Our friend Bob Vineyard over at InsureBlog might be losing his hair, but he isn’t losing sleep over it, and doesn’t expect health insurance to cover hair transplants (thanks Bob!) He’s written a thought-provoking article about how hair transplants and fertility testing/treatment are similar in the eyes of health insurance carriers – neither is a covered expense with most health insurance companies.
I’ve written about this topic too, and overall, I will say that I agree with Bob. Enough people are already crying uncle when it comes to health insurance premium increases. Every time we add a new treatment to the list of things that health insurance companies are required to cover, premiums go up. As premiums increase, more people find themselves unable to afford coverage.
But that said, I don’t think that the comparison between hair transplants and infertility treatment is completely fair. I do see the general connection. But hair loss happens to most men (and some women) eventually. It’s part of the aging process, and doesn’t really indicate that anything is physically wrong with the person. In a similar fashion, infertility happens to all women eventually, in the form of menopause. A person with unexplained hair loss at 25 might have a physical condition that goes beyond normal hair loss related to aging. In that case, it would be reasonable to expect the person to seek answers. And the same can be said for people who are experiencing infertility years before the onset of menopause.
Infertility is a medical condition. If you’ve been through it yourself or are close to someone who’s been through it, you know the heartache that it causes. For a little more reading on the subject, there are lots of blogs that document the long and winding road of infertility. In an ideal world, people wouldn’t have to shell out tens of thousands of dollars for infertility treatments. But without some form of subsidization for health insurance premiums, it’s not realistic to add infertility treatment to the list of conditions that health insurance covers. Although I would add that it probably feels like a slap in the face to infertile couples who are paying their own way through IUIs and IVFs to know that erectile dysfunction is covered by health insurance.
One of the often-overlooked benefits of health insurance is the negotiated fee schedules that are worked out between providers and health insurance carriers. When claims are considered “covered expenses” the billed amount is almost always reduced because of network negotiated pricing discounts. Unfortunately, infertility treatments aren’t covered expenses and don’t get repriced by health insurance networks. Couples seeking help with infertility use credit cards, home refinancing, private loans, and life savings in order to pay the bill. They may be able to work out deals with the clinic, or secure a great financing program – but at the end of the day, they’re on their own to pay the bill.
I agree completely with Bob’s position on low-cost treatments and health insurance: “if the cost of a “semen analysis” is reasonably low, why do we need insurance to cover the cost?” Covering low-cost treatment doesn’t fit the definition of insurance anyway. But for a lot of couples dealing with infertility, the semen analysis is just the beginning.
I found Bob’s article in last week’s Grand Rounds, which was hosted at In Sickness And In Health. Barbara did a great job of putting everything together and throwing in a little sci-fi nostalgia along the way. The Colorado Health Insurance Insider article about the nationwide nursing shortage was included in GR – thanks for hosting, Barbara!