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Understanding Insurance Benefits & Fertility Treatments in Missouri


Before seeking and undergoing fertility treatment, many couples and individuals list financial considerations as one of the more stressful and daunting concerns of treatment. The doctors at SIRM St. Louis, Missouri are compassionate towards the additional stress financial planning can have on the journey to parenthood. We’re here with you and for you. Our financial counselors are experts in maximizing existing coverage and exploring cost-saving options. Our expert team has outlined tips to help you learn more about your specific insurance benefits as they relate to your personalized treatment plan, so make sure to consult our insurance information page for additional details.

Unfortunately, not all insurance policies provide coverage as it relates to reproductive health services like IVF or IUI treatment in Missouri. A medical necessity such as infertility treatment is not the same as a medical benefit.  A medical necessity is something that your doctor has decided is necessary in order to reach a certain outcome, whereas a medical benefit is something that your insurance plan has agreed to cover.

Every insurance policy is different, and it is important to thoroughly understand your plan, paying attention to covered benefits, exclusions, and restrictions as they relate to reproductive health services, infertility diagnosis, and treatment. The first step is to request a current covered benefits package or a Summary Plan Description (SPD) from your insurance company.  This will have everything in black and white about what is covered for you and your dependents, what services are included and will require a co-payment, the rules for pre-existing conditions, and the circumstance under which your employer can change or terminate a health benefits plan.

Some insurance policies offer benefits that may cover initial appointments and procedures that diagnose infertility. Ask your benefits provider if your coverage extends to fertility diagnostic procedures. For example, a blood test, semen analysis, or initial exams and consultations could possibly be covered. If you or your partner are diagnosed with a specific condition contributing to infertility such as endometriosis and need surgery, your general medical plan may cover the surgery even though it contributes to infertility.

Once you’ve researched your benefits plan, reviewed the coverage tips provided by our SIRM St. Louis Fertility experts and consulted with your local fertility doctor to determine your specific treatment protocol you will have a full view of your exact financial responsibilities.

The team at SIRM St. Louis is passionate about helping you create the family of your dreams. It is our sincere hope that if full insurance coverage is not possible for your fertility treatments, that through financial assistance and financial planning we can work together to help you fulfill your goals and grow your family.