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Fertility Insurance

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Boston IVF/ IVFNE is committed to helping our patients achieve as much insurance coverage as possible for their treatment cycles.  

At Boston IVF we accept all major insurance plans. However, what is covered varies depending on which state you live in, the benefits of your plan, and the fertility services and treatments you may require.

Our Financial team is a great resource for helping our patients to navigate the fertility insurance process. Each team member will work directly with you to clarify and assist with all aspects of coverage. They will advocate on your behalf to insurance companies, optimize your fertility coverage and reimbursement options, and provide suggestions and guidance with available financial packages that may complement your treatments.

Most of all, they are a phone call or email away if you have any questions before, during, or after receiving treatment at our fertility center.

accepted insurance plans

Boston IVF accepts all major insurance plans. We are a "Preferred Provider" of fertility services with the following health insurance plans:

  • Blue Cross Blue Shield MA
  • Blue Cross Blue Shield RI
  • Out-of-state Blue Cross Blue Shield plans
  • Tufts
  • Harvard Pilgrim
  • Fallon (commercial plan only)
  • Neighborhood Health Plan (commercial plan only)
  • United Healthcare
  • Aetna
  • GIC Indemnity
  • Unicare
  • PHCS
  • Cigna
  • Carelink
  • Health New England (commercial plan only)

*We do not accept Mass Health, Medicaid, Medicare, or BMC Health Net.

not all plans are alike

A common misperception is that all insurance plans are alike. All insurance companies have multiple plans that they sell to employers. These different plans have very different benefits. For example, one plan might require the patient to select a doctor from a limited pool while another does not impose that limit. One plan may have a lifetime cap on fertility related services while another does not.

If you have your health insurance provided through your job, you will be able to obtain vital, useful information about your specific plan directly from your insurance company or employee benefits office. Of course, a Boston IVF financial counselors will assist you with any questions you may have regarding the benefits to which you are entitled under your insurance plan.

referrals

Many insurance companies require you to get an insurance referral or authorization from your primary care doctor for visits with any other doctor. Some insurers will not pay for visits unless the referral paperwork is in place at the time of your visit.

timing

Once your physician has put into place a treatment plan, the nurses and financial counselor will make sure all the clinical information is in place to be able to submit for insurance pre-approval. Each insurance company have vastly different guidelines, pre-requisite testing and treatments that must be done prior to submitting for approval.  Most of the insurance companies also have up to 15 business days to make a determination on the approval. Since this is the case for most insurances, it can take between 2 to 4 weeks to obtain an insurance approval once you have seen your physician for a follow up appointment. 

If you do not meet criteria for coverage under your insurance carrier’s guidelines, we can also appeal for the approval based on medical necessity.

diagnostic testing

After your initial visit to Boston IVF, your doctor may request that you have one or more tests performed. Commonly, each visit to Boston IVF for office visits or testing requires an insurance referral. The form that you faxed to your primary care doctor prior to your initial visit asks for 6 referrals. If your primary care doctor issues these referrals, then they will be used, one at a time, throughout your diagnostic testing. The administrative assistant of your Boston IVF doctor will keep track of these referrals and can tell you how many remain.

office consultations

As with all appointments during the testing phase, each appointment often requires an insurance referral from your primary care physician. 

ivf cycle authorization

Once your treatment cycle has been authorized, you may proceed with treatment as directed by your Boston IVF doctor. Some insurance companies issue approval one cycle at a time while others authorize several cycles at once. You must speak with our financial counselors to determine the specific details of your cycle authorization prior to starting treatment. This will help avoid unnecessary delays in your treatment and minimize your risk of incurring out of pocket expenses.

thaw cycle IVF 

A common question is whether insurance companies count thaw cycles as equivalent to fresh IVF cycles. The answer is that each insurance company handles it differently. You must speak with our financial counselors to determine how your insurance company authorizes thaw cycles.

donor egg ivf

Some of the cost of donor egg IVF may be covered by your insurance policy. However, insurance company authorization for donor egg coverage may restrict your donor to having blood tests or ultrasounds at Boston IVF-approved sites. Some donors live a considerable distance away. You may be responsible for the costs of blood tests and ultrasounds performed outside of Boston IVF. You must speak with our financial counselors to determine how these outside costs can be minimized.

