Medical insurance has gotten extremely complicated. The situation for infertility coverage is even worse. Patients may have coverage by the same insurance company, work at different places, and have plans that don't resemble each other because of different riders that their company has purchased. The situation is completely unfair. It doesn't make any difference why a couple has infertility. The cost of care is also not the issue. More expensive, more elective medical conditions are routinely covered while excluding infertility coverage. For example, the cost of hip replacement surgery would pay for three IVF cycles (the most expensive infertility therapy). Many infertility therapies are extremely inexpensive compared to medical care in other areas. The cost of infertility care is lowest in settings in which it is universally available. The cost of providing infertility insurance coverage in states that require it be part of regular insurance is similar to the cost of providing medical nutrition services.
All of the states surrounding Pennsylvania have passed some legislation that helps patients working in those states. Currently, the best situation for patients is in New Jersey. In 2001, New Jersey passed legislation requiring most large companies to provide infertility coverage for their employees. This includes payment for infertility medications and up to three cycles of IVF when less extensive appropriate therapies have failed.
Infertility Solutions, P.C. participates in many insurance plans. Although we can not know your insurance company as well as you can, we will try to share our experience in working with your company with you as much as possible to try to determine what costs are covered. Over time our participation in insurance plans changes. We may stop or start participating in a plan.
Some of the major plans that we currently participate with are:
Aetna plans, Amerihealth, Capital Blue Cross, Cigna, Eastern Pennsylvania Health Network (EPHN), First Priority Health (FPH), Health America, Health Assurance, Health One, Keystone East (KHP East), Keystone Central (KHP Central), Cigna, Oxford Health Plans, Personal Choice, Physician's Care, United Healthcare, and US Healthcare.
We also particpate with a number of smaller plans. Feel free to call us with any questions.
