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Going Up Against the Big Dogs

a blog by Alice Crisci, June 6, 2012

As a patient advocate for fertility preservation, I am spending much of my time these days negotiating with insurance companies to cover egg, embryo and sperm freezing for our cancer patients. I am growing weary of the letters I receive stating “Procedure is not a covered benefit. Basis of decision: Infertility.”

I am no stranger to the loopholes the insurance industry jumps out of — after all, I had breast cancer four years ago and had to appeal twice to receive benefits for my reconstructive surgery, and that has a federal mandate behind it!

How do you use Infertility as a basis to deny a patient preventative care, when that patient is not currently infertile? This makes no logical sense whatsoever. But then, if the Rick Santorum’s of this country make the laws that govern us, I wouldn’t expect this to be an argument based on logic.

Logic would have the insurance companies use a patient’s cancer diagnosis as the basis for covering egg freezing, embryo freezing and sperm freezing. My cancer diagnosis was used so I could receive my breast implants after my double mastectomy. Why would an insurance company not use the same rationale when it comes to fertility preservation?

Is it because those who passed the law mandating my breast reconstruction were men, and they’d rather look at my fake boobs than protect my right to bear their children? Are we really that un-evolved of a society still?

In medicine, we are supposed to do no harm. But, cancer treatment, in saving our lives, does a ton of harm, including leaving about half of all patients of reproductive age infertile. Just like my mammary glands taken during the mastectomy can’t be rebuilt (I will never be able to breast feed), you can’t put eggs back into my ovaries after chemotherapy has destroyed them.

Does the Federal Government and the Insurance Industry really think I’d rather have implants than the ability to bear children?

Here is how I imagine a verbal conversation with the insurance company would go:

“It’s not a covered benefit.”

You told me that preventative care is 100 percent covered. Did you sell me this insurance plan under false pretense? Fertility preservation is most definitely preventative care.

“Preventative care for a woman includes your mammograms and pap smears.”

Mammograms and pap smears don’t prevent breast cancer or cervical cancer; those tests help diagnose disease. Fertility preservation prevents the disease of infertility. How could that not meet the preventative care criteria?

“Our company doesn’t consider infertility a disease.”

So your company disagrees with the Federal Government that infertility is a disease? Is that even allowed in as regulated an industry as insurance?

“It’s an elective procedure.”

So was my breast reconstruction.

“We don’t have a way to put this claim through.”

Let’s find a way. Surely your company didn’t launch with every single covered benefit already in place. You’ve added benefits throughout the years. Who do I talk to who is responsible for reviewing what is a covered benefit and what is not?

“I can't give you access to that person ma’am.”

How can you sleep at night?

If the Rick Santorum’s of the world have their way, my frozen embryos would have more rights than me, a living, breathing, tax-paying being. For as long as I am helping to pay the salary of those voting on my reproductive rights and the rights of the 1.4 million young adult cancer survivors, I will fight for what is fair. I will write letter after letter until the righteous and just take notice.

Here’s how my next letter begins. Dear Mr. President:

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