"There is nothing more thrilling in this world, I think, than having a child that is yours, and yet is mysteriously a stranger."
"There is nothing more thrilling in this world, I think, than having a child that is yours, and yet is mysteriously a stranger." With those words, Agatha Christie, the famous novelist, described the elation of giving birth to a child. In the Old Testament, King Solomon expressed a similar thought while recognizing children as a blessing from God: "Children are a gift from the Lord; they are a reward from him" (Psalm 127:3, NLT). Sadly, however, due to infertility, many would-be-parents miss out on this blessing and can never experience this joy. That is, not without infertility treatment. Without infertility insurance, however, infertility treatment is not an option for many.
How Does Infertility Insurance Work?
For many people, getting pregnant is as natural and as straightforward a process as any other. To others, it can be a struggle, to say the least. The CDC places the number of women "of impaired fecundity" (to use their term) in America at more than six million women - or nearly 11% of all women of childbearing age (which they count as women between the ages 15 and 44). If that seems quite shocking, consider this - the number for women who have ever used infertility services is even higher - at 7.5 million. To anyone who knows how expensive infertility treatments can be, this has to be a shocker. A single in vitro fertilization treatment cycle can cost upwards of $25,000 at a reasonably-priced clinic. How do all these families afford their treatments? The answer, of course, lies in infertility insurance.
How do you get infertility insurance?
It is not routine by any stretch of the imagination for American health insurance to include infertility insurance. Denial is the norm with uncommon healthcare needs of this kind.
In fact, insurance companies have no standard policy when it comes to the kind of infertility coverage they will offer anyone. A lot depends on the laws that your state has that cover these matters.
There are certain states that have very liberal policies governing infertility insurance. In the states of Rhode Island, Arkansas, West Virginia, Montana, Hawaii, Louisiana, Ohio, Massachusetts, New Jersey, Maryland, Illinois, and New York, the law absolutely requires complete coverage right from the tests that a couple may need to actually arrive at a diagnosis of infertility right down to many infertility treatment options that there are.
In some states that do not have family-friendly laws - like California, Texas, and Connecticut, the law only requires standard health insurance policies to offer riders (specific kinds of coverage that you can you can choose as add-on extras). If your employer wishes to offer you infertility insurance, he needs to buy this right on top of the standard coverage that he buys.
In other states still, health insurance policies only provide coverage up to the diagnosis stage. After that, you are on your own.
While there are some states where health insurance companies do stop short of offering any kind of infertility insurance whatsoever, those are rare. In most places, there always is a limited amount of coverage. You will find that your insurance company pays for the diagnosis and for treatments like intrauterine insemination and for drugs like Clomid.
Sadly, for more than 50% of American families, there are many infertility treatments that will forever be out of their reach because they are too expensive to buy and their insurance companies do not cover them. Fertility medications can run $1000 a week or more. Many couples will bravely try to pay for the treatment on their own. Many of these couples wind up filing for bankruptcy.
Basically, you do need to be extremely careful before setting down on a path to infertility treatment, whether your insurance company pays for it not. Even if you do have coverage, it would always be a good idea to make exhaustive inquiries with your insurance company to make sure that the exact treatments that you seek are covered.
How do you know what kind of infertility insurance coverage you have?
The first step would be to approach the human resources department at your company to ask for a copy of your Certificate of Insurance or Evidence of Coverage documents. You could try to look for the information you need in the Summary of Benefits, as well. You usually do not see enough information in that, though. Even if you do get a copy of the documentation that you require, make sure it's the latest version possible. These things change frequently.
You must not ever think that it's anybody else's responsibility to make sure that you know about the kind of coverage you have. The way the system is set up, it is completely your problem.
Since infertility treatments can end up costing even $100,000 or more by the time you get done, you really should take your time before you even set foot in a specialist's clinic or hospital, to make sure that you know exactly what you are dealing with. You need to speak to the insurance company, the HR department of your company, the doctors and the insurance department of the hospital you go to. There are fertility help forums on the Internet as well. You need to take this very seriously.
Since these rules tend to be very complicated, it is possible that you will receive conflicting information at various points. It's always a good idea to maintain a detailed log of all the people you speak to, their designations, the date and time at which you speak to them and the exact things that they tell. You really need to run this like an investigation.
If you have questions that you cannot really find an answer to, try calling Fertility Lifelines at 1-866-538-7879. It would not also be a bad idea to read up either. That is what all the books in the library are for. In particular, try Evelina Sterling's Budgeting for Infertility for excellent information on how exactly you are to go about paying for your infertility treatments.
In particular, you need to ask for some very pointed information to make sure that you have coverage for the treatments you need. When you call your insurance company, pose these questions:
. What infertility benefits are included?
. What do they feel is excluded?
. Do they have an age limit for the coverage that they provide?
. Do they cover fertility drugs for your plan? How about drugs like FSH, hCG, Gonadotropin, Clomid and HMG?
. What specific treatments do they cover? How about IVF, IUI, ICSI, GIFT or ZIFT?
. How many cycles of IVF to they cover, and how exactly do they define a cycle? If you drop a cycle midway because it doesn't look promising, does it still count as a cycle?
. What specific tests do they cover? Do they cover ultrasounds, semen analyses, progesterone and estrogen tests, lab work, post-coital tests?
. What clinics do they specifically offer these treatments in? What clinics are affiliated?
. Are there any specific doctors and specialists that you should go to?
Do make sure that you know all the diagnostic codes for all the treatments and tests that the clinic does. You will find these records quite useful, should a dispute arise.
You absolutely do need to make sure that you know exactly whom you speak to at the insurance company each time you pick up the phone and call them. You should also look into recording your conversations. In fact, it would not be a bad idea to conduct all your conversations over live chat. This way, you will have a written record.
It's just the way insurance works...
Certainly, this is not the way a happy fertility treatment process should go, but it's the best we have. At a time when most people do not have infertility insurance, it can be a pleasant problem to have, to need to grill your insurance people for specific answers.
We live in a time when people need to turn to infertility treatments more than ever before, to simply have a child. The fact that people think of starting a family quite late in life does have something to do in all of this. The way these treatments are priced though, most people could never afford them without help from their insurance company. How does infertility insurance work, though? Who gets it and who doesn't? This is what this article, based on the keyword phrase "infertility insurance", is all about.