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Should Insurance Companies Fund Fertility Treatments?

Back in graduate school, we paid a yearly fee to the graduate student union which funded a plethora of projects including the graduate student newspaper. Though I went to graduate school in Massachusetts, the front page article of the weekly newspaper was usually inexplicably about the Israeli-Palestinian conflict arguing in favour of Israelis moving out of the Middle East entirely. Week after week, while there were plenty of newsworthy things happening in the college town and on campus, these topics were eschewed for Middle East politics. And the whole thing made me beyond uncomfortable.

I made an appointment with the Dean of Graduate Students and she patiently listened to why I might feel uncomfortable with my graduate student dollars supporting a newspaper that advocated the extermination of…myself. And then she explained that she cannot control what the editor of the newspaper chooses to print, though the university did end up establishing an anti-Semitism task force to deal with the fallout from the articles.

I then expressed my Plan B, which was to stop paying my yearly fee to the graduate student union. It made perfect sense–I didn’t want to support the newspaper, so I would pull my funding from the organization that supports the newspaper. Except that it didn’t work that way. It turned out that out of the $100 fee, under a penny went to fund the newspaper and the rest of that fee went to support great programs such as rape/crisis hotline and financial aid. Pulling my penny wasn’t going to sink the newspaper that included such scintillating headlines as “Death to Israel” but protesting our graduate student fee or refusing to pay it was going to affect a lot of other programs.

It was my first life lesson in the idea that simple solutions sometimes don’t take into account all the facts.

With health care reform being a hot topic, the discussion of whether it is cost-effective for insurance companies to fund IVF is being debated within and outside the US.

According to Resolve, the National Infertility Association, “Some insurance companies and employers incorrectly believe that adding infertility coverage to a health benefit package leads to increased premiums. In fact, states that have passed laws requiring coverage of infertility treatment actually have reduced overall health care costs.”

The reason being that those with insurance coverage tend to treat their infertility based on the best course of treatment rather than first trying procedures, surgeries, and medications covered by insurance. It saves money to bypass expensive attempts that have a lower success rate based on the reason for the person’s infertility. Coverage of expensive procedures such as IVF, means that those utilizing the procedure can make sensible decisions such as transferring fewer embryos and therefore lowering costs on the back-end including the financial burden associated with premature birth (which is often the case with multiples). According to Resolve, “In states with full coverage for infertility treatment, multiple birth rates (twins, triplets, etc.) are lower than in states with no infertility coverage. (New England Journal of Medicine, August 2002).”

Think about it this way: would you rather have your insurance dollars going towards a $10,000 IVF cycle or a $150,000 hospital bill for a three week NICU stay for premature triplets?

Barb Collura, the executive director of Resolve says,

RESOLVE: The National Infertility Association has known for years that insurance coverage for IVF treatments is not only the right thing to do, but it will dramatically reduce and perhaps even eliminate higher order multiples as a result of IVF treatments. Study after study shows that when you take the cost issue of an IVF cycle out of the equation, patients make better decisions about the number of embryos to transfer, thereby reducing the risk of a multiple birth. A recent study by Shady Grove Fertility on eSET (elective Single Embryo Transfer) among their Shared Risk patients confirms this – patients make better decisions when they are not pressured with paying out of pocket for every IVF cycle. If you only have $10,000 to spend, as a patient you want to get the most for your money, which does not always lead to a healthy pregnancy, mom, or baby.

Yet even with these stark financial facts on the table, if you take the comments and blog posts popping up about insurance companies covering IVF, it appears as if the average, vocal, non-infertile man or woman would rather pay the astronomically high costs associated with premature birth rather than have a few pennies of their insurance premiums go towards IVF. Childfreedom posted two emails that she got from readers on this topic, with one stating:

Covered by insurance? It should be illegal. Nobody ever died from not having a baby…This is the thing I hate most about assisted reproduction: for some reason your body is not able to sustain an embryo or bear a child, but we can chemically torture it into doing what it shouldn’t, all because society says you are a failure as a woman if you don’t pursue every possible option to get a baby, no matter how impractical or expensive or detrimental to your health. Look what Science can do for you! Oh, so many beautiful babies! It’s a miracle!

