When Health Insurance for Fertility Treatments Runs Out


When Health Insurance for Fertility Treatments Runs Out

Creative solutions to make your dreams a reality

When I set out to get pregnant as Solo Mom, I quickly realized that my fertility treatments would not be covered by health insurance. I also realized I would need lots of doctor’s offices, vials of frozen sperm, and shots of hormones and other drugs. And, in my case, it eventually involved using an egg donor. Initially I was put off by the exorbitant costs. But I did not give up. Instead I got creative!

So what can you do when coverage for fertility treatments runs out or does not exist? Don’t despair. There are a number of options to help you realize your dream. You just need to be flexible and tenacious.

Get creative—do your homework

First of all, take a look at the fine print of your health insurance policy. Sometimes physician fees are covered but technical procedures are not, or vice versa. Many times infertility testing is covered if it is related to an underlying medical condition. For example, you may be able to get coverage for a sonogram to assess your endometrial lining or time an insemination if your doctor codes the tests as treatment for an irregular menstrual cycle.

You may also be able to appeal a denial by your insurance company. To do so, you and your doctor will need to write a letter, explaining why the treatment is medically necessary and not experimental.

If you do have to pay out of pocket, you should be able to deduct these expenses on your tax return. Or you may be able to use pre-tax dollars to pay for treatment through a medical spending plan, thereby reducing your out-of-pocket costs.

Financing and refund programs at IVF clinics

Many fertility clinics offer various plans to help offset the cost of fertility treatments, such as special financing loans or share of cost programs that provide multiple cycles at a reduced rate. For a set payment, you receive a number of prepaid ART cycles (usually three). The cost is usually more than a one cycle but less than three cycles. So if you get pregnant on the first try, you’ve overpaid, but if it takes three tries, you come out ahead. It’s basically a roll of the dice. Some programs offer a refund of 70-100% of your prepaid fee if the treatment does not result in a pregnancy.

In most cases, to qualify, IVF has to be medically indicated, and you may be required to transfer all embryos retrieved from the initial cycle before starting a new stimulation cycle. With all such programs, make sure you understand the fine print. Familiarize yourself with the programs at several different clinics, as they can vary greatly.

Vacation IVF

Finally, if you are more of an adventurous spirit, you may consider going abroad for fertility treatment. Many countries offer fertility services at a fraction of the cost in the U.S. I traveled to Mexico to use an egg donor for about a quarter of the price of a U.S.-based clinic. I had a lovely beach vacation and got pregnant on the first try.

Many who pursue fertility treatments abroad find that being in a foreign country, forced to take a break from their busy day to day life provides a helpful ingredient, relaxation, that boosts their chances of getting pregnant. The list of countries with IVF clinics is long, so it is possible to combine a vacation with a visit to many different countries.

Remember there are downsides to going abroad. The drastic reduction in price may mean that the success rates will not be commensurate with the premier clinics in the U.S. The clinics also differ culturally from the U.S, often having slower response times and offering fewer details and hand-holding. I, as a former attorney, was shocked at the simplicity of the contract for services provided to me. Many times, I had to tell myself to relax and trust the process because it did not comport with my U.S. sensibilities. (You can read a detailed account of my experiences here.)

Many foreign clinics realize that most patients are using precious vacation days to pursue treatment. Thus, they minimize the number of days required to be abroad by having their patients complete much of the preparatory treatment in the U.S. In my case, I only needed to be in Mexico for about 7-10 days, though I stayed longer just to lay on the beach a few more days. My OB/GYN was willing to prescribe necessary medications and order initial tests. But if you do not have the support of a U.S.-based doctor, it can be tricky to obtain medications. You may need a prescription from the foreign doctor and to order the prescriptions by from a UK or Canadian pharmacy, which often has the added benefit of being cheaper than buying the drugs in the U.S.

Make sure you do your research and know what to expect. Find other women who have travelled to the same clinic and can vouch for the services. You can find discussions on chat rooms and get referrals from past patients. There are people who act as liaisons and can provide additional information about various clinics. They can also help make your experience more enjoyable and smooth by translating, recommending hotels, providing trusted taxi cab drivers, and more.

Not everyone is well suited to going abroad. So make sure to ask yourself some questions to decide whether you are a good candidate. Most importantly, do you like to travel? Do you feel safe in a foreign country? Do you generally trust people and enjoy different cultural experiences? Can you suspend your expectations of our health system and embrace another approach?

Good practice

The road to pregnancy can be challenging and very expensive when you don’t have insurance coverage. But with some determination and creativity, you may uncover some surprising solutions. And that will be good practice for solo motherhood!


Image via Shutterstock.com

Sarah Kowalski, ESME’s Solo Mom by Choice Resource Guide, is an attorney, somatic coach, Feldenkrais practitioner, and qigong teacher, specializing in the mind/body connection. As the founder of Motherhood Reimagined, she coaches women through their emotions and fears so that solo motherhood, egg donation, adoption, or other means can become an option to consider. She helps women redefine what it means to be a mother so they can cultivate the love, courage, and tenacity it takes to conceive and raise a child by unconventional means. Join her private Facebook group for juicy discussions and support, or follow her on Facebook or Twitter.

Please feel free to contact us with any comments or questions.


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