About 10% of American couples experience infertility. The average cost of an IVF cycle in the US is $12,400. Ohio IVF costs mirror the national average. At Ohio Reproductive Medicine we understand that dealing with the costs of infertility care can be perplexing.
Fortunately, Ohio residents may find some relief in the new Ohio law that became effective on October 12, 2016.
This new law mandates health insurance coverage for basic health care services, when medically necessary. By definition, basic health care services include preventive health services, which are defined specifically to include voluntary family planning services, and infertility services. Infertility services are defined as “diagnostic and exploratory procedures to correct medically diagnosed diseases of the reproductive organs, including but not limited to:
- Clogged or collapsed fallopian tubes, and
- Testicular failure.”
Thus, Ohio residents are entitled to health insurance coverage for the conditions listed above. That means that procedures used to diagnose infertility may be covered. Your initial consultation may also be covered. Procedures to correct medically diagnosed diseases of the reproductive system may be covered. Many procedures fall into a gray zone, including IVF, which leaves much to interpretation and denial of claims. Our staff can provide codes for your treatment to help you determine your exact benefits.
Note also that employers who self-insure and large companies are exempt from the requirements of this law.
Insurance companies have specific guidelines. They are obligated to provide you with this information but you must ask. Ohio Reproductive Medicine suggests that patients call their health insurance company and ask the following questions:
- Do I have coverage for fertility treatment?
- Do I need a referral from my primary care doctor or prior authorization before contacting Ohio Reproductive Medicine?
- Is there a lifetime maximum for fertility treatment?
If yes, what is the amount?
Does this amount include fertility medications?
- Am I covered for fertility drugs?
If I am covered, do I need prior authorization? If so, how do I get prior authorization?
Is there a lifetime maximum for fertility drugs?
Do I have to use only pharmacies that participate with my insurance plan?
- Does my plan include coverage for artificial insemination (IUI)?
If IUI is a covered service, do I need prior authorization for this procedure?
- Does my plan include coverage for other assisted reproductive technologies like IVF?
If IVF is a covered service, do I need prior authorization for this procedure?
Ohio state and federal tax regulations can be a source of assistance. Flexible Spending Accounts and Health Savings Accounts allow patients to pay out of pocket medical expenses with pre-tax dollars.
But, medical expenses reimbursed from HSAs and FSAs are not included in medical expenses on your taxes, because these sums are tax-free.
Itemized Deductions on state and federal income taxes
The IRS allows medical expenses that exceed 10% of adjusted gross income to be deducted from your tax liability when you itemize deductions on Schedule C of your IRS 1040 tax return. Talk to your accountant.
Leave from your job for infertility treatments may be covered under the Family and Medical Leave Act (FMLA), the Americans with Disabilities Act (ADA) or the Pregnancy Disabilities Act (PDA). Talk to your Human Resource department to determine your eligibility for these programs.
Ohio Short Term Disability benefits may help when one parent needs to stop working.
You may qualify for prescription drug discounts for fertility medications. Walgreens offers free access to fertility drugs for cancer patients seeking fertility preservation. Military families may be eligible for discounts as well. We can provide you with information on these programs at your first visit.
Talk to your employer, you may be able to convince them to cover the care you need.
Grants for IVF:
- The Cade Foundation’s Family Building Grant (infertility treatment or domestic adoption)
- Baby Quest Foundation (infertility treatments)
- Pay it Forward Fertility Foundation- payitforwardfertility.org. offers funds toward fertility treatments including IVF, IVF using donor eggs and embryo adoption.
- Parenthood for Me Grants (infertility treatment or adoption)
- The Samfund.org (Only for cancer survivors offers $1,000. For egg, sperm or embryo storage, maximum is $1,000. For IUI, IVF, Gestational carrier and adoption maximum is $4,000
These are some suggestions for discounts that may be available to you. Patients need to do their homework. This will allow you to be prepared for the costs of your treatment. You are ultimately responsible for the costs of your treatment. At Ohio Reproductive Medicine, in Columbus, Ohio we are here to support you in your quest for parenthood.