Fertility Financing Advice

To Gain Benefits Through Your Employer

A guiding principle to successful communication is to approach your employer with the belief that your infertility treatment is not only a way to help yourself, but also a way to help your employer and your coworkers.

You are advocating a win-win scenario, and that is not something to feel selfish about. In your appeal, it helps to include your own personal, heartwarming story, and to also show a financial benefit to the organization.

Communicate with your employer's Human Resource Department. Share an example of IVF coverage from another company. Educate everyone you talk with about the benefits and affordability of offering IVF coverage.

One way to demonstrate the affordability of IVF coverage is to explain that research shows patients with insurance coverage transfer fewer embryos, thus reducing costs associated with high-risk pregnancies, premature labor, and NICU expenses. Let them know that providing IVF coverage also leads to higher employee morale and loyalty.

Advocate for yourself: If your employer is unwilling to provide coverage, consider changing employers. Or take a leave of absence to work for an organization that does offer IVF benefits. Double check to make sure you meet the medical guidelines to qualify for your new employer's insurance benefits.

To Gain Benefits Through Your Insurer

Communicate with your insurer. If you submit a claim that is denied, file an internal appeal. Make certain the reason for denial is stated and note the date by which your appeal must be received. Ask your insurer for information on ‘internal appeals’ (the process of appealing a decision on a denied prior authorization).

Let your insurer know that although your policy does not offer IVF benefits, you would like them to make an exception.

The term ‘predetermination of benefits’ describes the process of convincing your insurer to make an exception because it is in everyone's best interest. Make sure to take notes during your conversation and ask that all assurances from your insurer be provided in writing.

Collect and send your appeal to your insurer. Send all documentation at the same time. Relevant documents to send include related medical history, a letter of medical necessity, and research supporting your case. Make sure to mail in a manner that requires a signature.

If your internal appeal is denied, there are still more options. You can file an external appeal. Healthcare.gov offers more information about external appeals. If the external appeal is determined in your favor, your insurance company denial is then overturned. If you believe your insurance company has wrongfully denied coverage, another option is to file a complaint with the Massachusetts Department of Labor.  

Add low or no interest credit cards or loans to options for funding your treatment. If you find yourself in a situation where your insurer should provide benefits, but refuses to do so, you still have options. 

To Fund Yourself

If the need arises, it may be possible to fundraise on your own as a way to offset the cost of treatment. If you choose to go this route, options include:

Utilizing a Flexible Spending Account, which consists of pre-tax dollars designated to cover medical expenses, through your employer
Money you've spent on fertility treatments above 10% of your income incurs IRS healthcare deductions, which are available to you crowd-funding through online platforms