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Experts Debating Whether Insurance Should Cover Infertility Treatments Under New Law
Filed under: In The News, Infertility
Should health insurance cover infertility treatments? Credit: Getty
Infertility is a painful reality for 6 million women and men across the country -- that's one in eight couples, according to the Centers for Disease Control -- so it's significant that experts are wrestling with the issue of whether or not infertility treatments should be included in health insurance policies available through state-based insurance exchanges where individuals and small businesses may buy coverage starting in 2014.
The IOM will deliver its recommendations to the Department of Health and Human Services, Kaiser reports.
Infertility coverage is slim. Only about 20 percent of employers cover assisted reproductive therapies such as in vitro fertilization, according to a 2006 survey of almost 1,000 employers, conducted for Resolve: The National Infertility Association, Kaiser reports.
Most of the employers that didn't offer coverage cited cost concerns, but 91 percent of those that did offer it said it hadn't significantly increased their costs.
Existing coverage for infertility varies dramatically. Some plans offer fertility drugs to stimulate ovulation or intrauterine insemination (IUI, often called artificial insemination), but don't cover pricier assisted reproductive technology (ART) procedures, such as in vitro fertilization, according to Kaiser.
And, even if a plan does cover IVF, it may cover only a certain number of cycles -- or attempts -- or cap the dollar amount it will pay for services.
So far, 15 states require medical insurance coverage for infertility treatment, according to research compiled by Georgetown University's Health Policy Institute, Kaiser reports.
But mandates often promise more than they deliver, Sean Tipton, a spokesman for the American Society for Reproductive Medicine, tells Kaiser, noting that small employers are generally exempt from such rules, as are large employers that self-insure or pay employee health claims directly.
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Experts say it's too soon to know how the coverage issue will be resolved in the health insurance exchanges. But it's worth noting that when employers in the Resolve survey were asked why they covered infertility benefits, 65 percent said it was because employees asked them to.
"We were shocked" that it was so easy to get coverage added, Barbara Collura, executive director of the infertility group, tells Kaiser.
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ReaderComments (Page 1 of 1)
1-27-2011 @ 2:38PM
NonMom said...10 years ago when we needed help our employer's insurance wouldn't even cover the cost of diagnostic tests to determine the cause of our infertility. It was spelled out in the policy that the only testing excluded was infertility. Sometimes the very same test would be covered for one woman and denied another because the first "didn't appear" to be trying to get pregnant (older, already had kids) and the second did! Appalling. I can understand denying the cost of conception attempts; they can add up. But testing? Come on.... It's hard enough to go through months/years of wanting a child without knowing what's wrong. To have your company tell you that entire aspect of your body isn't worth checking out. Dismal!
Reply
1-27-2011 @ 3:59PM
Sandyone said...Infertility should be covered because it is a problem with the normal, healthy workings of the body.
That said, covered treatments should be those proven to be effective at *healing the body* instead of just doing an end run around the problem. (hint: IVF wouldn't make my cut) You want to be healed? I'm all for insurance paying. You don't care to be healed, just want a baby? That should be out of your own pocket.
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1-27-2011 @ 7:50PM
Alicia said...I'm all for it, if contraception is also covered. All's fair.
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2-01-2011 @ 11:56AM
Amy said...If insurance companies will cover contraception and procedures aimed at preventing pregnancy (i.e., Vasectomy, Tubal Ligation, etc) then why wouldn't they cover fertility treatments up to a certain number of cycles or a capped amount? I feel its a type of discrimination - you don't want a baby - ok we'll go ahead and pay for those procedures. You want a family but need the help of a reproductive endocrinologist to get pregnant - sorry, too bad for you.
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4-06-2011 @ 12:30PM
tasha said...I think they should more than cover the cost, its bad enough that we are going through this emotionally, mentally and physically.We shouldnt have to deal with it finicially...Its about time ..
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