Insurance Coverage

Maximizing your coverage

We want to help you find every opportunity available to you in your quest to have a baby. Our financial counselors are experts in navigating the complexities of insurance coverage. They will work closely with you to ensure that you are making the most of your insurance coverage.

Finding Clarity

Coverage varies greatly depending on your insurer, your coverage plan, where you live, and even where your insurance plan is headquartered. We will help you to understand exactly what is covered.

Accepted Healthcare Plans

We accept the following Healthcare Plans:

 
Provider Plan
Aetna HMO, POS, PPO
Blue Cross/Blue Shield of Illinois POS, PPO
Cigna - Great West Healthcare Out-Of-Network
Non State of Illinois
Benefits Only
Coventry/First Health/Personal Care HMO, POS, PPO
HFN PPO
Humana HMO, POS, PPO
Multiplan PPO
Private Health Care Systems POS, PPO
TriCare HMO, PPO
United Health Care/OptumHealth HMO, POS, PPO

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  877-324-4483

Where to Begin

Contact your insurance provider about your specific coverage after consulting with one of our financial counselors. Our financial counselors will guide you on what questions to ask. Try to be as detailed as possible, take notes and get a reference number for the call in the event that there is any dispute later. We have compiled two lists of questions to start with:

Fertility Coverage in Illinois

Illinois is one of the few states in the country with a mandate to cover infertility fairly extensively. That does not mean that an Illinois resident will be covered for everything. You can expect to most likely have more coverage than you would in most other states as a result of this mandate.

Who is Eligible for Fertility Treatment

There are specific criteria that must be met in order to qualify for infertility coverage. First of all, verify that the insurance offered by your company is actually Illinois insurance. Companies headquartered in other states usually have health insurance based in that state.

Secondly, according to regulations, your health insurance "must be a fully-insured group policy of accident and health insurance or HMO contract for a group larger than 25."

Finally, you must personally:

  • Be unable to conceive after one year of unprotected sexual intercourse
  • Be unable to sustain a successful pregnancy
  • Have been diagnosed by a physician as having a medical condition that renders conception impossible through sexual intercourse; or
  • Have undergone one year of medically based and supervised methods of conception. A physician must determine that completed artificial insemination was a failed treatment, thus, not likely to lead to a successful pregnancy.

What is Covered

Illinois group insurance and HMO plans are required to cover the diagnosis and treatment of infertility the same way they would any other conditions. In other words, there cannot be additional co-payments or deductibles applied only to fertility coverage.

Your benefits will likely include:

  • Testing and diagnosis
  • Prescription medications
  • Intrauterine Insemination (IUI)
  • In Vitro Fertilization (IVF)
  • Intracytoplasmic Sperm Injection (ICSI)
  • Donor sperm and eggs (medical costs)
  • Procedures to retrieve oocytes (eggs) or sperm and to then transfer to the covered recipient

Payment is Your Responsibility

We are happy to contact your insurance company as a courtesy to explore the details of your infertility coverage. But please understand that this is in no way a guarantee of benefits. Due to the complexities of insurance, what the insurance company tells us is occasionally inaccurate.

While this occurs rarely; the responsibility for payment will fall to you. However, in such an event, you are highly encouraged to dispute the issue with your carrier. Fertility Centers of Illinois is not responsible for any insurance carrier’s omissions or incorrect information.

The Limitations of Coverage

Certain advanced procedures — like In Vitro Fertilization (IVF), and intra-cytoplasmic sperm injection (ICSI) — are often only covered once you have first tried a number of attempts at pregnancy through less expensive procedures. Consequently, you may need to try a certain number of Intrauterine Inseminations (IUI) before being allowed to move on to In Vitro Fertilization (IVF).

You will probably be limited to a certain number of attempts in your lifetime once your insurance company authorizes you to proceed with IVF. Prior IVF procedures that were covered by a different insurance carrier may apply to that lifetime limit. Some policies do not have annual limits, while others only allow four cycles per year. Furthermore, when considering limits on your benefits, keep in mind that you may want to preserve some of them for the future if you think you may want a second child.

What May Not be Covered

Not everything related to your fertility treatment is covered, even under the Illinois State Insurance Mandate. For example, your group insurance or HMO plan may not be required to pay for:

  • Preimplantation Genetic Diagnosis/Screening (PGD/PGS)
  • Reversing tubal ligation or vasectomy
  • Fees paid to a surrogate or gestational carrier
  • Preserving or storing sperm, eggs or embryos
  • An egg or sperm donor when it has not been deemed medically necessary
  • Non-medical fees paid to an egg or sperm donor
  • Experimental treatments
  • Procedures that violate the religious or moral teachings or beliefs of the insurance company or covered group