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Dollars and Sense
by Evelina Weidman Sterling, March 2009
For more than 70 percent of families struggling to have a baby, fertility-related expenses must be paid completely out-of-pocket. How can this be, when almost one in six couples are in this situation? Why won’t more insurance companies foot the bill for at least some of these expenses? It just doesn’t make sense.
Why Infertility Should Be Covered by Insurance
Basically, infertility has experienced a bad reputation for a very long time. Many people view infertility as simply a “choice” or lifestyle issue. After all, infertility isn’t exactly seen as life-threatening, and many believe, “you don’t really have to have a baby, do you?” Unless you have been personally touched by infertility, it is difficult to fully comprehend the magnitude of this issue and the severe impact it has on millions and millions of women and men throughout the U.S.
The truth of the matter is that infertility is a treatable medical condition. With appropriate treatment, almost 90 percent of families are able to have a baby. The American with Disabilities Act and the U.S. Supreme Court confirm that the ability to procreate is a “major life activity.” And a disability is technically defined as any physical condition that prevents someone from participating in a major life activity. For most families, infertility can be treated effectively through well-established and minimally invasive medical procedures, including medications, intrauterine insemination (IUI), or in vitro fertilization (IVF).
Treating infertility is also absolutely medically necessary. By definition, “medically necessary” means a treatment must be: 1) safe and effective; 2) not experimental; and 3) appropriate. So if the question arises as to whether infertility treatment is medically necessary, the answer is an astounding YES on all three accounts. In fact, let’s take IVF—IVF is safer, more effective, and less costly to the healthcare system compared to many other fertility-related surgical procedures that are commonly covered by insurance.
Covering infertility treatments through insurance will lower costs for both patients and society. Everyday, patients make decisions about their care based solely on what they can afford. When you have very limited financial resources to attempt treatment, you might feel compelled to “push the envelope” by taking more risks and increasing your chances for serious and incredibly expensive complications like multiple births. Compared to all the costs associated with higher order multiples, paying for IVF looks like chump change.
And let’s not forget, financial well-being is a major stressor. We all know that stress affects fertility. Sometimes this stress can even inhibit the response to treatments, making it more time-consuming and expensive to get pregnant.
Fifteen states throughout our country—Arkansas, California, Connecticut, Hawaii, Illinois, Louisiana, Maryland, Massachusetts, Montana, New Jersey, New York, Ohio, Rhode Island, Texas, and West Virginia—have all seen the light and passed laws encouraging some sort of insurance coverage for infertility. Some of these states provide better coverage than others but they are all sending a message that fertility matters and everyone deserves access to the most appropriate fertility treatments.
Still, this leaves 35 states with no such insurance mandates. And many of the 15 more fertility-friendly states battle each year to maintain their laws; plus not all companies in these states meet the criteria necessary requiring them to provide insurance coverage anyway.
What’s a Girl to Do?
I know, I know … infertility is hard enough to talk about. And mixing money in with that makes for a nearly impossible conversation. But, it’s up to us to educate more people about infertility and the tremendous financial pressure it puts on us. Don’t be shy! People just don’t get it. And it’s our responsibility to change this type of mentality.
If you don’t think one person can make a difference, look at Belle Degenaars, the mother of two children—six years and several miscarriages apart—who devoted four years to obtaining passage of the New Jersey Family Building Act. Today (thanks largely to Belle), this law provides one of the most generous mandates supporting the insurance coverage of infertility treatments.
It can be done. It has been done. Even if it doesn’t work out for you right now, we need to fight for those that follow us. You already know how difficult this is. We should all find ways to make it easier for someone else to seek treatment and realize their family-building dreams. Besides, good karma never hurts.
Evelina Weidman Sterling, PhD, MPH, CHES is the co-author of Budgeting for Infertility: How to Bring Home a Baby without Breaking the Bank along with several other best-selling and award-winning books about fertility, including Having Your Baby through Egg Donation, Living with Polycystic Ovary Syndrome (PCOS), and Before Your Time: Living Well with Premature Ovarian Failure and Early Menopause. She is also the co-founder of My Fertility Plan, a new innovative company that provides patients with the information, skills, and tools they need to fully understand their own individual fertility and progress through their infertility treatments in the most effective and efficient ways possible.