The Globe and Mail wrote about this topic in regards to Ontario and received 400 comments on the online article which states: “Life’s unfair, and health care is a bottomless pit, and some of these procedures have wretched outcomes” to which many of her readers agree: “To the infertility zealots all infertile couples are angels. Dose of reality many are not, and some have indeed created this by their own making as well. Some should NOT have children, and if nature has assisted with that, maybe that is a good thing too.”

Like It Is jumps off this article with her own thoughts: “it’s clear that it’s not just childfree people who object to being the purse strings for women who think having IVF is their right. The tax-paying public has a right to be alarmed.”

The problem, of course, is that when insurance companies pick-and-choose what they cover without rhyme or reason, the general public is left to argue amongst themselves. Treatments for impotence are covered (“Within weeks of hitting the U.S. market in 1998, more than half of Viagra prescriptions received health insurance coverage.”) but the drugs that help the body release an egg are not. Pregnancy and maternity benefits are well-covered, but abortion and fertility treatments (two sides of the same reproductive coin) are not. We pay a lot of lip service to family building and reproductive health, but then do not give people the means to help themselves or make sound personal decisions in regards to their body.

We can reduce people to caricatures and chalk up all problems to bad decision-making. Those who don’t want insurance to cover gastric-bypass surgery reduce all people experiencing obesity as “lazy, irresponsible, sly and greedy folk.” We can write off all children with ADHD as just needing to lower their sugar intake.

And even though the facts point to the contrary–according to a December 2005 report of the CDC’s National Survey on Family Growth (NSFG), the fastest-growing segment of U.S. women with impaired fecundity (the capacity to conceive and carry a child to term) is those under 25– we can say that those who are experiencing infertility just waited too long to start building their family.

Returning to the lesson learned back in graduate school, simple solutions don’t usually take into account all the facts. That simply writing off sections of the population and deeming certain diseases the fault of the person is reductive and lumps all the various causes for a disease down to a single factor. Instead of stating via insurance coverage that some diseases are worthy of treatment and others are not, let’s aim to have policies that neither reward nor punish, but instead enable citizens to treat their health ailments.

So rather than discuss the people with the disease, let’s discuss the disease itself and whether or not insurance companies should fund treatment based on the ideals and ethics we subscribe to within our respective countries.  I plan to pass on all our thoughts in the comment box to Resolve so they can know our thoughts on the fight they’re fighting on our behalf within the US.

Cross-posted with BlogHer.


1 Heather { 03.15.10 at 9:17 am }

I want to post something thoughtful but reading what people write about me (an infertile woman) my heart hurts too much to write something coherent.

2 Erika { 03.15.10 at 10:44 am }

Thanks Mel! You’re always so great at saying what we would like to say in a way that makes sense and doesn’t put our hearts on the line either! I so appreciate this post.

3 Lynn { 03.15.10 at 10:55 am }

I truly think it is disgraceful some of the comments directed at those suffering from infertility! While it is true that some people who are infertile would not make good parents, the same can be said of some of those who find no difficulty whatsoever getting pregnant, yet no one would dare suggest forced sterility upon them! That would be monstrous! So why do they suggest the inability to conceive is okay for those of us who would make excellent parents?

I wrote a paper last year for one of my classes discussing why infertility treatment should be covered by all insurance companies. The fact is that the cost of adding fertility coverage (to include infertility treatment as well as abortion) would amount to approximately $.16 per premium. This is not even a noticeable amount!

It is my opinion that those who have such horrible and nasty things to say about infertiles should step back and review if they would like such things said to them should they be affected by a disease. For instance, there are many people suffering from cancer who are wonderful people who never deserved such an illness to befall them, yet there are those out there who are suffering with the illness that some would argue deserved it due to their previous actions and attitudes. However, no one would ever say this to them, let alone suggest treatment be withheld from them.

The attitudes directed at infertile individuals due to their infertility are, in many cases, biased, contemptuous and, indeed, bigoted. A person’s ability to naturally conceive a child does not dictate that person’s worth as a human being. We are still guaranteed under the Constitution (at least in America) the right to life, liberty and the pursuit of happiness. In the case of an infertile, the pursuit of happiness may include the pursuit of fertility treatment. If you consider that the right to life includese the right to treatment covered by insurance companies, then you must consider the same for the pursuit of happiness via fertility treatment.

