Health Insurance After Infertility Treatment
I just read a post by ForHealth about infertility treatment and individual health insurance. Her experience is one we’ve seen with some clients over the years. She went through fertility treatment – Clomid, in this case – which was unsuccessful. Three years later, she applied for an individual health insurance policy and was declined. The reason? A history of infertility treatments.
I do understand the reasoning behind the medical underwriting when it comes to infertility treatments. In Colorado, all health insurance policies are required by law to cover complications of pregnancy. So if a woman has toxemia, or preeclampsia, or requires a month of hospitalization during her pregnancy, it’s covered by her health insurance, just like any other medical condition. Even though most individual health insurance policies in Colorado specifically do not cover routine maternity care, they all have to cover complications. And the underwriters know that infertility treatment is more likely to lead to a high-risk pregnancy (especially likely if multiple babies are conceived) than an unassisted conception.
So… pretty much every Colorado health insurance company will decline a person who has had fertility treatments, usually within the last five years. While I understand the cold hard logic behind this strategy, it seems to just add insult to injury. Especially for someone who has had unsuccessful treatments and has abandoned their attempts to get pregnant. They still can’t get health insurance, because the insurance company is concerned that they just might be successful in future treatments and could end up pregnant with quadruplets. Seems that someone who is actively undergoing fertility treatments would not be likely to be applying for an individual policy that provides no routine maternity care anyway (just on the off chance of those quadruplets showing up). But that’s the way the insurance companies look at it.
I agree with ForHealth that doctors should be educated about the health insurance implications of fertility treatments – even something as un-invasive as Clomid – and should be able to advise their patients beforehand, in case there may be a need to apply for individual health insurance in the future. It’s got to be a nasty surprise to find that out after the fact.
I support the state mandate that health insurance policies cover complications of pregnancy. A $10,000 routine pregnancy can quickly become a financial nightmare if serious complications arise, and it makes sense that health insurance should cover them, just as they would if an insured developed any other type of medical problem. But there should be some way around this for people like ForHealth, who had fertility treatments in the past but are now looking to get catastrophic health insurance coverage. Health insurance companies should be allowed to offer policies with full exclusions for pregnancy. A policy that excludes anything to do with pregnancy, including complications, would probably fit the bill for a lot of these women. They are no longer undergoing fertility treatments, so they’re not likely to get pregnant (and if they do conceive naturally, they probably have about the same chances of a normal, low risk pregnancy as any other woman). But they would be able to have health insurance coverage for all the other curve balls that life can throw at us, which is what they are applying for in the first place. With an option to exclude anything to do with pregnancy, at least the health insurance companies would have something to offer these women. It would then be up to the applicant to decide if the policy being offered was something she felt comfortable with. Having options – even though they might not be ideal – is far better than just getting a flat out rejection.
Because of the state mandates for complications of pregnancy, health insurance companies in Colorado don’t have the option to offer policies with this type of an exclusion. And the result is that women who have had fertility treatments are pushed into high risk pools, or forced to remain at a job just for the group health insurance benefits, or end up uninsured. As with most state mandates for health insurance coverage, the intention was good, but the unintended consequence is that more people end up finding that getting health insurance can be pretty tough.
Thank you for bringing this to light. It is insulting to be denied for a catastrophic plan that covers nearly nothing. It is frustrating that the insurers wouldn’t even look at my medical records or talk with my doctors – to see how little infertility treatment I actually received. The sad thing is that I was covered by health insurance the entire time I was under treatment and paid out of pocket for most of it. I was never officially diagnosed with infertility, but it was the reason I sought treatment. I could have lied on my insurance application. But I knew the insurance company could come back with retroactive premiums at a later date if they actually took time to research my medical records. Unfortunately, my case is not unique. There are thousands of women playing the insurance game trying to get at least part of their infertility diagnosis and treatment covered. Almost none of them know they will become uninsurable if they no longer have their group policy. Infertility is as real a disorder as heart disease or cancer that can interfere with the quality of life.
