Will my insurance pay for fertility treatment?
You can get out in front of the insurance coverage for fertility treatment debacle before you're even in it by finding out what your policy actually says. Here's how you can do that: Call your insurance company's billing department to learn about how your benefits work.
Does infertility treatment contribute to health care inequality?
However, the often-prohibitive costs associated with infertility treatment, coupled with the lack of universal insurance coverage mandates, contribute to health care inequity, particularly along racial and socioeconomic lines.
Does Aetna Health Insurance cover fertility treatment?
Aetna is a well-known health insurance company that offers fertility treatment and a comprehensive host of resources to help you determine your likelihood of success with fertility treatment, find an infertility provider, and learn about fertility treatments via videos and other resources.
Which fertility treatments are not covered by insurance in Illinois?
Although most fertility treatments must be covered by insurance in Illinois, a number of fertility treatments are not covered, including: Fertility treatments for patients who do not meet the fertility criteria
Why is IVF insurance important?
The authors conclude that state IVF insurance mandates are an important mechanism for reducing costs for patients and improving utilization of single embryo transfer.
What is the American Society for Reproductive Medicine?
For almost a century, the American Society for Reproductive Medicine (ASRM) has been the global leader in multidisciplinary reproductive medicine research, ethical practice, and education. ASRM impacts reproductive care and science worldwide by creating funding opportunities for advancing reproduction research and discovery, by providing evidence-based education and public health information, and by advocating for reproductive health care professionals and the patients they serve. With members in more than 100 countries, the Society is headquartered in Washington, DC, with additional operations in Birmingham, AL. www.asrm.org
How many embryos should be transferred to induce pregnancy?
The American Society for Reproductive Medicine and the Society for Assisted Reproductive Technologies recommend the transfer of a single embryo for most patients.
Does IVF have a higher rate of live births?
In states with comprehensive insurance mandates, new studies find lower numbers of embryos transferred per procedure and higher rates of live births from IVF.
Is IVF higher in women?
In one study, the researchers found that live births per cycle were significantly higher in states with comprehensive IVF mandates, most notably among women age 35 and older. They also found that utilization of IVF was higher among all age groups, and multiple births were lower in states with mandates.
How does infertility affect people?
Infertility affects people in a wide variety of ways and can have significant detrimental effects on quality of life. For example, approximately 40% of infertile women suffer from anxiety and depression, about twice the rate seen in fertile women. 9 One study of 488 American women found that infertile women had rates of anxiety or depression equivalent to those of patients diagnosed with cancer, hypertension, myocardial infarction, or HIV. 10
What are the causes of infertility?
There are myriad causes of infertility. In women, these causes include tubal abnormalities, ovulatory dysfunction, premature ovarian insufficiency, and uterine factors such as fibroids or congenital uterine anomalies. 7 In men, they include factors such as decreased sperm count or motility and abnormal morphology.
What is the rate of tubal factor infertility?
Tubal factor infertility. Tubal factor infertility typically affects 25% to 35% of IVF patients and provides a good example of how insurance status can dictate care. 27 Tubal dilation or damage can be incurred from a variety of insults such as ectopic pregnancy or gonorrhea or chlamydia infections. The presence of a hydrosalpinx, or dilation of the fallopian tube, directly impacts the success of ART, with pregnancy rates essentially doubling for patients who have undergone either laparoscopic salpingectomy (removal of the affected tube) or proximal tubal occlusion (34% vs 17%) prior to starting IVF. Thus, it is now a formal recommendation of the ASRM to surgically treat hydrosalpinges, if present, prior to starting ART. 27
How many states have infertility insurance?
16 Only 6 states have what is considered comprehensive coverage that includes all or most of the costs associated with IVF (Connecticut, Illinois, Maryland, Massachusetts, New Jersey, and Rhode Island). 16
What is the term for the inability to conceive within 1 year?
