The first step in learning how to finance your fertility care is to determine your insurance benefits. Insurance coverage varies widely from person to person, employer to employer and plan to plan. Why? Every business that contracts with an insurance company to write a group policy for its employees will customize its coverage. Thus, the degree to which services are covered depends on what your employer and the insurance company have negotiated.
We strongly encourage all patients to read their insurance policy, or speak with their employer’s Benefits Department, to determine the scope of benefits, coverage, deductibles, and co-insurances as well as when coverage takes effect. If you do not have a copy of your insurance plan, you should contact the insurer directly for a copy. It is advisable to have in writing all coverage information.
Insurance plans which our physicians and The Valley Hospital participate in are:
If you don't see your insurance listed, please call one of our financial counselors at 201-634-5511 or 201-634-5513. They will be more than happy to help you navigate the insurance issues.
If insurers do not cover specific infertility treatments, they may cover diagnostic procedures such as blood tests. It is the responsibility of the patient to contact the insurance company for verification of coverage. In New Jersey, many people may have access to coverage via the NJ Family Building Act passed by NJ State Legislature in 2001. Click here for more information.
Here are some questions to ask when exploring your medical benefits:
- How does the insurer define infertility?
- Do any procedures require pre-authorization?
- What are the policy’s limits in terms of number of treatment cycles, procedures, time seeking treatment, embryo transfers, patient’s age, etc.
- Is there a maximum dollar limit? Is it an annual or lifetime limit?
- What are the co-payments and deductibles?
- What procedures are excluded from coverage?
- What are the drug benefits? (Having health insurance does not guarantee that fertility medications are covered, even if you have prescription coverage.)
Please note that the Fertility Center and its physicians may contract separately with certain insurers, so couples should investigate whether their insurance is accepted by both. Click here for a list of the insurance plans accepted by the Fertility Center and its physicians.
The responsibility for payment of services not covered by insurance, or any other means, resides with the patient. As we are aware that financial matters related to infertility can be different, our financial counselors are available Monday through Friday to assist you.