While most states require insurance companies to provide or give coverage for infertility treatment, California, Louisiana, and New York have rules that expressly ban coverage for in vitro fertilization. An insurer can deny coverage for any reason, even if it's not listed as a justification for denial. Many health insurers, including Aetna, Blue Cross/Blue Shield, Cigna, Empire, Harvard Pilgrim, MetLife, United Healthcare, and Viant, offer coverage for IVF under their group health plans. However, the cost of treatment can be high, and many plan members are unable to afford all the necessary treatments. As a result, many people with infertility issues choose to go without treatment rather than incur an expensive debt they may not be able to pay off. It is important to understand that insurance policies are contracts between an insurer and a health care provider. In order for an insurer to provide coverage for a given service, that service must be considered medically necessary by both the insurer and the provider. States regulate how much an insurer can charge for services that are not deemed essential. For example, some insurers will not cover any costs associated with infertility treatment because these cases are seen as personal matters best left up to couples to resolve among themselves. Other insurers may charge extremely high rates for coverage of this type.