Infertility, a broad disease state that encompasses the inability to achieve a viable pregnancy within 1 year of attempting to conceive, 3 is a condition affecting millions of patients in the United States.
Does the government cover infertility?
Government insurance. There is no coverage for infertility treatment for patients with public or federal insurance. Federal civil service employees working for the US government, for example, have no insurance coverage for infertility treatment. 22 As of March 2018, there were 34.7 million adults enrolled in Medicaid, none of whom have insurance coverage for infertility. 23 For those on public assistance requiring government aid, mandating coverage for infertility treatment is a controversial topic, one that falls outside the scope of this brief essay. However, financial limitations alone should not be paramount in determining which citizens are appropriate parents. For most people, paying for ART out of pocket is impossible, leaving many without a financially feasible way to manage their disease or achieve their reproductive goals.
Is infertility a disease?
The World Health Organization defines infertility as a disease. Infertility has multiple associated billing codes in use, as determined by the International Statistical Classification of Diseases and Related Health Problems. However, the often-prohibitive costs associated with infertility treatment, coupled with the lack ...
When is infertility coverage available?
Coverage is only available once you've proven that you meet the criteria for infertility, which varies according to the state's law.
Why is it important to discuss fertility at work?
Why? Because great fertility coverage can both attract and retain employees. Discussing fertility treatments at work, as well as with your friends, also destigmatizes infertility and allows for folks to talk about their experiences instead of perpetuating any silence or shame around the topic.
Which states have fertility preservation bills?
Currently, both Massachusetts and New Jersey have active fertility preservation bills pending in their state legislatures. If these bills are passed, these states would be added to the list of those that require insurance plans cover medically induced infertility.
Do fertility clinics have financial counselors?
Many fertility clinics also have financial counselors who guide patients through the process of managing funding. And finally, Modern Fertility was born (pun intended!) to help you navigate all of this. We want you to get information about your fertility now — while kids are still a hypothetical.
Does the bill require healthcare to cover fertility treatments?
The bill would not only require healthcare plans and individual markets to cover fertility treatments, but also fertility preservation services. For more information on advocacy around these bills, check out the Alliance for Fertility Preservation.
Can religious organizations opt out of insurance?
In some states, religious organizations are also allowed to opt out of coverage. Additionally, there are seven states that legislate that insurance plans must cover treatments for folks whose infertility is medically induced (i.e. from chemotherapy, radiation, surgery, or other medical care that compromises fertility).
Do you need insurance for infertility?
If you live in one of these 17 states , there are laws in place that require insurance coverage for infertility treatments. This means that:
Is infertility a medical condition?
Infertility is a disabling medical condition, and it can significantly reduce quality of life. If we have the capability to treat this medical condition effectively, don’t we have a duty to do so, and do so in a way that is accessible to those who need it?
Is infertility a male or female issue?
Following the subject of women’s rights, I feel that it is important to clarify that infertility is not only a female issue. In fact, about half of all infertility cases are attributable to male factors. 1 Both men and women should be interested parties in the coverage of treatment for this medical condition.
What is fertility insurance?
Fertility insurance is health insurance that covers the diagnostics and treatments needed to help potential parents who are struggling to conceive or to carry a child to term. Fertility insurance isn’t usually a separate health insurance policy but is covered under health care plans by many health insurers. Seventeen states currently have laws ...
Why is progyny a good plan?
Progyny is such a good plan because its approach focuses on results instead of on reducing costs. Many health plans start with lower-cost procedures, but Progyny allows its patients and their doctors to decide on the best method of treatment and gives them access to the assistive reproductive technologies that they need to conceive and have a child without having to prove that less expensive treatments didn’t work.
How many states does Wellcare sell?
Wellcare has a network of over 571,000 health care professionals that they work with nationwide. They sell plans in all 50 states, and your plan premium and deductible will vary depending on your state and the plan you choose. They have an app to help you manage your care.
Does Cigna cover IVF?