4 PaleMother { 03.15.10 at 11:38 am }

Thanks for helping to arm us with the rational, financial facts about infertility coverage.

“Life’s unfair, and health care is a bottomless pit, and some of these procedures have wretched outcomes”

“Some should not have children … if nature has assisted with that, maybe that is a good thing too.”

What kind of scary, Orwellian, Sci-Fi ‘logic’ is that? These aguement fail completely:

As if nature — of all things — were that discriminating. Nature is purely physical; Man is more than he sum of his parts. How about Steven Hawking, just to name one of thousands? Total fail by Darwinian standards. Worthy?

Got heart disease? Diabetes? Manic Depression? Alcoholism? “Life’s unfair. Health care is a bottomless pit. Charles Darwin and the survival of the fittest”. Gee, with this kind of reasoning, we could completely eliminate health care altogether.

Do we withold treament for ~any~ medical condition based on someone’s (?!) assesment about whether the affected individual is ‘worthy’ of being saved? For one thing, who is qualified to judge that? Who actually BELIEVES they are qualified to judge that? You know, besides Hitler and rednecks and the like?

Or is the worthiness prinicple just for ~infertility~? I am so fed up with people who only “get it” if the gun is pointed in their own face. ‘Worthiness’ as the deciding factor … Honey, NONE of us want to live in that country.

Pursuit of happiness. Just pretty words? Only for some? WTF? This country was founded on prinicples designed to eliminate that kind of polluted structure of priviledge. People have lost sight of that and it scares me to death.

““it’s clear that it’s not just childfree people who object to being the purse strings for women who think having IVF is their right. The tax-paying public has a right to be alarmed.”

Um, totally missing the point of insurance. I don’t have heart disease, diabetes, alcoholism or manic depression (yet). So is it “fair” that the cost of my health care is inflated because lots of ~other~ people have these issues covered by insurance?

And how about the tax payers whose property taxes support our local school system. “Not fair,” right? Nevermind that if we don’t take educating kids seriously, regardless of who they belong to, our national standard of living and everything else that we take for granted will collapse (China the new world superpower ring a bell? How ’bout we let the Chinese governement judge ‘worthiness’ and see how that suits?). Other people’s problems not your problem, right? In your dreams, fools.

Why don’t we just dismantle everything? Because nothing is universally “fair.”

Shoot me now, democracy is the worst form of government, except for all the rest.

Let’s talk about who should get those Darwin awards FOR REAL.

“I never talk about problems. Eighty percent of people don’t care and the other twenty percent are glad you’ve got ’em.”

-Tommy Lasorda

5 Nicole { 03.15.10 at 11:50 am }

The entire concept of infertiles being somehow “deserving” of the disease that has befallen them is completely outrageous! Some of the underlying issue that cause infertility (PCOS, clotting issues, varicoceles, to name a few) can have long term effects on overall health. Yet so many insurance companies deny treatment for these issues if infertility is even mentioned. I am one of the fortunate to live in a state where infertility coverage is mandated. I get the same coverage for my IUI’s and IVF as I do for any other in network doctor and procedure. No person should be denied coverage for fixing something that is wrong with their body. If infertility is “natural selection”, then so is cancer, so is HIV, and so is Heart Disease. No an infertile will not die from her disease, but a new life will not be created because of it.

6 PaleMother { 03.15.10 at 11:52 am }

Sorry that my response was so full of typos. !!

7 Barely Sane { 03.15.10 at 12:20 pm }

I don’t agree with it at all, but I understand why.

I’m in BC, Canada and I already have basic medical thanks to the government. Things like my HSG, lap, & bloodwork were automatically covered and yet, IVF was not. They were willing to pay for me to find out what was wrong but after that, I was on my own. My extended health insurance covered my meds (I’m one of the lucky ones) but not the proceedures, which as we all know, can add up FAST.

It’s much like my dental plan – they will not pay for me, as an adult, to get sealers on my teeth to prevent cavities, even though it’s cheaper than actually covering a filling should I get one. Why? Because it’s a crap shoot. Their mentality is this: I may or may not get a cavity so why pay for something now that they may not have to in the future? They gamble that I’ll take good care of my teeth and try to prevent the cavity in the first place.

