Insurance Information

Medical Insurance for Infertility

Many health insurance policies provide limited coverage for infertility and some require special authorization for care. The covered benefits and excluded services are specific to the policy obtained by your employer or by you as an individual and may differ from other plans offered by the same insurance company. Your policy may exclude infertility coverage completely, may only provide coverage for diagnostic testing or may have more complete coverage for both testing and certain types of treatment. If you have obtained an individual policy for yourself or your family directly from an insurance company and not through an employer, you may be subject to a pre-existing clause that can delay coverage for a certain period of time defined by your policy. We will try to advise you on insurance issues and obtain pre-certification when necessary once we obtain your specific policy information.

Maryland Mandate for IVF Coverage

Maryland requires that insurers cover in vitro fertilization if a married couple meets one of five criteria (infertility for two years or more; absent or damaged fallopian tubes; endometriosis; male factor; DES exposure). Additionally, many insurance companies require that you be married. Finally, the law does not apply if your company is a small group of 50 or fewer employees or if your company is self-insured. Additionally, the insurance must generally be written in Maryland. While several other states also have mandated coverage for IVF, there is no such requirement in the District of Columbia or Virginia.

Participating Insurance Plans

  • Adventist HealthNet (Shady Grove Adventist Hospital/Washington Adventist Hospital)
  • Aetna (Aexcel Provider)
- Patients must call 800-575-5999 to register with the Aetna Infertility Program and obtain an authorization
  number for the initial infertility consultation unless you are enrolled in a PPO plan
  • Beech Street
  • BlueCross/Blue Shield (all plans nationwide)
  • CareFirst BlueChoice HMO
- Primary care physician referrals are not required
  • CareFirst BlueCross/BlueShield of Maryland (Preferred Provider)
  • CareFirst BlueCross/BlueShield of the National Capital Area (Select Preferred Provider)
  • ChoiceCare
  • CCN (Community Care Network; First Health; Coventry National Network)
  • Coventry Health Care (First Health; Mail Handlers)
  • Devon Health (NCPPO; Unicare)
  • First Health (CCN; Coventry National Network)
  • Great West Healthcare
  • Johns Hopkins EHP
  • Kaiser Permanente Select
- Kaiser Select members must obtain authorization from Kaiser for an infertility consultation
- Kaiser Signature members must be seen in Kaiser centers unless authorized for an outside consultation
  • Mail Handlers (Coventry National Network)
  • MAMSI Life & Health PPO
  • M.D.IPA HMO (UnitedHealthcare)
- Primary care physician referrals are not required
- The primary care physician must obtain an authorization number from M.D.IPA for an infertility
  • Medicare
  • MultiPlan (PHCS)
  • National Association of Preferred Providers
  • NCAS (National Claims Administrative Services)
  • NCPPO (National Capital PPO)(Devon Health; Unicare)
  • Optimum Choice HMO (UnitedHealthcare)
- Primary care physician referrals are not required
- The primary care physician must obtain an authorization number from Optimum Choice for an infertility
  • PHCS (Private Healthcare Systems PPO; Multiplan)
  • Tricare (Champus)
- Tricare Prime (HMO) members require a referral from their primary care manager
- Tricare Standard members do not require a referral
  • Unicare (NCPPO; Devon Health)
  • UnitedHealthcare

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