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Is my health insurance company required to compensate me for infertility screenings and treatment?

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asked May 13, 2013 by anonymous

1 Answer

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Health insurance, like other types of insurance, is regulated on a state-by-state basis. Treatments that are covered by law in Arkansas may not be covered in California, and others may only require coverage for diagnosis, but not for treatment. For this reason, the best place to find out whether infertility diagnosis and treatment is covered in your state is to contact the state's Department of Insurance.

Since the 1980's more and more states have begun including infertility as part of normal health care insurance. Arkansas, California, Connecticut, Hawaii, Illinois, Louisiana, Maryland, Massachusetts, Montana, New Jersey, New York, Ohio, Rhode Island, Texas and West Virginia all require health insurance plans to provide coverage for diagnosis and treatment. Other states prohibit discrimination due to infertility, and still others fall somewhere in between.

Some states not include coverage for infertility treatment; they have made provisions to allow for in vitro fertilization as well. In some cases, the question of coverage will depend on the nature of the infertility, while other health plans will handle all infertility cases in a similar manner.

Only two states specifically exclude health insurance coverage for infertility diagnosis and treatment. Louisiana and New York stand apart as the ones which will not require any sort of health insurance coverage for fertility problems. Even these states may change their stance in time, so if you live in one of them, check with the Department of Insurance before you give up hope or take drastic steps such as moving to another state.

Diagnosis and treatment are not the biggest reasons that some health insurers are opposed to providing coverage. The fact is, in vitro fertilization can result in premature birth and low birth weights. Care for these conditions cost more than $26 billion annually, and insurers are hesitant to promote or pay for treatments which have such a high risk of expense. The hope is that with new breakthroughs in medical technology, the cost and effectiveness of treatments will go down, and that would not only make them more reliable, it would also take some of the expected risks out of the healthcare equation.

answered May 13, 2013 by anonymous
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