I imagine that IF coverage is much the same. Some actuary is sitting in a room, crunching numbers and those of us with IF are on the wrong side of them. They gamble, we lose…. or do we? There are more multiple births than ever before, better medical care allowing premies to survive and more of us suffering from IF that are pursuing treatments than ever before. Somehow, I think these guys need to crunch their numbers again.

Don’t even get me started on Viagra coverage!

8 julia { 03.15.10 at 1:04 pm }

YES, YES, YES, YES!!!!!! Insurance companies should definitely cover IVF. It is not my fault that I can’t get pregnant like everyone else. I need help too!!! I can have all sorts of other surgeries and they will pay. But, when it comes to creating a family and happiness, the insurance companies say no. Shame on them!!!

9 InfertileNaomi { 03.15.10 at 1:05 pm }

Yes. But there should be a limit on treatment.

10 Baby Smiling In Back Seat { 03.15.10 at 1:09 pm }

First of all, I was 26 when I started TTC, so the “your own fault” advanced age argument never sat well with me.

Even with ALL the money we spent on treatments, the bill for my month-long hospitalization plus the twins’ NICU stay was more than we spent to have them — but it was close. The IF chunk out of our pocket and the pregnancy and NICU chunk from the insurance company. If we’d had IF coverage including IVF the total bill probably would have been 15-20% of that, even assuming several cycle attempts, and I’d have enough extra money to buy half a dozen new cars.

11 Katie { 03.15.10 at 1:11 pm }

I’m so glad that Viagra coverage was mentioned here. I’ve written several letters to my state reps about mandating IF coverage in our state (I live in Florida) and I always mention Viagra. Why? My insurance policy does not cover IF treatments because they are “elective procedures” (this includes meds). However, it WILL cover Viagra. In that case, why is getting an erection medically necessary, yet ovulating isn’t?

I have a friend who writes her company’s HR department every year about their lack of IF coverage, yet their willingness to cover penile implants. No joke.

I just want equal treatment for IFers. That’s all.

12 Flying Monkeys { 03.15.10 at 2:05 pm }

When the contract at my husband’s job was bought by a new company and we learned the insurance would be revamped, we promptly wrote letters. We explained that infertility is recognized as a disability and how the its inclusion would help lift a “burden” off of the workers who might be struggling with it thus leading to more productivity and happier workers. We didn’t expect much. They added it. It’s capped but they added it and because of that we have The Sprout. We’d already spent all we had on the 3 1/3 previous years and a cycle that ended in m/c and 2 failed FETs. We had another shot. I was just grateful that a chance at all was given.
Yes, I think it should be covered to some extent. Maybe not limitless, but a chance.

13 Megan { 03.15.10 at 2:14 pm }

I think our first hurdle is getting the general public to recognize infertility as a treatable disease. Look what this did for alcoholism. Suddenly “drunks” were no longer “drunks” but people with a disease that could and should be treated (and even covered by insurance).

Yes, no one will DIE if they don’t have children. No one will DIE without a wheelchair to assist their mobility. No one will DIE if their eyesight is not corrected. Society does not deem most diseases and conditions as worthy of insurance coverage based on whether a person will DIE without treatment.

(This is where my arguements get a little radical.) And if having children is elective, then why do we cover childbirth with insurance dollars? Why should my premiums go toward the “treatment” of someone’s elective condition of pregnancy? Why do I have to pay real estate taxes to support schools when my family has no means to participate in public education?

(Back to less radical argument.) Once infertility is accepted as a legitimate treatable medical condition it is hard for people to argue that it should not be treated with insurance dollars.

Even age related infertility should be considered a disease. Yes, choice is involved…arguably older parents would not be infertile if they had not waited to have children. But we don’t withhold insurance coverage to smokers who develop lung cancer (which is also a choice with well publicized risks).

I think the key…and where we all need to focus awareness efforts is recognition of infertility as a treatable disease.

14 Megan { 03.15.10 at 2:18 pm }

…and another hurdle is that religion gets all wrapped up in IVF.

15 Heather { 03.15.10 at 2:38 pm }

I hate it all.