sperm freezing

Most insurance companies do not cover the costs of elective sperm freezing and storage. To determine the current cost of freezing and storing sperm at Boston IVF, speak with our financial counselors.

if coverage is denied

What happens if your insurance company denies your request for coverage? Every insurance company has an appeal board that considers the merits of individual cases that have been denied. Your Boston IVF doctor will gladly write a letter on your behalf supporting your treatment plan. If coverage for a service is denied you have the right to proceed with the treatment plan agreed to by your Boston IVF doctor at your own expense. In such cases it is necessary to arrange for payment of services with our financial counselors prior to starting therapy.

changing insurance plans

If you change insurance plans during your time as a patient at Boston IVF it is critical that you notify our financial counselors immediately. Sometimes a change in insurance policies will necessarily delay initiation of treatment. Fortunately, you can minimize and often avoid these delays entirely by giving a copy of your insurance card (both sides) to our financial counselors and your Boston IVF doctor's secretary. If you know in advance that your insurance plan will change on a specific date, notify us immediately. This will often allow us to plan for the transition and help avoid delays in your diagnostic testing and treatment.

As you embark on your treatment path, it's best to conserve as much attention and energy as possible for your own self-care. The emotional and physical burden of infertility exacts an enormous toll on any individual or couple, and withstanding that stress can take an enormous amount of emotional effort.

To help ease the burden, we have put together some tips to help navigate the process of fertility financing.

TO GAIN BENEFITS THROUGH YOUR EMPLOYER

A guiding principle to successful communication is to approach your employer with the belief that your infertility treatment is not only a way to help yourself, but also a way to help your employer and your coworkers.

You are advocating a win-win scenario, and that is not something to feel selfish about. In your appeal, it helps to include your own personal, heartwarming story, and to also show a financial benefit to the organization.

Communicate with your employer's Human Resource Department. Share an example of IVF coverage from another company. Educate everyone you talk with about the benefits and affordability of offering IVF coverage.

One way to demonstrate the affordability of IVF coverage is to explain that research shows patients with insurance coverage transfer fewer embryos, thus reducing costs associated with high-risk pregnancies, premature labor, and NICU expenses. Let them know that providing IVF coverage also leads to higher employee morale and loyalty. 

Advocate for yourself: If your employer is unwilling to provide coverage, consider changing employers. Or take a leave of absence to work for an organization that does offer IVF benefits. Double check to make sure you meet the medical guidelines to qualify for your new employer's insurance benefits. 

TO GAIN BENEFITS THROUGH YOUR INSURER

Communicate with your insurer. If you submit a claim that is denied, file an internal appeal. Let your insurer know that although your policy does not offer IVF benefits, you would like them to make an exception.

The term ‘predetermination of benefits’ describes the process of convincing your insurer to make an exception because it is in everyone's best interest. Make sure to take notes during your conversation and ask that all assurances from your insurer be provided in writing. 

Collect and send your appeal to your insurer. Send all documentation at the same time. Relevant documents to send include related medical history, a letter of medical necessity, and research supporting your case. Make sure to mail in a manner that requires a signature. 

Add low or no interest credit cards or loans to options for funding your treatment. If you find yourself in a situation where your insurer should provide benefits, but refuses to do so, you still have options. Make certain the reason for denial is stated and note the date by which your appeal must be received. Ask your insurer for information on ‘internal appeals’ (the process of appealing a decision on a denied prior authorization).

If your internal appeal is denied, there are still more options. You can file an external appeal. Healthcare.gov offers more information about external appeals. If the external appeal is determined in your favor, your insurance company denial is then overturned. If you believe your insurance company has wrongfully denied coverage, another option is to file a complaint with the Massachusetts Department of Labor.  

TO FUND YOURSELF

If the need arises, it may be possible to fundraise on your own as a way to offset the cost of treatment. If you choose to go this route, options include:

  • utilizing a Flexible Spending Account, which consists of pre-tax dollars designated to cover medical expenses, through your employer
  • money you've spent on fertility treatments above 10% of your income incurs IRS healthcare deductions, which are available to you crowd-funding through online platforms
ASK RHONDA
Have questions about your fertility? Need info on available treatments or just general advice on where to begin? Don't hesitate to call or email Rhonda! For 30 years, she has been a phone call (888-300-2483) or email away and the perfect resource if you need answers.

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We look forward to speaking with you, and will be in touch as soon as possible!