Health Insurance Covering Infertility Treatment
I wrote an article yesterday about how hard it is to get individual health insurance after you’ve had fertility treatments. We got a comment on the post that mentioned how ironic the whole thing is, considering health insurance almost never pays for the actual fertility treatment, even if you have coverage while you’re going through the process.
That got me thinking. Should health insurance cover fertility treatment? Is infertility a disease that should be treated like any other medical condition? The basic premise of health insurance is the idea that major medical problems can be financially crippling, and that spreading the cost over a huge group of people makes treatment more affordable for everyone (ideally this group would include every American, with nobody uninsured). Another basic premise that a lot of people misunderstand is that health insurance was never meant to cover every little cough and sneeze. The idea is to protect assets and prevent devastating financial losses in the event of a medical crisis. But over the years, the system has developed to the point where people often expect that every doctor visit and prescription will be paid for by insurance. Health insurance companies were happy to comply - with ever increasing premiums, of course.
So how does infertility fit into this picture? It’s a lot more common than most people think, affecting roughly 1 in 8 American couples. And the medical bills can mount very quickly when a couple pursues treatment. So it does fall into a category of conditions for which health insurance coverage would seem to make sense. I do not know of any health insurance companies in Colorado that offer coverage for infertility treatment, although we do not work with large group carriers and there may be some options there. One of my best friends has been trying to conceive for 11 months, and has been seeing a fertility doctor for the last 6 months. She and her husband have spent $4,000 so far, and that’s really just been for testing - they haven’t gotten as far as AI or IVF, when the bills would really start rolling in.
My heart goes out to couples who are unable to conceive. But my honest opinion is that fertility treatment should not be included as mandatory under health insurance coverage. While I recognize that it is a medical condition, I just can’t justify putting it in the same category with heart disease or kidney failure. A person who has kidney failure will die in a matter of weeks without dialysis. A person with heart disease or Type 1 diabetes will also die without treatment. But a person who is unable to conceive will not die without treatment. And if there are no other underlying medical reasons for the infertility (eg, PCOS), the person should be able to lead a healthy life, albeit without biological children.
An infertile couple can adopt (granted, this can also be a pricey option), or they can choose to remain without children. Or they can decide to go ahead with treatments in an attempt to have their own biological children. But this is their choice, and not one that is required in order to fulfill basic health needs. Since it can be such an expensive process, it would place a high burden on health insurance carriers if it were required to be covered. In the individual health insurance market, premiums have been increasing at a rapid rate for years now - it’s not uncommon in Colorado to see rate increases of 10% or more every year. Adding a mandate that infertility be a covered condition would drive the prices even higher, and would likely lead to more people dropping their health insurance coverage as the premiums rise.
In an ideal world, we would have a single-payer health care system, with significantly lower cost structures for care, and payment required - in the form of taxes - from every American. Perhaps in this type of a system, infertility could be considered a disease like any other, and could be less of a financial burden on the individual couples who are struggling to get pregnant. But with our current system, it doesn’t seem feasible or fair to increase every one’s health insurance premiums in order to treat infertility.
I know one reason that others have brought up for having insurance cover fertility treatments is that perhaps couples wouldn’t feel a need to transfer more than one embryo and thus, decreasing the chance of having multiples and having those babies be in the NICU for however long or for the mother to be on hospital bedrest - both of which are covered by insurance and cost insurance companies quite a bit. When insurance doesn’t cover fertility treatments, there’s a need by many couples to transfer 2 or 3 embryos which sometimes, though not always, result in multiples. In the long run, would have been less expensive to cover treatments or to cover the NICU and hospital bedrest stays?
That being said, I’ve gone through IVF. I had two embryos transferred and it did result in a twin pregnancy. We paid for IVF out of pocket. I ended up spending 5 weeks in the hospital on bedrest. Thankfully, my babies did not need a NICU stay though I know of many other twin moms whose babies did. My hospital stay alone was a little over $131,000. That doesn’t include all the doctor fees for myself and for my children. One single round of IVF costs $10,000 plus another $3000 or so for the drugs. In all honesty, I don’t know if I would have done things differently if my insurance covered my treatments. I love my twins so much and I can’t imagine life without them, but there is possibility I would have chosen to transfer just one embryo at a time as I did fear a twin pregnancy but I also was afraid if I just transferred one, it wouldn’t work and we’d have to spend another $13000 to do it all over again.
“My hospital stay alone was a little over $131,000. That doesn’t include all the doctor fees for myself and for my children.”
I guess that’s why health insurance companies won’t even consider somebody who has gone through IVF before. If that person pays the $13,000 out of pocket for the IVF when she has coverage, the insurance company is on the hook for a big claim. Allowing them to put an exclusion on pregnancy would be a perfect solution.
Well, in Colorado, sex change operations are acceptable for insurance companies to cover…and a person won’t die if they don’t get it done. Mental illness is an illness, and depression can be a factor when TTC and being unable to seek further treatment because of the high costs. I think if insurance companies can cover things like sex change operations, viagra, etc, then they ought to cover infertility, which is, by the way, a medical condtion. I think that you have a better chance of people choosing more conservative options (maybe IUI or transfer of less than 3 embryos) and less cost to the insurance companies in the long run. I think that by NOT covering, many couples would get desperate, and with the fear that the treatment won’t work, would go to extremes to avoid #1 the disappointment of it not working and #2 the fear that they would have pay for another cycle they cannot afford. Thus, more expense for having to cover NICU and other complications from higher-order multiple births, or maybe, you’ll get women self-treating with ovulation induction medications, because of cost, and the pregnancy would be compromised…yet another cost for not covering…
Thanks for the comment Cheri. You make a good point. But to be clear, the point of this article is “how hard it is to get individual health insurance after you’ve had infertility treatments.” None of the individual health insurance companies in Colorado cover sex change operations.
Coverage is often a question of quality of life - whether a disease is terminal or chronic. A protestic limb or reconstructive surgery are typically considered appropriate medical assistance, whether a congenital or acquired loss. Likewise, I would propose that assistance to overcome defects and losses related to fertility would be covered. I believe to have children is a quality of life choice a person ought to have the OPPORTUNITY to make. If a person who has lost a limb chooses not to get a prostetic because they are not physically active (or whatever their reason), that is their choice; but they have an opportunity to choose what quality of life means to them. (I think that most would opt for a prostetic.)
My husband and I have had unexplained infertility and pregnancy loss for five years. Treatment was recommended to us, but we did not pursue as we have no coverage. I got pregnant naturally for the fourth time and ironically I near lost my life - it was an ectopic pregnancy that ruptured despite early medical intervention. That one day to save my life cost $40K, more than five years of fertility testing and conventional treatment would have been.
So now I am without “limb” so to say. I would like the opportunity, like other survivors, to pursue the quality of life I desire. A medicine could assist me (and my husband who has genetic issues). Of course these are not covered, not does my company cover the extensive adoption expenses. My choices are to continue “limping” along until we raise money for treatment or adoption, or choose a child-free life - which for my husband and I would be loss of our quality of life. We would find ways to compenstate, but it is sad that our “community” does not support us.
We have visited two IVF doctors, the prices they are mentioning continues to bother us. Depression is about to set in as age roles in on us. We need kids. Our insurance cannnot cover IVF. Please tell us if you know any insurance that would cover IVF. We can’t afford to pay out of pocket. Please help us. SOS
@sunnie: We are not aware of any health insurance companies in Colorado that cover IVF. I am so sorry that you’re having to go through this. You might try searching online for places that offer low-interest loans for IFV or other financial assistance. We wish you all the best.