Insurance and Infertility…
Posted on March 12, 2008
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Yesterday, there was yet another article addressing an insurance company’s hestitation to cover infertility treatments. I know there are smart people who work at these insurance companies. I understand that mandated coverages can increase premiums, but don’t they realize that if they covered infertility treatments and somewhat regulated RE’s they could save MILLIONS of dollars? The bad RE’s (i.e., insurance deemed non-network providers), the ones who put in too many embryos that result in triplets or quads, would loose clients to the more conservative REs, (i.e., the in-network providers the insurance company chooses!), who try for one baby. The resulting savings from the premature births could pay for hundreds of IVF cycles and not increase the insurance company’s cash outflow - actually this would save them millions!
My twin daughters racked up more than $500,000 during their 7 week NICU stay. I know I’m not alone, there are a lot of twin, triplet and quads from IVF incurring expensive hospital bills that the insurance companies are paying for.
From the article in the Missourian: “‘The more mandates, the more costly programs become and are then less affordable to Missourians,” said Deborah Wiethop, a spokesperson for Anthem Blue Cross and Blue Shield in Missouri. “With all the mandates we’ve added to the insurance programs in the past 20 years, that’s added an 11 to 14 percent increase in the cost of a premium.’…Wiethop said one of the reasons insurance companies don’t cover infertility treatments is because they are optional.”
Obviously Ms. Wiethop has never experienced infertility first hand. I wonder if she would make the same comment about a woman having a mastectomy because she had breast cancer. Unbeknown to most people is that infertility is a DISEASE. Also, a study conducted by Mercer Health & Benefits showed 90% of insurance companies showed NO increase in medical costs when offering infertility benefit to their members.
I’m looking for case study data to present to an insurance organization. Basically, I think the following information would be helpful:
- Did you have to pay for infertility treatments or did your insurance company pay?
- If the insurance company didn’t pay for the treatments, did they at least cover the costs of testing for infertility?
- What was your total out-of-pocket for infertility treatments? How many cycles, what was the cost per cycle?
- What was your outcome? No pregnancy, pregnant with singleton (one baby), twins, triplets, etc.
- If you became pregnant, did you encounter any preterm labor? If so, did you spend time in the hospital? How many days? What was the cost of this hospital stay?
- Was/were your babies born premature? If so, how early? How long were they in the hospital? Can you estimate or provide the amount the insurance company paid for their NICU stay?
- If your baby/babies were born premature did they have complications? If yes, please describe. If no, are they performing tasks at their corrected or actual age?
- Would you have approached your treatment options differently if your insurance company paid for IUI, IVF, etc.? Meaning would you have been more conservative in the number of embryos you & your RE transferred?
To maintain your anonymity, you can submit this information via survey monkey.
Someday insurance companies will cover the cost of fertility treatments. Please help by providing your case study data, even if you didn’t have success through treatments. Thanks for your help.
» Filed Under Infertility
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2 Responses to “Insurance and Infertility…”
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My insurance will not cover a penny of ANYTHING branded with the scarlet I. Not Clomid, not an ultrasound for IUI monitoring, zilch. Hell, as far as I understand, they don’t even cover the Pill. In short, they suck.
The only reason they’ve covered my testing and subsequent hysteroscopy and lap was that my doctors know how to code things and I was lucky enough (hear the sarcasm?) to have symptoms that hinted at gyno problems.
We’re still in the process of addressing IF. But one reason why it’s taken us more than two years to start working with a specialist was lack of money and lack of insurance coverage. I know that if we decide to pursue IVF eventually, we’ll have no choice but to transfer 2-3, as we’ll only have enough money for 2-3 cycles max. And that will wipe out all our savings and likely leave us in debt for years.
I’ve done three seperate rounds of IF stuff so here goes.
1) My first insurance paid only for testing and nothing for treatment. If you can believe it.
My second paid just about everything up to IVF, and wouldn’t pay for that.
My third paid for 4 lifetime IVFs and here’s the fine print OR 25K. Do you know how much IVF costs? That gives ABOUT 2 cycles. No I’m not bitter, why do you ask.
2) For the first one, barely.
3) Since none of them paid for meds…I’d have to say at least 10K total
4) No pregnancy.