IVF Insurance Coverage Denied: Not Enough Suffering

In-vitro fertilization (IVF) has existed for nearly 50 years, providing people struggling with infertility the opportunity to grow their families through assisted reproductive technology (ART). But there’s a dark side to this life-changing medical breakthrough: Insurance coverage denials. 

Anyone who has navigated the bureaucratic nightmare of IVF insurance coverage very likely knows that it’s a marathon, not a sprint. Over the past decade, numerous articles have appeared on the topic, first highlighting the limited insurance coverage (The New York Times, 2014) available, then on the growing movement to “expand insurance coverage for infertility treatment in the United States” (CNN, 2018). Now, in 2025, several states boast infertility insurance laws, with some requiring IVF insurance coverage. (You can check the details of your state’s coverage options over on Resolve’s website.) But even if your state requires IVF insurance coverage, according to a 2023 article in the Associated Press, those requirements don’t apply to individual insurance plans or coverage sold through small employers. 

“People tell us that their biggest barrier to family building is lack of insurance coverage,” Resolve CEO Barbara Collura told the AP at the time, citing that some insurance carriers don’t view treatments like IVF as “medically necessary.”

The truth is, prospective parents are still having their claims denied, regardless of their physicians’ insistence that IVF is a medical necessity in their case. 

Meela’s story

Meela Imperato is the Head of Marketing at Cofertility, a company that provides the unique opportunity for women to freeze and donate their eggs to intended parents trying to conceive. Like many who seek out Cofertility, Imperato had her own TTC challenges, including getting coverage for IVF treatments, which can cost tens of thousands of dollars. 

After experiencing three miscarriages, all due to genetic abnormalities, Imperato made an appointment “with one of the best reproductive endocrinologists in New York City” to try to get some answers. But the only answer the RE could give her was that she had “really, really bad luck.” Every test came back normal, leaving her with the dreaded “unexplained infertility” diagnosis. “In some ways, that was almost worse than having an answer,” says Imperato. “No underlying condition to fix, no treatment plan to follow — just a cruel game of odds.”

With no straightforward directive, Imperato had two options: TTC naturally and risk yet another miscarriage, or explore IVF. 

“My heart, my body, and my mind knew — I couldn’t go through [trying naturally] again. I didn’t even recognize myself anymore. I was riddled with anxiety, convinced that in every aspect of my life, the odds didn’t apply to me anymore. I wasn’t the rule — I was the exception.” 

Imperato decided to proceed with IVF, only to be met with yet another unforeseen hurdle: “For three years [our insurance] had covered our D&Cs, our testing, panic attacks, medications, but the second IVF became the recommended route, everything changed.”

Three attempts at IVF coverage through Imperato’s insurance were all denied. Her doctors (“the best team of reproductive endocrinologists at the top-rated clinic in New York”) sent multiple, evidence-backed appeals, only for Imperato to be told every time that she didn’t meet the criteria for coverage. 

It wasn’t until Imperato called her insurance company herself, begging for an explanation, that she got some semblance of an answer: “I remember sobbing, unloading every ounce of my trauma onto one particular woman who answered the phone that day with a sweet Southern accent. She seemed kind. She sympathized. But there was nothing she could do.”

The insurance company didn’t care that Imperato and her husband had been trying to get pregnant for more than three years, or that they had suffered three miscarriages, or that they had a top-tier Manhattan RE in their corner. 

“I’m sorry, sweetheart, but three miscarriages aren’t enough,” the insurance company employee told Imperato. “You need to have more. There’s a minimum.”

Yes, you read that correctly. An insurance company refused to pay for someone’s IVF until she endured more loss, more pain, and more heartbreak.

“According to insurance, I hadn’t suffered enough,” says Imperato.

Although her doctor offered to appeal on her behalf again, Imperato and her husband decided that waiting to grow their family was no longer an option. “We were getting older,” she says. “It was wearing on our bodies, our minds. I was losing the will to keep going.”

Imperato and her husband ultimately paid out of pocket for IVF (read: thousands of dollars), which led to the birth of “our incredible son, Ari.” But Imperato is aware that not everyone can afford to pay directly for IVF.

“Access depends on privilege, not need,” she says. “Hope comes with a price tag. And the burden — emotional, physical, and financial — falls hardest on those who can least afford it.”

How to fight back

Until reproductive access becomes need- and not privilege-based, the best way to avoid any potential blindsiding from your insurance company is by getting ahead of your claims early on.  

Since every coverage plan is different, and the laws in every state are different, you’ll want to call your insurance provider before you even start with IVF, and ask the following questions:

1. Does my insurance cover in vitro fertilization? 
2. If my insurance does cover IVF, what is the necessary criteria for coverage?
3. How much of the IVF treatments does my plan cover, and how much will be my responsibility? (100%? 50%?)
4. Does my insurance cover just the IVF procedure? What about medications?
5. Is there any part of IVF treatments that my plan does not cover? 

Resolve.org also has a resource page for navigating IVF insurance and out-of-pocket costs.

In 2022, NPR reported on a Florida couple who, despite having IVF insurance, still paid thousands of dollars out of pocket for additional costs and medicines. This is why you must make a solid plan before that first appointment; even with IVF insurance coverage, you could still be financially responsible for other costs.

“Fertility care needs to be proactive, not reactive,” observes Imperato. “Insurance policies still leave far too many people behind, and families are forced to navigate impossible financial and bureaucratic hurdles just to have a child. It shouldn’t be this way.”

No, it shouldn’t, especially considering that the Trump administration recently dismantled the Division of Reproductive Health as part of their Department of Health and Human Services reduction in force (RIF). According to an article in Mother Jones, all six members of a team dedicated to assisted reproductive technology were laid off during this RIF. This means, per the Mother Jones article, “[President] Trump is stopping the very work he promised to promote.” This "work" the article is referencing is the president’s February executive order requesting “policy recommendations to protect IVF access and aggressively reduce out-of-pocket and health plan costs for such treatments.”

Since IVF insurance coverage continues to be such a tangled web of confusion, a good first step for prospective parents is to, in Imperato’s words, become more proactive in their care. That means becoming an expert on your state’s infertility insurance laws, as well as an expert on your insurance plan. Yes, it will likely require extra hours on the phone (the worst!), but when it comes to your body, your health, and your family’s future, you are entitled to begin your IVF journey armed with all the knowledge — financial and reproductive — you need to succeed. 

Sarene Leeds holds an M.S. in Professional Writing from NYU, and is a seasoned journalist, having written and reported on subjects ranging from TV and pop culture to health, wellness, and parenting over the course of her career. Her work has appeared in Rolling Stone, The Wall Street Journal, Vulture, SheKnows, and numerous other outlets. A staunch mental health advocate, Sarene also hosts the podcast “Emotional Abuse Is Real.” Subscribe to her Substack, the Critical Communicator, and follow her on Instagram, BlueSky, or Threads.