July 16th, 2006

I wanted to address the topic of insurance. First of all our insurance does not cover infertility treatments of any kind. We do have pretty good insurance though. Here’s how it works:

  • The first $1500 of covered medical expenses for the year is covered at 100%
  • The next $1800 has to be claimed so we can get the insurance company’s negotiated rates, but it is completely out of pocket.
  • We do not get credit toward the $1800 for expenses that would not be covered by the insurance company, although we may still save through the negotiated rates.
  • The rest is covered under various percentages.

We like this plan even though it requires quite a bit of planning before the year begins to figure out how you will stay within budget. We do contrubute to our flexible spending account (FSA) in the amount of about $1300 for the year. This means that if we had a $20,000 surgery we would spend the $1500, then the $1300 from FSA, which insurance views as out-of-pocket, then come up the $500 (1800-1300) on our own. That would leave about $16,900, which the insurance company would cover at probably between 80% and 90%.  Of course, none of this applies to our situation because infertility treatments are not covered.

Some states do require insurance companies to offer infertility treatments. Others require the insurance company to offer the coverage to every employer, who can decide to accept or deny it. For a listing of states and a summary what is covered by their law check out this page on Fertility LifeLines.

Our Progress & Expense page has brief descriptions of our charges so far.  Next to those descriptions you may notice in parenthesis the abbreviations CBI, PI and FSA for “Covered By Insurance”, “Partial Insurance” and “Flexible Spending Account”, respectively. This is to let you know exactly what our expenses are for those of you who want to know what to expect as you go through the process and also exactly where the donations are used since they are not needed for every visit.

Here’s a quick statistic for you: “Spending on IVF is up over 50% over the last five years to over 1 billion dollars last year.” U.S. News and World Report, Sept. 27th 2004, Article: “Making Babies”