ORM Statement: IVF + Roe v. Wade
Affording Care

Affording Care

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:

  • Endometriosis
  • Clogged or collapsed fallopian tubes
  • 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?