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There’s no ifs ands or buts about it. Coverage for fertility hormone testing is complicated––and it doesn’t cost the same for everyone. Coverage depends on your insurance provider, your employer, the state you live in, and can even depend on your age and whether or not you’ve been trying to have kids.
Insurance and fertility testing
The majority of insurance plans do not cover proactive fertility testing. Generally, couples have to prove that they’ve been trying to conceive for up to a year in order to get coverage. Only 16 states cover fertility testing for women that have been diagnosed with infertility (you have to prove to your doctor and your insurance company that you’ve been trying for 6 to 12 months, depending on which state you’re in and your age). This is problematic because it prevents women from being proactive and doesn’t apply to same sex couples.
The lack of insurance coverage is precisely what sparked our Co-founder Afton to start Modern Fertility. She sought to get her fertility hormones tested proactively, and it took months to get the tests and cost $1,500 out-of-pocket, but the results were eye-opening.
Last on the insurance front, it’s worth noting that with more women on high deductible plans, even if infertility testing is covered, they will still have to pay $800 to $1,500 out of pocket for the lab tests if they have already hit their deductible. It’s also good to know that women are billed separately for the follow-up consult to discuss their results with their physician––the consult can be $500+ alone and also typically is not covered by insurance.
On our website we state that fertility hormone testing can cost anywhere from $800 to $1,500. To research that number we called 8 leading fertility clinics in the Bay Area and asked their billing departments what it would cost out of pocket to test the same 8 hormone panel that Modern Fertility measures.
The first thing we learned is that not every clinic offers a panel as comprehensive as Modern Fertility:
- One clinic only measured FSH and LH for $485. AMH testing was not available, and the consult cost $525.
- One clinic charged $798 to measure E2, FSH, LH, PRL, fT4, TSH, and T. AMH testing was not available, and the consult would run $200 to $500.
- One clinic charged $827 for AMH, FSH, E2, LH, and TSH. The consult cost $1,050 on top of that.
- One clinic charged $235 for AMH, FSH, E2, and LH. The consult cost $340.
Of the 4 clinics that do test all 8 of our hormones:
- Four clinics reported that the full 8-hormone panel would cost approx. $800 (roughly $100 per hormone). They all send their patients to Quest or LabCorp for testing.
The highest end of our spectrum – $1,500 – comes from our founder Afton’s own personal fertility experience. When she had her levels tested, she received a bill from her insurance provider for $1,500.
Bottom line: traditional fertility testing is expensive, and most women can’t get this testing covered by their insurance. We dig deep into insurance coverage for testing and treatments here.