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A new generation of women is more self-aware and proactive about their fertility health than ever before. With advancements in reproductive technology, more individuals and couples are exploring options like in vitro fertilization (IVF) to grow their families. However, even with this increased awareness, barriers still exist when it comes to making critical decisions. According to the Centers for Disease Control and Prevention (CDC), approximately 12% of women aged 15-44 have used infertility services as of 2022*. While the growing demand has prompted many insurance companies to include fertility treatments in their coverage plans, understanding whether a plan covers fertility or infertility benefits isn't always straightforward. That’s where Sheer Health steps in—to help you navigate these complexities and ensure you’re fully informed about your potential costs and coverage.
Recognizing the emotional and financial challenges of infertility, many people on their family-building journey are turning to Sheer Health to better understand what their healthcare plan covers. In addition, organizations like RESOLVE, the National Infertility Association, offer valuable resources to those navigating these challenges. If you want to see if there are laws in your state that provide infertility coverage you can look here: State Legislation Map.
Fertility benefits and infertility benefits are related but different. Fertility benefits typically cover treatments and services aimed at enhancing fertility, while infertility benefits address medical interventions for diagnosed infertility issues. The need for affordable fertility treatment options has increased as more people seek these services. Many individuals and couples want to start families but face financial barriers to accessing the necessary medical support. Even with insurance, the copay for treatments like IVF can be significant, often ranging from a few hundred to several thousand dollars. Educating yourself before choosing a fertility provider is crucial.
The fertility journey is challenging enough with doctor visits, injections, and emotional stress. You shouldn't also have to worry about complicated insurance terms. The number of unfamiliar terms you’ll encounter when deciding whether you can afford the cost of fertility care under your insurance plan can feel overwhelming. Here are some terms that will come up most often as you navigate fertility care:
Take some time to think about what you want from a fertility provider. Depending on your location, you may have multiple options. Importantly, the state you live in will determine your access to fertility coverage. Some states have laws that mandate insurance companies to cover certain fertility treatments, while others do not. Resources like the American Society for Reproductive Medicine and RESOLVE, the National Infertility Association, provide valuable information on state-specific legislation affecting fertility coverage. You can use RESOLVE's State Legislation Map to find out what's happening in your state.
Once you’ve created a Sheer Health account and connected your health insurance, Sheer will help you better understand your health insurance benefits and coverage. Instead of spending hours deciphering complex insurance terms or waiting on hold for hours for your insurance company to confuse you, Sheer provides clear, personalized information about what your plan covers regarding fertility treatments. It simplifies the process by showing you which treatments are covered, what costs you might expect, and how to maximize your benefits. This way, you can focus more on your fertility journey and less on navigating insurance complexities.
If you’re already seeing a fertility specialist that you pay for out-of-pocket, Sheer Health will not only determine whether you’re being accurately billed but also ensure that your insurance benefits are correctly applied. Sheer conducts a detailed claims review to ensure that your claims are being accurately processed. They actively monitor your claims, working directly with your provider and insurance company to resolve any billing or claims discrepancies, so you have nothing to worry about.
Unexpected costs can add up quickly with out-of-network providers operating from in-network hospitals or treatment facilities. Depending on your benefits usages, Sheer can provide insights into how you can maximize your coverage and minimize out-of-pocket expenses.
Depending on your health plan, some companies provide reimbursement for a range of services, including IVF, medical management, and diagnostic services. Sheer will confirm ALL coverage for you. Insurance companies can be sneaky, and if your plan says fertility treatments are covered, that doesn’t mean all services are included. Sheer can tell you how much actual “coverage” you have because it can vary considerably.
If your health plan has a high deductible and doesn’t cover your preferred fertility provider, consider using a Health Savings Account (HSA) or Flexible Spending Account (FSA) to pay for your fertility treatments. Here’s what you need to know.
Before leveraging these accounts, Sheer Health's billing review can help ensure that all your costs are accurate. By thoroughly examining your bills and verifying that charges align with your insurance benefits and coverage, Sheer Health ensures you're not overpaying. This means you can make the most of your HSA or FSA funds, using them effectively for your fertility journey.
Embarking on a fertility journey is both an emotional and physical rollercoaster. Sheer Health is there every step of the way, taking care of the financial and insurance stress so you can focus on making the decisions that best suit you. We're committed to easing your burden, providing the support you need to confidently move forward on your path to parenthood.
