Annon

There are ways to get your insurance/employer to cover infertility treatments, by using the fact this is a preexisting condition.  I spoke with Brian Allen (brian-allen@uiowa.edu) at the University of Iowa and he explained ways I could approach my husbands company to have them pay for our next procedures this coming up months to try for #2.  It takes some time and some aggressiveness but it is all worth it.  Where do you live?

You may live in one of the 13 states that provide mandates for infertility services. Mandated benefits vary by state. An actual mandate requires insurers to provide infertility coverage, but some states only have a "mandate to offer." A mandate to offer requires insurers to offer coverage, which employers may or may not choose to purchase. Mandated coverage may also depend upon the relationship between you and the insurance carrier.  However, federal ERISA (Employee Retirement Income Security Act) laws exempt self-insured groups from state mandates. As more and more employers choose to become self-insured, fewer people will have infertility coverage from mandates.

Many self-insured employers provide inadequate infertility treatment coverage. But employees can be a catalyst for change. For example, an infertility patient employed by a large self-insured manufacturing company in the Midwest wrote to her third-party administrator and requested her current infertility benefits. When the administrator informed the patient in writing that her plan did not reimburse for fertility treatment, the patient approached her Human Resources Department and asked for an exception to her denial. Human Resources contacted the infertility clinic’s financial counselor and discussed adding an infertility benefit to the company’s current coverage. As a result of a meeting between the infertility patient’s employer and representatives of the infertility center to discuss potential benefits, the employer added a $25,000 infertility diagnosis and treatment benefit for 6,000 employees nationwide to become effective the following year. The Human Resources manager commented during the meeting that adding an infertility benefit that includes assisted reproductive technologies is "pro-family and the right thing to do for our employees."

Employees and self-insured groups partnering with medical providers can increase benefits and contain costs. Employees can help their self-insured employers see how changes to their current benefits can better serve everyone.

Many traditional insurance companies reimburse for unlimited infertility diagnosis and tubal surgery but do not reimburse for assisted reproductive technology procedures because they assume that paying for these procedures will increase overall costs.

But traditional insurance carriers can limit their financial liability and increase subscriber benefits by providing a limited diagnosis and treatment benefit that includes assisted reproductive technology procedures. For example, in 1988 an infertility center approached a large traditional insurance carrier in the Midwest. As partners, they created a $15,000 infertility diagnosis and treatment benefit that included assisted reproductive technology procedures. They based the benefit on proper coding and a willingness between the infertility center and the insurance carrier to work together. The insurance carrier recognized that a limited benefit would limit their financial liability. They also discovered that they could offer the new benefit with no rate increase in premiums. In other words, subscribers received assisted reproductive technology benefits at no additional cost. The insurance carrier commented that they were interested in stopping patients from having numerous and ineffective tubal surgeries. They continue to offer this benefit to over 1 million subscribers today.

There is still over $4,000 we are still paying for, but I got on a payment plan through the doctors office.  Good luck and feel free to email me if you have any questions.

The question you want to ask them should be:

"Through no fault of my own I have a medical disease that doesn’t allow me to have children.  There is medical advancements that would allow me this opportunity and you (employer/insurer) have determined what is best for me by eliminating the ability to cover for these procedures.  Even though I am paying for my co-workers to have children, smoke, etc."  Educate on the diagnosis and procedures does not break the bank for the employer/insurer.