The Rising Cost of Infertility
How insurance coverage affects your infertility treatment options
Infertility treatment is not an easy path. Along with the physical discomfort and emotional ups and downs, most of those who choose to try to build their families through infertility treatment also face steep financial implications.
States Offering Insurance
Infertility treatment is rarely covered by insurance. As of March 2010, only 15 states have laws requiring insurance coverage for infertility treatment—Arkansas, California, Connecticut, Hawaii, Illinois, Louisiana, Maryland, Massachusetts, Montana, New Jersey, New York, Ohio, Rhode Island, Texas, and West Virginia. And even in those cases, not everyone is covered.
Exceptions to the Rules
*Melanie Dwyer of Chicago, Illinois, is lucky to live in a state that mandates insurance coverage, but there are always exceptions to laws—and in Illinois, self-insured companies are exempted. At the time she began treatment, Dwyer’s employer self-insured, but she wasn’t totally out of luck; they did offer some infertility coverage, with a $10,000 lifetime maximum benefit.
To put this in perspective, one in vitro fertilization (IVF) cycle can easily cost $10,000 or more, and since IVF is rarely the first step in infertility treatment, most, if not all, of the benefit can be used up before getting to IVF. As a result, Dwyer switched her insurance coverage to her husband’s plan, which will cover multiple IVF attempts.
Two teachers from St. Charles, Illinois, made national news when they sued their self-insured school district. The teachers’ employer provides no coverage for infertility treatment. The women, Lisa Mack and Angela Moreau, sought coverage for infertility treatment, claiming that the school district’s policy both violates the Americans with Disabilities Act and discriminates against women. The federal Equal Employment Opportunity Commission (EEOC) ruled that there was “reasonable cause to believe that the district has discriminated against a class of employees on the basis of disability by maintaining a health benefits plan that excludes coverage for (the women’s) disability.” The EEOC issued a letter allowing the women to sue the district in federal court.
This is not the first time the EEOC has ruled that infertility is a disability and thus, covered under the Americans with Disability Act—in October of 1998 they found that Franklin Covey had discriminated against employee Rochelle Saks by not covering her medically necessary infertility treatment in their self-insured policy. According to legal experts, most courts will continue to find infertility to be a disability. But these opinions are just that, and while the future may be promising for mandating treatment, what about the here and now?
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