Everyone’s insurance coverage is different, even at the same insurance company. Coverage rules and restrictions vary based on the package you or your employer purchased. Please review your current benefits and feel free to contact us regarding any questions specific to infertility coverage.
Insurance Benefits and Coverage
Our team is dedicated to providing you with all the information needed regarding treatment coverage as a first-time patient. Here are a few tips to guide you during your journey with SIRM St. Louis when exploring your insurance benefits and coverage:
- Review your current health insurance policy.
- Check with your insurance company to see what infertility treatments they cover.
- Make sure you take notes from your insurance company, especially the name of the person you spoke with.
- Research specific details about coverage for different treatments and drugs.
- Check to see if there is an age restriction or lifetime benefit?
- Check to see if a referral is needed, and if so, the best way to obtain one.
- Check to see if you are required to be seen as a specific clinic.
It is important to also ask if your insurance company covers procedures that diagnose infertility. Example of different procedures may include a blood test, semen analysis or initial exams and consultations. Many insurance companies cover these initial appointments and procedures.
If your doctor diagnoses your infertility, there is a possibility your insurance company will cover procedures needed to treat it. For example, if you choose to have surgery for pelvic pain or endometriosis, your general medical plan may cover for the surgery, even if it does contribute to your infertility. However, if SIRM St. Louis does not contract with your provider, you will likely be required to pay for these expenses out of pocket.
If you have further questions about your insurance coverage or any other financing options, please do not hesitate to contact us.
There are insurance plans that do allow for “out-of-network” coverage. Even if SIRM St. Louis is not contracted with your provider, you may still have a small amount of coverage available. We do not bill your insurance company directly for “out-of-network” coverage.
We will provide you with an insurance form detailing all necessary information required for you to be reimbursed. The exact amount of reimbursement depends on many factors and varies widely. It is a complex topic with many variables, we recommend you work with your financial counselor to determine your level of coverage and help you evaluate your options.