States Without Coverage
*Charlotte and Bob Fairchild illustrate how a lack of insurance coverage for infertility can affect the lives of an infertile couple. The Fairchilds live in a state that does not mandate insurance coverage for infertility. In four years, they spent about $60,000 on treatment. They have made numerous financial sacrifices in pursuit of a family.
"We have not had vacations, except to visit relatives," she says. "We drive old cars. We use coupons, never eat out, never see movies, don't get the [news] paper. Bob takes his lunch to work, we cut up the credit cards, and don't buy new clothes. I have home parties for Tupperware, jewelry, or crystal to get presents for family." She adds that they also cashed in retirement stocks four times and maxed out credit cards twice to pay for treatment. She has been pregnant twice, with both pregnancies ending in miscarriage.
Virginia does not require insurance companies to cover infertility treatment, and Lori Page has not been able to afford treatment for infertility. She and her husband had to pay out-of-pocket surgery expenses. "Our RE (Reproductive Endocrinologist) worded it as 'oviduct repair' and our insurance reimbursed us for 50 percent," says Page.
Part of the diagnosis is "severe male factor," but they are unable to find out the cause or whether it can be treated, because they can't afford to pay for the testing and doctors' visits. The Pages had to take out a loan to pay for tubal surgery. They are hoping to be able to secure credit to cover treatment from their RE. Without that credit, they will be unable to pursue infertility treatment.
Why the Lack of Coverage?
Why don't insurance policies cover infertility treatment? According to Deborah Wachenheim, government affairs director for RESOLVE, the national infertility advocacy and education organization, the major opponent of legislation mandating that health insurance include coverage for infertility is the insurance industry. The Catholic Church and some employers' groups also oppose legislation that requires that infertility treatment be included in insurance policies.
"Insurance companies and the employers' groups that oppose this coverage use figures that claim it's very expensive to provide this coverage," says Wachenheim, who cites two well-regarded studies that show that it is, in fact, very inexpensive for an insurance provider to add infertility coverage to a health plan. One study says that it would cost just a few dollars a year per insured person, and another says that it would cost about $20 a year per insured person. Wachenheim adds that insurance companies feel that any mandate for coverage is a "slippery slope" that leads to other mandated coverage. She also points out that the companies provide industry studies that contradict the studies by RESOLVE, regarding the cost of covering infertility diagnosis and treatment.
*Sally Adams of Dallas, Texas, and her husband were in treatment for a little over a year and had spent $6,000 on inseminations, fertility drugs, and monitoring. The Adams' infertility diagnosis includes both male and female factor. At the time, Texas did not require insurance coverage for infertility. "Had insurance covered infertility treatments, we probably would have gone straight into IVF attempts rather than doing the insemination cycles, since due to our combined problems, IVF gives us the greatest chance at pregnancy," she says.
Be an Advocate for Coverage
Often an employer can make a difference in whether or not a company's health insurance benefits cover infertility diagnosis and treatment. Wachenheim advises individuals to be sure to convey their desire to have infertility treatment as part of the health insurance plan. Companies have a great deal to say about what is part of their plan, especially when it is time to renew a contract with an insurance company.
* Name has been changed to protect privacy.