Because infertility has long been considered a women’s health issue, insurance companies perceived it as a niche issue and denied coverage to those experiencing it. This is despite the fact that nearly half of all cases are due to “ male factor infertility.” Just 30 years ago, “most insurance companies didn’t even cover obstetrics [childbirth].
Why do I think insurance should cover infertility?
- An overall 60% reduction in the rate of multiple births through IVF
- 44% fewer twins and 90% fewer triplets 585 fewer premature babies born
- A reduction in prenatal, delivery and neonatal costs of about $29 million
- A reduction in long term disability costs of approximately $156 million
- A net savings to the healthcare system of $78 million
Why does insurance not cover infertility?
Why does my insurance not cover infertility? Because infertility has long been considered a women’s health issue, insurance companies perceived it as a niche issue and denied coverage to those experiencing it. This is despite the fact that nearly half of all cases are due to “male factor infertility.”Jul 25, 2018.
Are fertility medications ever covered by insurance?
Many fertility treatments are not considered “medically necessary” by insurance companies, so they are not typically covered by private insurance plans or Medicaid programs. When coverage is available, certain types of fertility services (e.g., testing) are more likely to be covered than others (e.g., IVF).
Will my insurance pay for fertility treatment?
Standard Health Insurance: This type of fertility insurance involves paying a monthly premium to your insurance provider. In exchange for this monthly premium, your insurance provider will pay for certain fertility treatments, up to a maximum dollar amount.
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:
How many states require infertility coverage?
Advocates from Resolve and the American Society for Reproductive Medicine hope that the American Medical Association’s designation will help them get states to pass laws mandating infertility coverage. Nine states require some degree of infertility coverage, some of which offer multiple rounds of IVF, while others only offer less expensive, and less effective, treatments.
How much does IVF cost?
IVF costs, on average, roughly $20,000 a cycle and is not, in most cases, covered by insurance. For the vast majority of the infertile population, this means they either have to take on considerable debt or avoid receiving treatment and likely the chance to have children altogether. A movement to expand insurance coverage for infertility treatment ...
Why do insurance companies stay away from women's bodies?
Another thing insurance companies have historically stayed away from: women’s bodies. Because infertility has long been considered a women’s health issue, insurance companies perceived it as a niche issue and denied coverage to those experiencing it. This is despite the fact that nearly half of all cases are due to “ male factor infertility .”
Why do they transfer multiple embryos to the uterus at once?
They are choosing to transfer multiple embryos to the uterus at once, instead of the now-recommended single embryo transfer, in order to avoid paying for more procedures. This leads to a higher risk of complications for mother and child – and higher long-term health care costs for insurance companies. Shutterstock.
How long has the pregnancy discrimination act been around?
More than 30 years the Pregnancy Discrimination Act, many pregnant women still experience unfair challenges on the job.
How many babies have been born from IVF?
8 million babies have been born as a result of IVF, but it's mostly seen as elective. 12% of American women have difficulty becoming pregnant or carrying a pregnancy to term. Editor’s Note: Elissa Strauss writes about the politics and culture of parenthood as a contributor to CNN Health. CNN —.
Is IVF expensive?
When we stop thinking of IVF as a lifestyle option and start thinking of it as a cure for a medical condition that effects women from all socioeconomic backgrounds, IVF doesn’t seem particularly expensive at all.
What is an FSA?
An FSA, or Flexible Spending Plan, lets you set aside pre-tax money for certain qualifying medical (and dental) expenses. What’s a qualifying medical expense, you ask? Ah, the devil is in the details.
Does health insurance go by the year?
Health insurance goes according to the plan year, which is usually the same as a calendar year. Flexible Spending Plans are a form of tax benefits, so they go by the tax year. But fertility treatment can easily span more than one year, so you should be mindful when these benefits reset.
Is infertility financially devastating?
For too many couples, infertility is financially as well as physically and emotionally devastating. Having health insurance that will cover at least some of the cost is critical to helping more people expand their families.
Does Obamacare cover infertility?
In most states, there is no requirement to cover infertility treatment at all. That’s partly because the federal Affordable Care Act (Obamacare) does not include infertility treatment as an “essential health benefit.”
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 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 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 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 ...
How many states require infertility insurance?
In the United States, only 19 states require some level of insurance coverage for infertility, according to the national infertility association Resolve. That means that in the other 31 states, insurance companies in the fully insured market (when a company purchases a plan from a commercial insurance carrier) don’t have to offer fertility benefits.
Does Tricare offer fertility?
When it comes to active-duty military and their spouses, the government’s insurance carrier, Tricare, does offer fertility benefits, but it’s complicated. Specific to military service, an active-duty member may qualify for fertility treatments like IVF if they suffer from an illness such as cancer or if they “are seriously injured as a result of urogenital trauma.”
Is there a difference between insurance and access?
While I agree that a difference does exist, I would respond that affordability is encompassed within accessibility, and offering insurance coverage is one method of increasing the affordability of, and therefore access to, treatment.
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.
