A while back I asked if infertility treatments would be covered under the new health care reform bill. We now have an answer, and it’s a not good one if you’re infertile. According to Susan Donaldson James at ABC News, there is nothing in the new health reform care bill that mandates insurance companies cover infertility. Nothing in the new law says that insurance companies have to cover the cost of IVF, egg donation, IUI, ICSI or any other infertility treatment. That’s the bad news.
The good news is that 13 states do mandate some form of coverage of infertility related medical problems. However, each state’s insurance laws are different. Maryland mandates that insurers cover up to three IVF cycles. New Jersey covers only women under 46 years old. Hawaii covers only one IVF cycle. In Arkansas, insurance payments for infertility are capped at $15,000. Massachusetts seems to be the most generous–there are no limits on the number of IVF treatment cycles. But even there, large companies with self-insured plans and small employers are exempt from the mandate.
The new federal health insurance reform bill does prohibit health insurance companies for denying you an insurance plan based on pre-existing conditions. If you suffer from polycystic ovarian syndrome, endometriosis, or uterine fibroids your chosen insurer still has to accept you. That’s the way it should be.
But outside the 13 states with some form of mandated infertility coverage, the decision to cover infertility treatments is up to your insurance company and your employer. Depending on the decisions your insurance company and employer make, the cost of infertility treatments could be an out-of-pocket expense or could be covered. 80 percent of Americans are not covered for infertility.
This story breaks my heart:
“Josie’s story in startling,” said Barbara Collura, executive director of RESOLVE, who has heard increasing complaints from couples worry about the financial burden of fertility treatments.
Josie, a 42-year-old from Virginia Beach, Va., and her husband have visited several clinics to inquire about IVF. Some charge as much as $17,000 for just one try.
“In vitro is our only option but we cannot afford this and our insurance doesn’t cover it,” said Josie, who didn’t want to share her last name.
“We also have tried to purchase health insurance on our own but couldn’t find one to cover fertility,” she said. “Financing such a dream is impossible as both my husband and I don’t have the best credit. Our dream is fading.”
What’s your perspective? Should we institute some form of mandated insurance coverage of infertility federally? Does your health insurance cover infertility treatments?