Blue Cross Blue Shield IVF Coverage – Overview
Insurance of IVF is among the most frequently asked questions today. It might sound surprising but there good chances that your insurance policy offers coverage for certain types of infertility treatments or at least coverage for an initial consultation and testing.
If your insurance policy covers the initial visit, then the insurance company will cover the expense of the first visit to an IVF specialist.
Let’s take a closer look at how Blue Cross Blue Shield offers IVF coverage.
How does Blue Shield define Infertility?
According to BlueCross BlueShield directives, infertility is an inability to conceive a child within a 12 month period of unprotected sex for anyone under the age of 35 years. Infertility is also the term used when an individual over 35 years is unable to conceive even after a 6 month period of unprotected sex.
How helpful is Blue Shield with Infertility Treatment?
Initially, the insurance covers the diagnostic process. The tests help determine if either partner has inhibited fertility. Infertility may be caused due to female-centric factors, such as ovarian dysfunction, pelvic adhesions, prior tubal ligation or endometriosis. Similarly, infertility in men may be caused due to problems in the male reproductive system, including abnormal sperm production, transport or function and even a prior vasectomy. Infertility may also be caused by a combination of male and female-centric factors.
Does Blue Shield insurance offer cover for IVF Diagnosis and Treatment?
Yes, Blue Cross Blue Shield offers extensive insurance cover for infertility diagnosis and treatments.
Once the main cause of infertility is diagnosed, Blue Shield also covers the expense of treatment. Initially, Blue Shield offers coverage for undergoing basic infertility treatment. If this fails, then the insurance also covers the expense of advanced infertility treatments, which are included in the Assisted Reproductive Technologies (ART).
An ART is defined as any infertility treatment in which the sperms and eggs are both manipulated. Usually, ART procedures require removing eggs surgically from the ovaries, mixing them with the sperm in a laboratory and finally implanting them in the uterus. It is important to remember that Blue Shield infertility treatment coverage does not take care of procedures that involve only the sperm, such as in artificial insemination or for treatment where only medicines are used to increase egg production.
In essence, Blue Shield IVF coverage includes diagnosis and treatment for infertility when it has been determined medically essential and the criteria are met.
What types of Infertility Diagnostic Tests are covered under Blue Shield Insurance Policy?
Here’s a detailed list of everything relating to infertility that is covered by the Blue Shield insurance policy:
The policy initially requires an accurate diagnosis of the condition to provide effective treatment. Some of the diagnostic tests that help determine the need for infertility treatment under Blue Shield include:
- General medical evaluation, including CBC (complete blood count), LFT (liver function test), RPR (rapid plasma regain test), HIV (human immunodeficiency virus) and chlamydia and gonorrhea culture tests.
- Tests to rule out endocrine causes of infertility, such as thyroid-stimulating hormone (TSH), DHEA, blood sugar, total and fractionated testosterone, etc.
- Pelvic ultrasonography
- Hormonal anti-sperm antibodies
- Fasting insulin
- Serum chlamydia IgG
- Semen analysis tests with two samples at least 1 month apart
- Endocrine evaluation is detected
- Anti-sperm antibodies
- Post-ejaculatory urinalysis
- Urine and semen culture
- Scrotal ultrasonography
- Testicular biopsy
What are the types of Infertility Treatments covered by the Blue Shield Insurance policy?
Once diagnostic tests establish infertility, the company offers to cover the cost of infertility treatments using several different techniques. You can find additional information in the member’s benefit booklet regarding infertility treatment.
The Blue Shield IVF coverage bears expenses of basic infertility treatments, including:
- Infertility drugs – The specific infertility drugs covered under Blue Shield IVF policy are listed in the member’s benefit booklet.
- Dopamine agonists – Including cabergoline and bromocriptine
- Clomiphene citrate
- Gonadotropins – Includes human chorionic gonadotropin (hCG), choriogonadotropin alfa (a bio-synthetic chorionic gonadotropin derived from recombinant DNA), human menopausal gonadotropins (hMG), recombinant FHS, etc.
- Therapeutic operative procedures – For females, such as therapeutic operative laparoscopy, open surgical treatments, salpingo-ovariolysis, terminal salpingostomy, fimbrioplasty, uterotubal implantation, balloon tuboplasty, ovarian wedge resection, etc.
- Therapeutic operative procedures – For males, such as varicocelectomy, transurethral resection of the ejaculatory duct, orchiopexy, surgical correction of epididymal blockage for individuals with obstructive azoospermia (epididymectomy, epididymovasostomy, excision of epididymal cysts and tumors, etc.).
The Blue Shield IVF coverage also bears the expense of advanced infertility treatments for individuals, including:
- Artificial insemination for female infertility – Artificial insemination (AI) is considered medically necessary if the individual is diagnosed with tubal abnormalities, ovulatory disorders, immunological factors or cervical abnormalities.
- Artificial insemination for male infertility – AI for male infertility is considered medically necessary in case the individual needs comprehensive urological evaluation, semen analysis, low sperm count, anti-sperm antibodies, retrograde ejaculation, seminal fluid liquefaction defect, aspermia, etc.
- IVF (in vitro fertilization) – IVF is considered for individuals who require monitoring of ovulation stimulation, stimulation of ovulation, oocyte removal, embryo assessment and thawing of cryopreserved embryos. Additionally, this policy also covers the cost of medicines & drugs, lab tests, pathology procedures and radiology costs for treatment techniques including TESE, TESA, PESA, MESA, ICSI, etc.
To learn the complete benefits of Blue Cross Blue Shield for IVF coverage, it is strongly advised to check the member’s benefit booklet you received along with your insurance policy documents.
Blue Cross Blue Shield offers comprehensive coverage that includes the most basic and advanced diagnostic tests and infertility treatment procedures for men and women alike.