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.