Does Blue Cross & Blue Shield of Texas Cover Infertility?

Does Blue Cross & Blue Shield of Texas Cover Infertility?
••• Image by, courtesy of Raphael Goetter

Are you struggling with infertility? You are not alone. On average, about ​nine percent​ of men and ​11 percent​ of women struggle with fertility problems. Further, 12 to 15 percent​ of couples will struggle to conceive. So, this is a serious issue and one that needs addressing.

Solving fertility issues involves several steps. These include doing tests such as hysterosalpingography (HSG) and undergoing treatment. And those things can be pricey, which is why it is critical that your insurance company covers them. In Texas, that is where the BCBS fertility coverage comes in.

Texas Infertility Insurance Coverage: The Basics

Texas happens to be one of those states that mandate limited infertility coverage from insurance companies provided specified conditions have been met. For example, you must have dealt with infertility for at least ​five years​. In addition, if you opt for in vitro fertilization (IVF) treatments, the sperms must belong to your spouse.

Texas’ laws, written in 1987 and 2003, also require health insurers to provide coverage for any outpatient services that arise from IVF procedures. However, employers are not obligated to pay for the treatment. And neither do you have to buy it when getting insurance coverage. Also, cost-sharing plans, especially religious ones, are free from those mandates; so are self-insured employers.

Luckily, Blue Cross Blue Shield can help you cater to some of the infertility treatment costs because it offers some infertility insurance coverage within some of its plans.

Getting the HSG Tests Done

Hysterosalpingography (HSG) refers to the use of x-rays to investigate the uterus and fallopian tubes. The test’s goal is to determine whether the fallopian tubes are open or if the uterus is shaped normally.

While experts can do this test within the outpatient radiology institution, it is necessary to help determine the causes of infertility. And it will guide your doctors in deciding on the best infertility treatment. So, it qualifies for infertility coverage.

Unfortunately, HSG is not cheap. Without insurance, it will cost you anywhere from ​$500 to $3,000​.

But if you want to lower the HSG test cost, Blue Cross Blue Shield of Texas covers fertility history and physical examination. Therefore, you could obtain coverage for that test if you worry about having fertility problems in the future.

Getting IVF Treatments Done

IVF is a popular method for treating infertility. And since Texas mandates most health insurers to cover it, the Blue Cross Blue Shield IVF coverage within various plans is worth considering.

Typically, it costs anywhere from ​$10,000 to $15,000​ if you pay for IVF out of pocket. And that is for a single cycle and excluding fertility medication, which costs an additional ​$1,500 to $3,000​ per cycle. And for every extra cycle, expect to pay another ​$7,000​. It’s safe to say that infertility treatments are unaffordable for most people.

Thankfully, you can lower the IVF cost with insurance. Blue Cross Blue Shield offers IVF coverage in Texas for couples struggling to conceive. And depending on the plan you choose, the coverage you obtain could cater for three to eight IVF cycles.

Blue Cross Blue Shield Infertility Insurance Costs

On average, you may pay premiums of ​$400 to $1,000 a month​ with deductibles of ​$0 to $7,000​ or more. And the maximum out of pocket will be about ​$8,000​. Everything depends on the state you reside in.

In Texas, you typically have the choice of three plans with multiple packages: bronze, silver and gold.

Bronze plans have individual deductibles ranging from ​$6,000 to $8,700​ and maximum out of pocket of ​$7,000 to $8,700​, while silver plans set individual deductibles of ​$0 to $1,250​ and out-of-pocket maximum limits of ​$8,700​. On the other hand, gold plans have individual deductibles of ​$0 to $1,500​ and out-of-pocket maximums of ​$5000 to $8,700​.

Each plan determines what you pay for tests like x-rays or when you see a specialist, such as an infertility expert. But you will need to talk to a sales representative to obtain the final premium amount you will need to pay because you first have to meet specified conditions to qualify for infertility coverage.

The reality is that when your insurance plan also covers infertility, it may end up being more expensive than normal, and you may have higher-than-average co-pays. However, no matter which way you look at them, they will still cost less than what you would pay if you paid for the entire IVF treatment out of pocket.