Just because two people share the same health insurance company, doesn’t mean they have the same coverage. Coverage rules and restrictions really depend on the plan that you or your employer have purchased. We recommend you carefully review your benefits and inquire about the specific details of your infertility coverage.

Benefits and Coverage

We make every attempt to verify infertility treatment coverage for our new patients. However, it can get complicated since most insurance companies have many different policies and varying degrees of coverage. To avoid the possibility of future problems it is a good idea for you to understand exactly what your specific insurance policy allows. We have outlined a few tips to help you along the way.

  1. Carefully review your health insurance policy.
  2. Ask your insurance company which infertility treatments they do and do not cover.
  3. Take notes when contacting your insurance company, including the name of the person you spoke with.
  4. Check details regarding which procedures and drugs are covered.
  5. Ask if there is an age restriction or maximum lifetime benefit.
  6. Find out if you need a referral, and, if so, how you get one.
  7. Find out if you need to use a particular clinic.

Ask if they cover procedures used to diagnose infertility. Many insurance companies do. Blood tests, semen analysis and initial exams and consultations may be covered.

If your doctor determines the cause of your infertility, your health insurance company may cover procedures used to correct it. For example, your general medical plan may cover the cost of surgery to treat pelvic pain or endometriosis, even if it contributes to your infertility. However, if UNC does not contract with your particular provider, the lack of infertility coverage may require you to pay for services out of pocket.

Our Insurance FAQ covers the questions we are most frequently asked by patients regarding insurance. If you have further questions about your insurance benefits coverage, or other financial concerns, please do not hesitate to contact one of our financial counselors at 919-908-0003.

Out-of-Network Coverage

Several plans do allow for “out-of-network” coverage. So, even if UNC Fertility is not a contracted provider for your insurance, you may have some level of coverage. If that is the case for you, please be aware that we do not bill your health insurance provider directly.

We will provide you with an insurance form detailing all necessary information required for you to be reimbursed. The exact amount of reimbursement depends on many factors and varies widely. It is a complex topic with many variables, we recommend you work with your financial counselor to determine your level of coverage and help you evaluate your options.

We currently accept Blue Cross Blue Shield, United Health, Aetna, Cigna and most other plans.

Get details on our billing and payment processes.