Thursday, July 30, 2009

Insurance and Infertility

This is a hot topic. Currently there is no national mandate to require insurance companies to cover infertility treatments. There are a few states (MA and NJ to name two) who require insurance coverage for infertility, but recently PA (the state I call home) shot down a bill to require coverage. To ready why, click here.

Jeff's insurance does not cover infertility treatments. For those of you who don't know, here is about what popular treatments can run you:

Clomid or oral meds: up to $1500/cycle (depends on what monitoring your doctor wants)

IUI: up to about $5000/cycle (could be less). This really depends on the types of meds you are on to induce ovulation.

IVF: $15,000+/ cycle.

Might I add that Jeff's insurance covers ABORTION (and in this it includes termination for medical reasons, but it also says it does not discriminate and covers abortion of all kinds) but not infertility treatments.

The arguments against this bill are ridiculous. The first point, for example, says that while it can be extremely emotional, it isn't medically necessary (as in life threatening) for a couple to undergo fertility treatments. Really? So instead they would rather the insurance pay for $ in therapy bills because the emotions can be so hard to take at times that therapy is often necessary.

The second point is that infertility treatments are costly. Well of course they are and so you are expecting a couple to spend their life savings on infertility rather than saving it for their baby or spending it to help the economy. It is adding extra stress on marriages, on budgets, on both parents to HAVE to work because they need to pay off the debt of their infertility treatments. Oh and remember Octomom? How about John &(minus?) Kate +8... do you remember them? What about the other extreme multiple families we hear about in the news? If insurance coverage covered infertility treatments, women wouldn't have to feel like they need to use every last embryo for one shot at becoming in pregnant because they can't afford treatments in the future, which results in multiples. Multiples almost ALWAYS require NICU stays, costing insurances millions of dollars. So millions of dollars would be better than a couple thousand for the couple to have one child instead of feeling pressured that they only have one shot?

Another reason was on the language in the bill, saying that it didn't stop post-menopausal women and habitual aborters from using fertility treatments. Honestly? Change the language of the bill then. Don't shoot down a bill that could help out desperate couples who want nothing more than to have a child because of a few people who ruin it for all (which always seems to be the case, huh?).

But here is the bottom line... here is the reason why they shut this down: "While the Council is sensitive to those suffering from infertility, we were unable to find needed proof in the review of SB 1183 that coverage of infertility benefits would be cost effective."

Money. That is all that matters in this case. Money. That is so painful that money has to be something that would stop the state from requiring this coverage, even taking in consideration how emotionally painful this can be.

Types of insurance are chosen by different companies. Jeff's company (which we love and have always found them family friendly except in this one area) offers more than one option of insurance. I don't see why one of the options couldn't cover this. This would trump one of the arguments in the bill, which is that they want everyone to be able to afford healthcare and by adding infertility coverage, it would make it unreachable for some. Why not pick one of the options to include infertility insurance? I plan on sending a letter to his company that says something similar to this (feel free to copy and edit it/ use it. This was shared by someone on the infertility board that I frequent and I tweaked it to work for our case):

Dear [HR person]:
My husband has been a dedicated employee for the past three years. My spouse and I are suffering with the disability of infertility and request that you consider covering infertility treatment in [company name]'s health benefit package.

Often employers believe that adding and infertility coverage benefit will increase health care costs. However, recent studies indicate that including comprehensive infertility coverage in a health benefit package may actually reduce costs and improve outcomes.

For example, a recent employer survey conducted by the consulting firm William M. Mercer found that 91 percent of respondents offering infertility treatment have not experienced and increase in their medical costs as a result of providing this coverage.

As also proven in the following studies, the perceived cost infertility treatment is typically overstated.

Often patients elect treatment based on what is covered in their health benefit plan rather than what is most appropriate treatment. For example, a woman having trouble conceiving because of blocked follopian tubes or tubal scarring may opt for tubal surgery, a covered treatment, which can cost $8,000-$13,000 per surgery. Many patients are forced to forgo in vitro fertilization (IVF) because it is not a covered service even though it costs about the same as tubal surgery and statistically is more likely to result in a successful pregnancy. I have been faced with similar choices myself, and will have to face difficult decisions that might not be necessary, given adequate insurance coverage.

According to William M. Mercer, "The decline in use of high-cost procedures like tubal surgery would likely offset the cost to include IVF as a benefit and provide improved health outcomes." (William M. Mercer, Infertility as a COvered Benefit, 1997). In states with mandated infertility insurance, the rate of multiple births is lower than in states without coverage. (New England journal of Medicine, "Insurance Coverage and Outcomes of In Vitro Fertilization," August 2002). Couples with insurance coverage are free to make more appropriate decisions with their physicians based on medical necessity rather than financial considerations which often result in multiple births and a high rate of complications during and post-pregnancy for mother and babies. Wouldn't it be better to cover a $10,000 IVF procedure than a $2 million NICU stay for 3 babies?

Comprehensive infertility coverage may actually reduce premium expense by as much as $1 per member/per month. According to "The Hidden Costs of Infertility Treatment in Employee Health Benefits Plans" (Blackwell, Richard E. and the William Mercert Acturial Team, 2000), insurance premuims now indirectly provide coverage for "hidden" infertility benefits such as surgeries to remove scarring in the fallopian tubes for women or varicose vein removal for men. The cost of those benefits were calculated to be adequate to cover more effctive and often less expensive treatments such as ovulation induction, intrauterine insemination and in vitro fertilization.

The cost of infertility services as a percent of the total health premiums went down after the 1987 Massachusettes mandate that required infertility coverage. (Study by Griffin and Panak, Fertility & Sterility, 1998).

According to a 2003 Harris Interactive Poll, 80% of the general population believes infertility treatment should be covered by insurance. (Harris Interactive Inc., Survey, 2003).

In vitro fertilization accounts for less than 3% of infertility services. According to the American Society of Reproductive Medicine (ASRM), 85%-90% of infertility cases can be treated with conventional medications. (ASRM website, Quick Facts About Infertility).

I have always felt that [company name] was a company that cared for their employees; however I have been disappointed that not one of the handful of insurance options offered by [company name] includes infertility treatment. Is that the kind of reputation they want to have about how they treat their employees? As the spouse of someone who works for [company name], I certainly hope not.

Please let me know if you would like any additional information on this issue. I hope [company name] will consider offering infertility coverage and support our family building efforts. Thank you for your consideration.


For more information on how you can advocate for insurance coverage in all of the states, or in your state, or mine, check out

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