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Old 05.06.2021, 18:11
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AMH fertility tests covered by insurance?

Partner and I have been trying to conceive for some time and it came time to do fertility tests for the both of us.

When I submitted the lab invoices to SWICA, I was surprised to see that they rejected the invoice for the Anti-mullerian hormone test. I then submitted to Helsana to see if supplemental would cover it but it was rejected there, too.

It was not a huge amount so not a big deal, but I was surprised - I would think that it's a standard test that would be covered by either Lamal or supplemental.

(Since I know EFers, yes I did talk to my insurance, and they confirmed it wasn't covered. However I'm prone to thinking insurance will always try to get out of paying, even if they're supposed to And, yes I can go to Helsana's documentation and see that TOP and SANA cover medicines, special forms of treatment and therapeutic methods, whereas AMH is just a hormone(?) and presumably not included?)

Just curious, for anyone else who has undergone fertility tests, does this ring true for you, that AMH lab costs were not covered? Anyone know why that is, or if there are any supplemental insurances that cover it, or if there are discussions to broaden the types of fertility tests covered by insurances (whether basic or supplemental)?
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Old 06.06.2021, 18:09
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Re: AMH fertility tests covered by insurance?

Was that the only test you had? Back when I was on the infertility merry-go-round, I had loads of different things tested from one blood draw. All the acronyms. I was on basic insurance and the tests were covered subject to franchise and co-pay. Maybe your test was coded as being for fertility treatment? Mine was classified/billed as illness the first time around, because we didn't know what was wrong. It was a "standard" appointment with a gynecologist with some blood work.
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Old 07.06.2021, 20:39
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Re: AMH fertility tests covered by insurance?

Hi 3Wishes,

They definitely tested lots of things with the same draw of blood (LH, FSH, TSH, etc. - a total of like 14 items on the lab bill!) but for some reason the AMH came on a separate invoice.

Interesting to know that all the tests you had were covered. I think I need to go back and ask specifically why it was not covered, perhaps something was not coded correctly!
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Old 21.06.2021, 18:42
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Re: AMH fertility tests covered by insurance?

An update, in case it's helpful to anyone else in the future.

I asked my insurance about it, and they confirmed that it's not covered by basic insurance because the laboratory code used "is not a current tariff position and is not included in the list of analyses. In order to have more information about this analysis, please contact the laboratory."

So I asked the laboratory about it, asking if they could provide the correct tariff code, but they confirmed that the code is correct, meaning it does not figure as an analysis covered by basic insurance and should be paid directly by me. (Normally the doctors are supposed to inform you of what is and isn't covered by insurance, but mine didn't.)

I am still surprised to hear it's not covered - maybe they'll update LAMAL at some point to include it? (Not sure how that works here in Switzerland.)
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Old 21.06.2021, 19:30
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Re: AMH fertility tests covered by insurance?

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An update, in case it's helpful to anyone else in the future.

I asked my insurance about it, and they confirmed that it's not covered by basic insurance because the laboratory code used "is not a current tariff position and is not included in the list of analyses. In order to have more information about this analysis, please contact the laboratory."

So I asked the laboratory about it, asking if they could provide the correct tariff code, but they confirmed that the code is correct, meaning it does not figure as an analysis covered by basic insurance and should be paid directly by me. (Normally the doctors are supposed to inform you of what is and isn't covered by insurance, but mine didn't.)

I am still surprised to hear it's not covered - maybe they'll update LAMAL at some point to include it? (Not sure how that works here in Switzerland.)
The Dr is trying to help you, are you saying you would have not done the test if you knew was going to cost CHF125 or whatever it cost.
If it was an expensive medicine costing 10k a month thats another matter.
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Old 21.06.2021, 20:06
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Re: AMH fertility tests covered by insurance?

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(Normally the doctors are supposed to inform you of what is and isn't covered by insurance, but mine didn't.)




Really? I can't recall the doctor ever having such a conversation with me about it in the last 30 years... what is your reference for this?
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Old 21.06.2021, 20:24
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Re: AMH fertility tests covered by insurance?

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Really? I can't recall the doctor ever having such a conversation with me about it in the last 30 years... what is your reference for this?
I have, a few times. And I’ve also had to sign something to say I would pay for such and such treatments. The providers know what the insurance will pay, and take steps to ensure that the doctors/clinics don’t get stuck with the bill.
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Old 21.06.2021, 21:03
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Re: AMH fertility tests covered by insurance?

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I have, a few times. And I’ve also had to sign something to say I would pay for such and such treatments. The providers know what the insurance will pay, and take steps to ensure that the doctors/clinics don’t get stuck with the bill.
Yes, however treatment & tests are very different in costs, especially as the OP want's to know the answer before the Dr can advise on if any treatment could even help.
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Old 21.06.2021, 22:49
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Re: AMH fertility tests covered by insurance?

