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.

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

If you don’t have fertility coverage, you may be eligible for self-pay patient savings on every cycle of Gonal-f® with the GO Direct to Savings Card. Learn more.

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.

We care about savings patients money. If you are unable to obtain fertility coverage, you may be eligible for self-pay patient savings on every cycle of Gonal-f® with the GO Direct to Savings Card. Learn more.

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.

To view the download, you need Adobe® Acrobat® Reader® installed. Don't have Adobe Acrobat Reader on your computer? Download it free, here.

Adobe Acrobat Reader is a registered trademark of Adobe Systems Incorporated.

Let Us Help You

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Gonal-f® Has Helped Many Couples

Learn more about this fertility medication.

FIND A FERTILITY SPECIALIST

Enter your Zip code to find a fertility treatment specialist or fertility clinic in your area:

FIND A UROLOGIST

The Society for the Study of Male Reproduction (SSMR) can help you locate a urologist in your area.

Locate a Urologist

Indication:
For women, Gonal-f® (follitropin alfa for injection), Gonal-f® RFF (follitropin alfa injection) and Gonal-f® RFF Pen (follitropin alfa injection) are indicated for 1) 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 and 2) for the development of multiple follicles in the ovulatory patient participating in an ART program.

Gonal-f® is also indicated to increase sperm production in men with a rare condition called hypogonadotropic hypogonadism.

Important Safety Information:
These products should only be prescribed by physicians specializing in fertility or reproductive health. Use of Gonal-f® or Gonal-f® RFF by women can result in multiple births. Patients should let their doctor know of any allergic reactions to recombinant FSH preparations or other product ingredients. Patients should also inform their doctor of a history of cancer of the sex organs or brain and uncontrolled thyroid or adrenal disease before starting or continuing treatment. Women with a history of abnormal bleeding from the uterus or vagina, swollen, enlarged, or painful ovaries should speak to their doctor before starting treatment. Gonal-f® and Gonal-f® RFF are potent gonadotropic substances capable of severe adverse reactions, including Ovarian Hyperstimulation Syndrome (OHSS) in women, which can result in hospitalization. Women should inform their doctor if they experience severe stomach pain, vomiting, bloating, or weight gain while taking Gonal-f® or Gonal-f RFF®. The most common side effects are headache, ovarian cysts, upset stomach, and sinus infections in women taking Gonal-f® or Gonal-f® RFF. The most common side effects in men taking Gonal-f® are skin acne, breast pain and growth, and tiredness. Needle injections may cause some discomfort.

For more information, refer to the prescribing and patient information offered below and talk to your doctor.

*RFF Revised Formulation Female


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