Tree of Life Center / Kaiser Permanente Fertility Coverage

Kaiser Permanente Fertility Coverage

A small group of Kaiser Permanente members may have fertility insurance coverage. As previously discussed, fertility benefits may or may not be part of your insurance plan. Fertility coverage is generally not linked to a specific insurance company, but to the terms that your employer has negotiated with your insurance company. Kaiser Permanente insurance will cover either 50% or 100% of fertility diagnosis and treatment - but only if fertility coverage is part of your plan. For example, LAUSD teachers, LAPD employees usually have fertility benefits.

Patients who have Kaiser as part of MediCal or as an individually purchased plan will have no fertility benefits included.

It is essential to understand that only patients who do have fertility coverage are allowed to see a fertility specialist within Kaiser Permanente. Members without fertility coverage can not book an appointment with a Kaiser fertility doctor. Kaiser Permanente instructs such members to see a fertility specialist outside of Kaiser and return once pregnant.

There are a few exceptions. They include members experiencing two or more miscarriages. Those patients have access to a fertility specialist for that is limited to two encounters. Another unique situation is: patients diagnosed with cancer who need chemotherapy. Such patients will be able to see a fertility specialist within the Kaiser network for a fertility preservation consultation. Patients with premature menopause might also qualify as an exception. Since infertility is not the primary diagnosis, these patient groups are allowed to see a Kaiser reproductive endocrinologist without having fertility treatment benefits.

Our reproductive specialist, Dr. Jovanovic, currently sees fertility patients at Kaiser Woodland Hills once a week. If you are a Kaiser member, you can call the Kaiser Woodland Hills fertility clinic at (818) 719-2315 to schedule a consultation.

Kaiser Permanente's fertility benefits include diagnosis and evaluation. Such coverage encompasses an initial consultation with a fertility specialist by either phone, video, or in-person appointment. A transvaginal ultrasound to evaluate the ovaries and uterus is an integral part of the initial visit. The purpose is to assess the ovarian reserve and the uterine cavity. Both males and females must undergo sexually transmitted disease testing, including HIV, hepatitis, syphilis, and HTLV. Almost every female will be required to undergo hysterosalpingography (HSG) to evaluate the tubal status. Following the initial consultation and after completing a panel of tests, the patient will schedule a follow-up visit to determine the treatment plan. Your treatment plan will be custom-tailored, considering the results of male and female testing.

There are no requirements to have a partner, be married - or even be in a relationship. Single women and same-sex couples can take advantage of the Kaiser fertility program. When presenting as a couple, the majority of members will share the same health plan; hence both partners will have Kaiser Fertility benefits. However, in some situations, a couple may have different health plans. Regardless, both partners can present for evaluation to the reproductive endocrinologist.

Kaiser can also help same-sex female couples who seek donor sperm inseminations. Kaiser does not provide donor sperm or operate a cryo-storage facility; thus, patients need to purchase donor sperm on their own. Los Angeles based patients prefer to buy sperm locally - e.g., at Fairfax or California Cryobank and pickup-up the sperm themselves. This way, expensive cryo-shipping can be avoided entirely.

Fertility treatments at Kaiser Permanente are limited to ovulation induction and intrauterine inseminations. Such procedures can provide a substantial benefit for patients who have irregular cycles and do not ovulate regularly. Typically these patients have Polycystic Ovarian Syndrome and can be treated with Clomid.

Kaiser Permanente will also pay for injectable gonadotropins. Such fertility medication is more potent and induces superovulation - and very expensive! During a superovulation cycle, the ovary will mature and ovulate multiple eggs. The preferred formulary medication at a Kaiser Permanente pharmacy is Menopur. Superovulation is, in most cases, combined with intrauterine insemination (COH/IUI). The injectable gonadotropin's in combination with inseminations, provide a substantial increase in pregnancy success rate.

The only treatment with a higher success rate than COH/IUI is in vitro fertilization (IVF). In vitro fertilization usually is not a covered benefit, and Kaiser Permanente in Southern California does not operate any embryology laboratory necessary for in vitro fertilization. In a rare circumstance, when a plan member does have IVF coverage, Kaiser Permanente will contract and pay an outside fertility clinic to perform in-vitro fertilization.

Fertility treatments are limited to patients under 43 years of age, and there is a limit of six fertility treatment cycles. After a successful birth, the patient restarts the cycle count and can pursue additional fertility treatments. Due to the high number of patients, a patient will typically see more than one medical provider per treatment cycle. Intrauterine inseminations are usually performed during the week and on Saturdays.

Kaiser Permanente's fertility benefits rarely cover in vitro fertilization and generally do not cover InVoCell, Egg Donation, or Surrogacy. These are considered advanced fertility treatments, and they are beyond the scope of essential services provided by Kaiser. Patients with blocked fallopian tubes or meager sperm count will need advanced fertility treatments. Such patients can utilize their Kaiser Permanente insurance to perform some of the bloodwork and a semen analysis before fertility treatment begins.

Once advanced treatment outside of Kaiser begins, the patients are not allowed to combine Kaiser medications or laboratory services because advanced fertility treatments are not part of their benefits package. Patients can, however, utilize any leftover medication from their previous COH/IUI cycles previously covered at Kaiser Permanente.

Once the member becomes pregnant, the utilization of Kaiser Permanente services can resume. Such members may utilize progesterone supplementation in early pregnancy and early obstetrical visits after a successful IVF pregnancy.

Egg Freezing for medical indications is a covered Kaiser Permanente benefit since 2020. If the patient is diagnosed with cancer and will undergo cytotoxic treatments, egg freezing is a mandatory benefit. Social egg freezing with no medical indication is not covered.

Another exception our employees of Kaiser Permanente will have additional fertility coverage purchased through the human resources department. Employees of Kaiser can utilize the health plan services for in vitro fertilization. Physician partners have unlimited fertility benefits, including in vitro fertilization administered by Meritain insurance.

Dr. Jovanovic has extensive experience in navigating the Kaiser Permanente health services benefits given his association with Kaiser Woodland Hills.

Patients who have 100% fertility coverage will only pay a small co-pay for the appointments and medications. The situation becomes more complicated for patients with 50% fertility coverage. Those patients need to pay half of the visit costs and medication costs. Kaiser does not provide any fertility medication discount program, unlike other fertility pharmacies. While having 50% coverage is better than no coverage, patients might qualify for up to 75% medication discount outside of Kaiser. Therefore, a thorough cost-benefit analysis should occur before moving on to fertility treatments with 50% coverage.

Here is an example of the Kaiser costs that a 50% covered patient will incur during the Woodland Hills fertility clinic visits. Please contact your clinic to verify the treatment costs.

Expected costs for the 50% self-pay fee for patients who do not have complete coverage

  • Initial visit with comprehensive consultation up to 60 minutes and transvaginal ultrasound $270
  • Intrauterine insemination $121
  • Transvaginal ultrasound $60
  • Estradiol $35
  • A return visit $64.50
  • Semen Analysis $15

Tree of life Center will support any Kaiser Permanente patients to utilize their fertility insurance and provide additional services on top of your included benefits. We are very experienced in obtaining medical necessity letters and finding the best solution for your situation. Please contact us if you have any other questions.