Just like the contraceptive pill isn't covered (even if you need it for medical reasons) because a pregnancy is not an illness, your unfulfilled wish to have children is also not considered an illness. Not helpful for you and adds to the many heartaches but that's the logic applied.
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Old 22.06.2021, 07:46
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Re: AMH fertility tests covered by insurance?

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The Dr is trying to help you, are you saying you would have not done the test if you knew was going to cost CHF125 or whatever it cost.
If it was an expensive medicine costing 10k a month thats another matter.
Yes, perhaps you are right that it came down to it being a relatively cheap diagnostic test vs expensive treatment and that's why it wasn't mentioned. As I said, it's not a large amount so I'm fine to pay it, but just wanted to put the information out there to help others who might find themselves in a similar boat and wonder why this particular line item was not paid by the insurance.
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Old 22.06.2021, 07:50
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Re: AMH fertility tests covered by insurance?

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Really? I can't recall the doctor ever having such a conversation with me about it in the last 30 years... what is your reference for this?
I've definitely had doctors in CH explain to me that X will be expensive or Y is covered/not covered.

It was also mentioned by the laboratory when I asked about the bill. They said:
Malheureusement c’est bien le code de l’analyse hormones Anti-Mullérienne le code LAB61, normalement vous devez être informée par votre Gynécologie.

La Remarque : Les patients doivent être informés que cet examen ne figure pas sur la liste des analyses prises en charge par l'assurance obligatoire des soins (AOS). Comme il n'y a pas d'obligation formelle de remboursement pour les assurances, cet examen sera facturé directement au patient à un prix équivalent.
I also called my insurance yesterday (for a different matter), and they also mentioned that normally doctors will all know whether something is covered by basic insurance and inform you, but that naturally I could also call the insurance customer service to double-check.

Finally, the governments official page on Assisted reproduction mentions that "During the first visit, your doctor will give you a comprehensive and detailed overview of the costs related to your case." So I'd say this is pretty normal here. (https://www.ch.ch/en/assisted-reproduction/)
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Old 22.06.2021, 07:56
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Re: AMH fertility tests covered by insurance?

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Just like the contraceptive pill isn't covered (even if you need it for medical reasons) because a pregnancy is not an illness, your unfulfilled wish to have children is also not considered an illness. Not helpful for you and adds to the many heartaches but that's the logic applied.
I won't argue with the logic, but even if not considered an illness, many things under "an unfulfilled wish to have children" are covered by basic insurance. All the diagnostics so far --- gynecological exams, sperm analysis, blood tests (testing iron levels, hormones, etc.) have been covered, except for this AMH. Intra-uterine insemination is covered (but not IVF). https://www.ch.ch/en/assisted-reproduction/
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Old 22.06.2021, 12:49
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Re: AMH fertility tests covered by insurance?

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Really? I can't recall the doctor ever having such a conversation with me about it in the last 30 years... what is your reference for this?
Could this perhaps be the case, for you, because the treatments you've received happened to have been within the standard range of items covered, or because you may have better than average insurance cover? Have you been surprised by a bill for anything that did exceed your cover?

For me, if ever a treatment, test or medication fell outside of the medical insurance's responsibility, it has been consistently set out by a doctor or pharmacist, out-patient or in hospital.
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Old 22.06.2021, 16:01
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Re: AMH fertility tests covered by insurance?

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many things under "an unfulfilled wish to have children" are covered by basic insurance. All the diagnostics so far --- gynecological exams, sperm analysis, blood tests (testing iron levels, hormones, etc.) have been covered, except for this AMH. Intra-uterine insemination is covered (but not IVF). https://www.ch.ch/en/assisted-reproduction/
My hypothesis: in Switzerland the AMH test might be considered a precursor to IVF, and thus, like IVF, not covered.* The other tests (LH, FSH, TSH, Estradiol, etc.) are useful to reproductive endocrinologists for detecting various fertility issues, and are also required for IVF, but the AMH value is regarded as indispensable for determining the right IVF stimulation protocol. While there's medical debate regarding the usefulness of AMH for assessing fertility overall -- e.g., in contrast to AFC (antral follicle count) -- for IVF it's never optional. And since IVF is where so many fertility journeys end up, many doctors order it as a standard part of the "day 3 test" for general fertility. Could that be what occurred in your case?

(*I was under the impression that up to a certain age IVF is covered by most Swiss insurance schemes, but only after one has cycled through 3 rounds of IUI -- at which point perhaps the AMH test then becomes covered after all?)
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