Why infertility insurance for everyone matters

November 13, 2016Carole 2 Comments »

If you have been reading this blog, you probably need help building your family.  There are many reasons you might turn to IVF or other infertility services:

  1. you are infertile and sex won’t make you or your partner pregnant.
  2. you are in a same-sex relationship and sex with your partner won’t make you pregnant.
  3. you are not in a relationship but still want to be a parent to a genetically related child.
  4. you are fertile, but you have suffered recurrent pregnancy losses and/or you or your partner have an underlying genetic condition and need genetic analysis to find healthy embryos for transfer.
  5. you are facing a cancer diagnosis and want to preserve your fertility by recovering and storing egg, sperm or embryos before cancer treatments destroy or severely reduce your fertility.

But for some reason, society does not recognize that these reasons are legitimate and should be covered by medical insurance just as medical services are covered for all other non-reproductive medical problems. Imagine having to fight for medical insurance coverage for a heart condition or cancer or a broken limb?

If you are affluent, you can afford IVF, even if your medical insurance plan does not cover IVF. You simply can.

If you are NOT affluent, and you have no insurance, you will have to sacrifice something else or decide not to have a family. You simply must.

That’s not fair but arguing for justice is not always a winning argument, so let’s look at another reason to support widespread insurance coverage–because it drives the quality of services rendered.

Physicians who want to be included as a provider on a insurance plan must meet certain requirements and can have claims denied if they are practicing medicine in a way that is outside the standard of care. Insurance companies keep track of whether physicians are properly credentialed, have a current medical license and are generally providing good quality care. If a service falls outside this insurance coverage safety net, anything is fair game.

Leaving IVF in the “optional services” category –like cosmetic surgery– means that even if you can afford it without insurance, you may not be getting the best infertility services available in your area. The clinic that spends a fortune on advertising and front office amenities may have dirty incubators in the lab, poorly trained or understaffed lab personnel. When driving patient volumes and making a buck is the main focus of a clinic because everyone is fighting for the few self-pay patients that can afford it, spending money on things that drive quality long term (better lab equipment, better qualified, better trained staff, adequate staffing) is often not a top priority.  Because patients , especially first time patients, don’t have enough information to be able to select the better providers, they don’t have the clout to insist on superior health care.

Insurance companies do have that clout and can set a bar for better quality services.

The outcome of the 2016 election does not bode well for more health care insurance for more patients, since Obamacare will  likely be repealed. Although it did not support infertility services directly, it supported reproductive health care and generally increased the participation of patients in the insurance pool.

So now, more than ever, we need to support insurance benefits for all, especially for the controversial services like IVF services, because coverage brings oversight and oversight drives improvements in health care services.

If you agree  in principle or if you need help right now in getting insurance coverage- head on over to Fertility Within Reach .

Fertility Within Reach is a non-profit organization that is working with patients, employers, and legislators to increase access to infertility health care for everyone. As you consider how your end of year charity can do the most good- consider donating to Fertility Within Reach and supporting high quality infertility treatments for everyone.



© 2016, Carole. All rights reserved.

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