It is interesting how well intended laws sometimes aren’t thought through all the way.
ForHealth,
I read through your blog. My understanding is that your idea does not have any type of payer for health care expenses other than the patient?
Correct. I would like to take the middle-man, or insurers out of the mix. I would prefer the free market to bring down the cost of routine health care. I would be in favor of paying doctors directly for a “retainer” in exchange for services. I also would be in favor of Medical “IRA’s” so that my money works for me and is not lost in the vacuum of premiums to never be seen again.
I am not completely against all insurance. I would be interested in buying a truly catastrophic plan, say “cancer” insurance or coverage for injuries from an auto accident. If such plans are available in my state, my insurance agent has not made an effort to sell them to me. (To be fair, I think he only reps the Blues. Still, it would be nice to know as a consumer).
forHealth
I understand your frustrations…sadly I deal with these types of situations every week. I am an agent for a major medical insurance company as well as an insured person myself. It is truly a daunting and hellish task to have to navigate the health insurance world unless you have a trust worthy, knowledgeable agent. Im not saying that your agent is not trust worthy or market savy but simply that he/she may not have the ability to help you where you are. If you would like, you can reply to this post and we can discuss what your options are. From my experience, every company has different underwriting guidlines….there may be a catastrophic plan out there that will fit your needs and budget.
Colorado Agent
Based on forHealth’s description of the risk pool offered to her, I don’t think she is in Colorado. And I don’t think she wants to make her contact info public.
I understand that many policies donot cover infertility treatment. However under the circumstances an individual becomes pregnet after the relevent infertility treatment. Are the expences occured then for maternity covered.
Sam,
None of the individual health insurance companies in Colorado will cover normal maternity expenses on their standard policies. There are only a few that even have the option to purchase a rider that will. Even those options aren’t a really great deal. The least expensive is $106.40/month and covers very little and the others are between ~$220/month – ~$450/month depending on your age and zip code.
Covering maternity isn’t really an actual insurance product because (for the most part) you can plan it – unlike cancer or a broken leg. So for profit insurance companies don’t see much profit in it. The free market also doesn’t make a big demand that it be covered standard because most people don’t need it and it would just inflate prices dramatically.
If you have ideas about how to improve the health insurance industry, you might like to share them in our new wiki. You could share your ideas about improving maternity coverage or improving individual health insurance underwriting.
My questions to Jay or the colorado agent.
We are talking about health insurance here. I can understand that there other logistics in place while processing an insurance claim for the clinics, which has do with dealing with underwriters. How are all these people paid? For example, I was approved for a coverage by a health insurance company, are you guys being the agents or underwriters paid on my expense. Does your salary impacts on my coverage, increases my premium? This questions brings us back to what ForHealth explained about paying the Dr’s directly. Enormous cost in the health insurance are primarily due to other logistics that has a share amount in the plan.
@sunnie:
Most underwriters and other employees of an insurance companies are paid a salary. However, agents are only paid a commission with no benefits. So they only get paid when they are productive. And if you purchase your policy through an agent, your premium is the same as if you went directly through the health insurance company (that’s the law).
Commission based pay with no benefits (vs salary) is the most efficient way to pay a workforce when it is logistical. Not having an agent leaves you exposed to either not having representation when you have problems with the insurance company after you have the policy (billing, claims, etc), or having to actually go out and pay extra money for representation.
You mention ForHealth’s comment above, she states:
“I would prefer the free market to bring down the cost of routine health care.”
In the free market where companies are competing with each other, money has to be spent on marketing and sales in the interest of employees and stockholders. Compare that with a single payer system that doesn’t have expenses associated with marketing, sales, legal, or dividends.
In the free market system with many different companies for the providers to negotiate contracts with, many providers have the need for a dedicated salaried person just to sort out the billing with each different carrier. Compare that with a single payer system with one payer to bill.