Insurance Coverage

Many insurers now offer coverage for the various stages of infertility treatment — from examinations and tests, to medical procedures and drugs. In addition, more states are now requiring that insurers include infertility benefits in their policies.

Unfortunately, fertility coverage is not yet universal. So take some time to study your policy and find out if, and to what extent, you may be covered. As you do, here are some pointers to think about.

If you'd like assistance verifying your benefits, call Fertility LifeLines™ at 1-866-LETS-TRY (1-866-538-7879).

Get approval in advance — and in writing

Knowing exactly what your policy covers before you see a healthcare provider is a huge timesaver. Your coverage may dictate the kind of healthcare provider you see, the types of tests you have, the sequence of the testing and which treatments will be covered.

When possible, it's best to get a commitment for coverage prior to seeing a fertility healthcare provider. This is called "preauthorization" or "predetermination." To help you along the process, we've created sample preauthorization letters as guides for you.

If you have questions about what your policy covers, Fertility LifeLines™ can help you verify what insurance benefits you may have. Call Fertility LifeLines™ at 1-866-LETS-TRY (1-866-538-7879) and a Fertility LifeLines™ benefits specialist can help you to verify your insurance.

Making sense of your policy

Read over both your medical coverage and your prescription coverage plans. Consider the following:

  • What is the definition of fertility in the contract?
  • What coverage is listed?
  • What procedures require preauthorization?
  • Are there restrictions on the type of healthcare provider that can perform fertility services?
  • What limits, if any, apply to your coverage (in terms of treatment cycles, procedures, months in therapy, etc.)?
  • Is there drug coverage?
  • Are infertility drugs covered under the pharmacy benefit or medical benefit?
  • Are there 30-day drug prescription limits for infertility drugs?

Unfortunately, fertility benefits aren't always clearly spelled out in policies. What's not written can be just as important as what is. In most policies, there's usually room for interpretation. If you'd like assistance verifying your benefits, call Fertility LifeLines™ at 1-866-LETS-TRY (1-866-538-7879).

We've been denied coverage. Now what?

If your claim has been denied, you may appeal. In fact, resubmissions are common. The key is to be prepared to address the issues that led to the denial. The more specific information you have, the better you'll be able to respond to your insurer's request. Learning how the medical industry codes treatments can also be helpful, since sometimes a denial can be attributed to a simple typo. A few digits can be the difference as to whether or not you're covered.

Being an advocate for your fertility coverage can get frustrating. At these times, it's important to remember your rights and goals. It can also be helpful to talk with your healthcare provider in advance about your coverage.

Become an advocate

If you'd like to help inform the community about the importance of fertility treatment issues, these sample letters can help you become an advocate for coverage. One is designed to support legislation that may be before your state legislator. The other two are written to help make employers more aware of the importance of adding a fertility benefit to their coverage — one you can customize to send to your employer yourself, and one that your healthcare provider can customize and forward on your behalf.

The letters can be downloaded and modified using Microsoft Word or any other text editing software. Once downloaded, insert information relevant to you wherever you (or your healthcare provider) see parentheses.

For more information

If you need assistance at any step of the way, feel free to call Fertility LifeLines™ at 1-866-LETS-TRY (1-866-538-7879). You may also wish to download a free booklet, Maximizing Your Insurance Coverage for Infertility.

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Gonal-f® Has Helped Many Couples.

Learn more about this fertility medication.

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Important Considerations:
Gonal-f® RFF Pen (follitropin alfa injection) is indicated for the induction of ovulation and pregnancy in the oligo-anovulatory infertile patient in whom the cause of infertility is functional and not due to primary ovarian failure. Gonal-f® RFF Pen is also indicated for the development of multiple follicles in the ovulatory patient participating in an Assisted Reproductive Technology (ART) program. Gonal-f® RFF Pen (follitropin alfa injection) should only be prescribed by physicians specializing in fertility or reproductive health. Gonal-f® is a potent gonadotropic substance capable of causing mild to severe adverse reactions, including Ovarian Hyperstimulation Syndrome (OHSS) in women with or without pulmonary or vascular complications, and multiple births. Gonal-f® is contraindicated in women who exhibit prior hypersensitivity to FSH preparations, primary gonadal failure, uncontrolled thyroid or adrenal dysfunction and pregnancy. Nursing women should not use Gonal-f®. Common side effects include headache, abdominal pain, enlarged abdomen, and injection site disorders. For complete product details, see full prescribing information.

Important Considerations:
Women: Gonal-f® (follitropin alfa for injection) is indicated for the induction of ovulation and pregnancy in the anovulatory infertile patient in whom the cause of infertility is functional and not due to primary ovarian failure. Gonal-f® is also indicated for the development of multiple follicles in the ovulatory patient participating in an Assisted Reproductive Technology (ART) program.
Men: Gonal-f® (follitropin alfa for injection) is indicated for the induction of spermatogenesis in men with primary and secondary hypogonadotropic hypogonadism in whom the cause of infertility is not due to primary testicular failure. Gonal-f® (follitropin alfa for injection) should only be prescribed by physicians who are thoroughly familiar with infertility problems and their management. Gonal-f® is a potent gonadotropic substance capable of causing Ovarian Hyperstimulation Syndrome (OHSS) in women with or without pulmonary or vascular complications. Gonal-f® is contraindicated in women and men who exhibit prior hypersensitivity to recombinant FSH preparations or one of their excipients, high levels of FSH indicating primary gonadal failure, uncontrolled thyroid or adrenal dysfunction, sex hormone dependent tumors of the reproductive tract and accessory organs, and an organic intracranial lesion such as a pituitary tumor; and in women who exhibit abnormal uterine bleeding of undetermined origin, ovarian cyst or enlargement of undetermined origin and pregnancy. Women who are pregnant or nursing should not use Gonal-f®. The most common side effects in patients using Gonal-f® include headache, ovarian cysts, nausea and upper respiratory infections in women and in men, acne, breast pain and growth, and fatigue. Injection site reactions were also reported. Reports of multiple births have been associated with Gonal-f® treatment. For complete product details, see the full prescribing information.

For complete product details, please read the Prescribing Information offered below.


© EMD Serono, Inc. CIM Last Update 2008-09-16
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