Insurance & Mandates

When obtaining information on insurance coverage, don’t just rely on a phone call to your insurer. If you simply call and ask about coverage for a certain procedure, you risk getting incorrect information.

Instead, we strongly suggest that you request a written pre-determination letter or document from your insurance company detailing your exact benefits and any requirements that must be met in order to ensure coverage. This written document is your most effective tool if you need to challenge a decision or file an appeal for payment with your insurance company at a later date.

• In-network: Refers to healthcare providers and fertility clinics that have contracted with your insurance company. Using in-network providers typically results in lower out-of-pocket costs, as the insurer has negotiated discounted rates with them.
• Out-of-network: Refers to healthcare providers that do not have a contract with your insurance company. Using out-of-network providers often results in higher costs because the insurer will pay a smaller portion of the bill.

These are the fertility treatments or procedures that are included under your insurance plan.

Covered services may vary widely between plans and providers. For example, some plans may cover in vitro fertilization (IVF), while others may only cover medications or diagnostic testing.

Understanding what is and isn’t covered is key to avoiding unexpected costs.

Establishing a point of contact with a representative at the insurance company is a good idea and may make follow-up easier. Keep a log of all phone conversations with your insurance company, including the date and time of the conversation and the name of the person with whom you speak.

During that conversation, get answers to these important questions:

• What specific procedures do I need to follow to ensure that my infertility treatment is covered? For example, do I need separate referrals or authorizations for each office visit, blood work, ultrasound or procedure?
• What are the qualifying criteria for receiving my infertility benefit? (i.e. previous attempts, a certain number of IUIs before being able to move onto IVF)
• Is there a maximum dollar amount associated with infertility treatment? If so, what is it and how much have I used to date?
• Is there a limit to the number of attempts allowed for intrauterine inseminations (IUI)?
• Is there a limit to the number of attempts allowed for in vitro fertilization (IVF)?
• Do I have prescription coverage?
• Do I have a separate prescription plan?
• Must I get my prescriptions from a particular pharmacy?
• Is there a separate phone number I need to call to find out about my drug benefits?
• Does fertility medication require prior authorization? 

Fertility treatment grants and scholarships can provide much-needed financial assistance to those struggling to afford the high costs of procedures like IVF.

Here's an overview of grant options and application requirements:

National Grant Programs

Several organizations offer grants on a national level, like the Baby Quest Foundation, which provides grants of $2,000-$16,000 twice yearly for treatments like IVF, gestational surrogacy, egg/sperm donation, and embryo donation.

State-Specific Programs

Some grants are only available in specific states. For example, non-profit organizations like the Nest Egg Foundation offer grants up to $20,000 for qualifying Connecticut and New York residents.

Application Requirements

While requirements vary by program, common eligibility criteria include:

• US citizenship or permanent residency
• Proof of infertility diagnosis
• Medical records
• Letter from healthcare provider
• Demonstration of financial need
• Age limits (often 25-44)
• Residence in specific geographic areas

For more resources, view our full list of infertility grants, grants for surrogacy, or explore other financial assistance options.

If you are currently covered by an employer-sponsored healthcare plan that doesn't include coverage for fertility care, here are some great resources to explore:

• RESOLVE: The National Infertility Association's Coverage at Work Employee Toolkit
• Fertility Within Reach's comprehensive guide to Advocating for Yourself
• RESOLVE's Federal Advocacy Day