Questions to Ask When Considering Infertility Treatment | Aetna

What health insurance plan covers ivf

I was a healthy, athletic 34-year-old woman when my husband and I started trying to get pregnant. I never thought for a second that she would have trouble getting pregnant. Every month when I had my period, I felt confused and heartbroken.

Infertility is a struggle, and it was the biggest challenge I’ve ever faced. there was something I had little control over and couldn’t work harder to get over it. What I was able to do was seek help from medical professionals, and that made all the difference.

Experts say that women under 35 who are trying to get pregnant should seek help after a year of unsuccessful trying. women over the age of 35 are encouraged to seek help after six months. Talk to your doctor before trying to get pregnant if you don’t have a male partner, have a condition like endometriosis or pelvic inflammatory disease (PID), or even have irregular periods.

If you’re ready to seek medical help on your journey to becoming a parent, it’s a good idea to do your research. Research the fertility options available to you and find out which ones are covered by your health insurance plan. Here are five good questions to ask:

1. Does my health insurance plan cover fertility treatments?

Maternity and newborn care are considered essential benefits in most health plans, but infertility care often is not. Coverage runs the gamut: Some insurance plans cover in vitro fertilization (IVF), but not the accompanying injections that women may also need. other plans cover both. some plans cover limited attempts at certain treatments. And some plans don’t cover IVF at all.

Men will want to check what their plan covers for semen analysis and male infertility care. remember that “infertility is a couple’s disease,” says joanne armstrong, md, senior medical director and chief of women’s health at aetna. “There are risk factors for both the woman and the man, so make sure both partners are tested.”

If you have a choice of health care plans, you’ll want to choose one that offers the most coverage possible. But here’s an important caveat: Just because a doctor says you’re a candidate for infertility care doesn’t mean you’ll automatically be eligible for services covered by your plan. aetna members can learn more by reviewing the infertility treatment frequently asked questions.

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2. Where do I start if I want to discuss infertility treatment options?

Your first stop should be your OB/GYN office. he or she may order diagnostic tests to measure hormone levels and analyze the semen of male partners. these steps will determine what medical problems, if any, are hindering your attempts to get pregnant. Your gynecologist can also advise you on the best time to have intercourse during ovulation and, if necessary, can prescribe medications to stimulate ovulation.

You’ll want to start with the least invasive methods, which are often those offered by an OB/GYN. a gynecologist tends to be less expensive than an infertility specialist. Depending on your insurance plan, you may also pay less out of pocket. Also be sure to check that your plan covers the particular medication your doctor prescribes. some plans cover one type of ovulation medication but not another. If your drug isn’t covered, ask your doctor about changing it.

Men with abnormal semen results are often referred to a urologist. the urologist may prescribe medications or suggest surgical solutions, depending on the diagnosis.

3. How do I choose an infertility specialist?

If the efforts of your OB/GYN or urologist are unsuccessful, your next step is to find an infertility specialist, also known as a reproductive endocrinologist. your gynecologist will usually point you in the right direction. my husband and I considered two local specialists. after speaking with both of them on the phone, we felt we had a more immediate connection with one than the other. If you’re not satisfied with your OB/GYN’s recommendations, you can consult fertility iq, a database of patient reviews from infertility physicians.

You’ll also want to make sure your doctor is in your insurance plan’s network. aetna members can find in-network reproductive endocrinologists through the docfind online provider directory, for example. aetna also maintains a network of infertility institutes of excellence, a select group of centers that provide high-quality, high-value infertility care.

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Your plan may have additional services and certification requirements for those seeking infertility care. Before undergoing infertility treatment, Aetna encourages members to register with their national infertility unit. The NFU issues authorizations for treatments such as injectable drugs, IVF, and preimplantation genetic diagnosis, or PGD. (pgd is used to test embryos for specific chromosomal or genetic disorders that you or your partner can transfer to the embryo). members can also call the unit to ask questions about infertility care and coverage.

4. How many cycles of infertility treatment will be covered?

My husband and I first tried intrauterine insemination (iui) before moving on to in vitro fertilization (ivf) and frozen embryo transfers (fet). In an IUI procedure, doctors inject sperm into the uterus through a catheter. With IVF, doctors surgically remove a woman’s eggs, fertilize them with sperm, and transfer the viable embryos back into the woman’s uterus. women can use their own or donor eggs. Although there are cases of families who are lucky in the first IUI and/or IVF, do not be discouraged if it does not happen to you from the beginning. she can often take several tries before becoming pregnant.

Check how many attempts your insurance plan will cover. And be sure to talk to your doctor to come up with a strategy. “Knowing what insurance benefits are available to you can be a factor in deciding which treatment to pursue,” Armstrong says. Many doctors will recommend up to six rounds of IUI before starting IVF. Some insurance plans will only cover IVF if you’ve had a certain number of IUIs.

With IVF, you need to determine how many embryos you want to implant at one time. our fertility specialist believed in transferring just one because complications are more likely to occur with multiples in utero. insurance companies may have their own policies regarding the preferred number of embryo transfers at one time. aetna, for example, strongly recommends the use of single embryo transfers when a quality embryo is available. an additional cycle of embryo transfer may be covered if the first cycle fails.

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5. What is my coverage for surrogacy and adoption?

if iui or ivf doesn’t work for you, you may decide to find a surrogate to take your child or adopt. If you plan to have a gestational surrogate (a woman who will have your eggs or a donor’s eggs implanted), your insurance may cover the retrieval and fertilization of your eggs. many plans do not cover services received by the surrogate. (Your out-of-pocket health care costs may also be your responsibility, depending on your subrogation agreement.)

In my case, I began considering adoption after our first frozen embryo transfer failed. that was the route one of my closest friends followed after her first embryo transfer failed as well. Today, she and her husband are the proud and resplendent parents of an adorable 4-month-old son. If she chooses to adopt, check to see if her insurance plan or employer offers reimbursement for adoption expenses. Happily, if you have a health savings account (HSA), adoption costs are an eligible expense.

Fertility treatments can be daunting. But with the right tools and research, it’s possible to grow your family. we finally saw success with ivf, which produced four viable embryos. the second embryo transfer resulted in a pregnancy: our beautiful baby was born in 2016.

we still have two embryos “on ice” as we like to say, and my mom has appropriately nicknamed them elsa and anna. we don’t know what will happen when we try to implement them in the future. but we celebrate every day with our son, knowing and appreciating the path we took to have him.

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