation. Realise that your treatment plan will be highly tailored
to your own needs as a couple. This selection of a plan may involve
some expensive tests or procedures but should be chosen to give
you the best results with the least overall risk and cost. Because
each couple's plan may be different, the infertility center may
not be able to give you an accurate idea of the cost for your
care until you and your doctor have developed and settled on an
appropriate plan.
You should also always feel free to obtain a second, or third,
opinion about your infertility care. The cost of this opinion
is usually not very great (possibly 250 dollars) when compared
to the total cost of infertility care. You might be surprised
by how different the recommended approach of different "recognized
experts" really is. If you understand the basic infertility
principles (such as described here) you can often decide for yourself
which plan makes the most sense "for you." Your initial
investment (including time, energy, money, emotions) in finding
the best doctor "for you" is repaid many times over
if you are comfortable with the doctor.
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