Cigna provides cost-effective coverage that includes in vitro fertilization (IVF) in many of their plans, while also covering a significant number of diagnostic fertility tests and other fertility treatments. Pros. Covers IVF and other rarely covered procedures. Covers a significant number of diagnostic tests.
Does health insurance cover fertility?
Seventeen states currently have laws making it necessary for health insurance providers to cover fertility treatments. 1 But, since it is not required in all states, not all insurers cover treatments, and some might cover a limited number of treatments or only certain types of procedures. This roundup will help readers find a health insurance ...
Does Aetna offer HMO?
Aetna does not offer individual and family plans on the health insurance marketplace. They only offer Medicare, Medicaid, and employer-sponsored plans. These plans include HMO, PPO, POS, EPO, and HDHP plans where your deductible and co-pays vary by plan. They have an app that helps you manage your care to make navigating your coverage easier.
Does fertility insurance cover progyny?
Except for Progyny, all are part of larger health care plans with fertility services offered as part of that plan. Your coverage from some of the health care insurance providers on this list might vary depending on your state. However, all offer coverage options for those experiencing infertility.
Why do insurance companies hire nurses?
Nurses have an even greater role as the health law and trends in insurance payment encourage more coordination of medical care to make sure patients are getting the right treatment, in the right place and at the right time. Insurers hire nurses to staff 24-hour nurse call lines with some even signing contracts with physician groups ...
Why are nurses being hired by insurance companies?
Health insurance companies are hiring record numbers of nurses as the Affordable Care Act boosts the number of patients with medical coverage and plans look for ways to coordinate care of the newly insured.
How many nurses does Humana have?
Meanwhile, Humana says it now has more than 10,500 nurses, which is seven times the 1,500 nurses the Louisville-based insurer had in 2010. “This reflects Humana’s ongoing investments into its clinical capabilities for complex chronic care management and chronic condition care management,” Humana spokesman Alex Kepnes said.
What are alternative reimbursement models?
Health insurers are shifting billions of dollars in payments to hospitals and doctor practices via alternative reimbursement models such as patient-centered medical homes and accountable care organizations (ACOs). In these models, nurses do more outreach to patients as part of a team-based approach with a doctor to make sure prescriptions are ...
Do nurses do more outreach to patients?
In these models, nurses do more outreach to patients as part of a team-based approach with a doctor to make sure prescriptions are taken, diets are adhered to and wellness protocols are followed. If the ACOs improve quality and reduce what they spend on care, insurers reward them with a portion of the dollars saved.
The Problem of Infertility
The State of Insurance Coverage
- Private insurance. Currently, there are 16 states that have infertility coverage mandates for private insurers, with requirements developed on a state-by-state basis (Arkansas, California, Connecticut, Delaware, Hawaii, Illinois, Louisiana, Maryland, Massachusetts, Montana, New Jersey, New York, Ohio, Rhode Island, Texas, and West Virginia).16 Only 6 states have what is co…
Disparities in Access to Care
- Minority patients face substantial barriers in seeking treatment for infertility. There is evidence that African American, Chinese, and Hispanic patients are much less likely to seek care than white patients and that African American and Hispanic women, despite having higher rates of infertility, are underrepresented in the infertility clinic population.17, 18, 24-26 After failing to conceive spo…
Disparities in Treatment
- Tubal factor infertility. Tubal factor infertility typically affects 25% to 35% of IVF patients and provides a good example of how insurance status can dictate care.27 Tubal dilation or damage can be incurred from a variety of insults such as ectopic pregnancy or gonorrhea or chlamydia infections. The presence of a hydrosalpinx, or dilation of the ...
Conclusion
- Infertility is a disease with a substantial psychosocial burden, and the lack of affordable options may have significant detrimental effects on the quality of life of millions of Americans. Because of the current lack of universal insurance coverage mandates for ART, infertility is implicitly designated as a disease undeserving of financial support, leaving many patients unable to fulfill …