With all the conversation about health care reform, are there any questions in your mind about infertility coverage and your fertility specialists? The conversation is taking place,
certainly in the media, although not in a big way. There’s an article here or there. I read an article this morning, in Kaiser Health News. Google alerts brought it up for me automatically given that it was on infertility.
Here’s what I learned. The Institute of Medicine has a panel of experts who are considering whether infertility coverage, among other things, should be included or not in a national health care plan. Their recommendations will go to the Department of Health and Human Services.
I also read, referred to in this article, about a study that Resolve worked on with Mercer Health and Benefits, in 2006, polling employers titled, “Employer experience with, and attitudes toward, coverage of infertility treatment”.
Really interesting stuff. Given that so few employers (only about 20%), offer coverage of fertility treatment, I would think that this would be at the forefront right now in the infertility field. Here’s our opportunity to see that those affected with infertility would be covered so that finances would not be a reason one could not have treatment.
This is really huge. So how come it’s so quiet? That is not a rhetorical question. How come it’s so quiet? Where are the patient advocacy and education groups on this subject? Resolve, The American Fertility Association, INCIID and more? And, at the risk of getting everyone angry, where are the other advocates and educators? There are millions, no exaggeration, of websites and blogs on infertility. How to support, educate, advocate; all those things are there on millions and millions of websites and blogs. How come we’re not coming together on this issue?
Don’t we have a real opportunity at this moment where history may be made to make sure that infertility is included in this health care plan? Am I missing something? Being naïve? Don’t we want to have infertility and fertility treatment covered? Is there someone in the driver’s seat and I don’t know who that is?
I would like to hear from my friends, readers, patients and colleagues about whether you agree with me about the importance of this moment and whether you would join me in creating a voice that would be heard. If I need to add my voice to a group that’s all ready started, sign me up, I’m there.
Let’s not miss the boat on this. If only 20% of employers choose to fertility treatment, that leaves an awful lot of us with no coverage and that needs to change. With the possibility of a national health care reform plan going into action, I want infertility covered.
I wrote last week about the cost of infertility treatment and even used the word elitist, which ticked some people off. Very shortly afterwards, I got into a spirited conversation with two of my closest friends about the political, emotional, financial in’s and out’s of infertility coverage in the United States. I was taken aback, frankly, listening to their points of view, and realizing that it was probably representative of the general public.
What I heard is that people without health insurance (that covers treatment), without a state mandate or without substantial financial resources, in essence, are out of luck, as far as they were concerned, about creating their families.
So my mind started jumping around about this and I started looking up information. Here are a few things that I found out.
About insurance, coverage and experimental treatment:
In the past, insurance carriers that do not have exclusions have denied claims for one of the following three reasons:
1. Infertility is not an illness;
2. Treatment of infertility is not medically necessary;
3. Treatment of infertility is experimental.
These are invalid reasons to deny your claim. Infertility is an illness (2). Medically necessary is usually defined by insurance policies as medically required and medically appropriate for diagnosis and treatment of an illness or injury under professionally recognized standards of health care. Treatments such as GIFT, IVF, ZIFT/PROST have NOT been on the American Medical Association's experimental list since the late 1980s.
Interesting information above, given that GIFT, ZIFT/PROST have not been options that have been used in infertility treatment for many, many years. This is information from INCIID, (InterNational Council on Infertility Information Dissemination, Inc.) a well respected patient advocacy organization, included in a paper written several years ago. The three reasons cited for non coverage are as true today as they were when this paper is written.
Many roads, in the early 2000’s led to the ADA (Americans with Disabilities ACT). It was felt that if infertility was recognized as a disease that it would be more compelling to have insurance covering it. While that has worked to a certain extent, has the ADA ruling been more helpful in creating state mandates? Currently we have 14 states with state mandated coverage.
From ASRM (American Society for Reproductive Medicine)in their area of patient information. A simple definition of infertility:
Infertility is NOT an inconvenience; it is a disease of the reproductive system that impairs the body's ability to perform the basic function of reproduction.
Under ADA, reproduction has been held by the US Supreme Court to be a major life activity. (In fact, no less important than learning or working.) More about whether or not infertility is considered a disease:
The U. S. Supreme Court held in 1998 that infertility is a disability under the Americans with Disabilities Act (ADA). But the Court subsequently held that a person is not considered disabled under the act if the disability can be overcome by mitigating or corrective measures. And a lower court held in 2000 that, while infertility is a disability, an employer’s health plan that excludes treatment for it is not discriminatory under ADA if it applies to all employees.
It seems to me that infertility is considered a disease, but a somewhat special disease in that treatment is considered optional, or even a life style choice as reported in Newsweek.
Here’s how the article begins:
When doctors at a local St. Louis clinic told Marcie Campbell it would cost more than $15,000 to try to get her pregnant, she was crushed. For somebody with polycystic ovary syndrome, coupled with blocked fallopian tubes, in vitro fertilization was the best option to conceive a child. But with a household income of $47,000 a year, it was hardly an option. (Missouri isn’t one of the 15 states that mandate insurance coverage for IVF.)
“I told them, ‘There’s no way.’ We can’t afford it. Maybe rich folks can,” says Campbell, 33.
It takes me back full circle to the conversation with my friends. Is infertility treatment elitist? Interesting to me that this article reports that this couple was able to afford treatment for $7,500, not $15,000; we all know that some prospective parents, in this economy can’t afford that either.
We don’t dictate to couples without fertility problems how much money they have to have, how far up the corporate ladder they have risen before they start their family. Without infertility, when and how you start a family is entirely within your own discretion and that decision is made in the privacy of your own home. Is someone making minimum wage less able to raise a child? Less able to be a loving parent?
The article continues, pointing out the significant differences between insurance and affordable Infertility treatment here in the US and in Europe.
Whether infertility should be classified as a disease or a socially constructed need is a dilemma at the center of this debate. While most other developed countries consider infertility a medical condition and insurance policies often cover the costs of IVF, health insurers in the U.S. typically don’t think “wanting a child” is a medical necessity.
We don’t value our children less in this country. So what is it? And better yet, going forward, what can we do to ensure that infertility treatment is either covered by insurance, a state mandate, or health care reform?
What can we do to make this a reality?