SO, what if Insurance companies decided that IVF wasn’t worth funding—but they funded adoption? Or that you could have the choice…adoption or IVF. I know with our insurance I could get Clomid covered, but that was it. Anything over that, was out of pocket.

The whole thing makes me nauseated.

and it hurts my heart.

16 Geochick { 03.15.10 at 2:55 pm }


Yeah, what you said!

17 Eve { 03.15.10 at 3:42 pm }

I was thinking along the same lines as Heather…how much of my insurance dollars have gone to treat smokers, heavy drinkers, sexually trasnmitted diseases and the myriad of other seemingly ‘preventable’ diseases that could be prevented?

I get so sad to read the hate that is out there. My state does cover infertility treatments, but there are loopholes, and my dh’s company used this to deny the mandate. We were were at least fortunate enough to have some coverage for IF, including ultrasounds for non-IVF procedures and even IVF meds. Sadly enough though, my IVF procedure resulting in twins (which we would not have chosen if we had full coverage) has resulted in thousands of dollars of medical treatment due to complications.

I figure, people think things are fair until suddenly they are put in an ‘unfair’ situation themselves. It may not be infertility, but assuredly, EVERYONE will face unfair in their lives at some point and be humbled accordiningly.

18 LJ { 03.15.10 at 4:01 pm }

I’m with the others that have said how those of us lucky enough to have insurance pay for thousands of treatments that a) we will never use and b) are not life threatening or even lifestyle threatening. I’m okay with that. I’m okay with paying more in taxes so that an impoverished family can get some food on their table.

I’m not okay with people not returning the favor when I need it.

19 Valery Val { 03.15.10 at 4:05 pm }

I live in a country where up to 3 rounds of IVF per child are covered, with two but mostly 1 transferred. Also the doctor decides wether it is worthwhile trying again, not me.

From a number crunching point of view: if more insurance companies were covering more IVFs, wouldn’t the price for one IVF go down? (Negotiating power of big companies bigger than of IFers?) Just a thought….

20 Lisa { 03.15.10 at 4:07 pm }

The problem I have with the argument that “covering IVF will actually save money” is this: if that’s really the case, why aren’t these supposedly evil, money-grubbing insurance companies already doing it?

I’m pretty skeptical of the notion that a bunch of state legislators know better than the actual companies about what’s best for their bottom line.

As an infertile — but one who strongly believes that free markets are best at providing the greatest good for the greatest number — I would only support mandatory infertility coverage if it included strict limits, especially an age limit for IVF. Otherwise things get ridiculous pretty quickly.

I’m fairly sure claims about how “cheap” mandatory coverage is do not include scenarios where 45-year-old women are entitled to multiple “free” rounds of IVF.

21 a { 03.15.10 at 5:25 pm }

I generally like to play devil’s advocate, but I can’t think of one rational reason why infertility should not be a covered disease. Life choices that lead to medical issues are covered all the time. Congenital defects and genetic diseases are covered all the time.

Based on the “it’s not fair” idea, the only thing that should be covered are legitimate accidents.

22 Courtney Boyle { 03.15.10 at 5:28 pm }

Having become infertile not by anything I did, but by the careless acts of doctors, I think infertility treatments (including IVF) should be covered by insurance. I did not ask for a doctor to botch my ruptured appendix surgery 15 years ago that caused so much scarring in my abdomen that one fallopian tube never worked. I did not ask the doctor to misdiagnosis my ectopic pregnancy as a miscarriage causing me to have life-threatening bleeding and surgery. I did not ask the doctor to try and save my fallopian tube and also try to fix the non-working tube, but in the process causing an infection in both tubes that required their removal in a second more invasive surgery. I fail to understand why my insurance company would cover endless ultrasounds for IVF purposes and thousands of dollars of bloodwork, but refuse to pay for one fertility drug or any part of IVF. They cover Viagra, birth control pills, Plan B, and some parts of IUI’s, but mention the words fertility drug or IVF, and they won’t cover a thing. Therefore, I believe they should cover infertility treatments (including IVF), but with limitations. I am not advocating for a endless try, endless money system. There should be limitations on how many cycles are covered and what is covered. I also believe (I’ll probably get hate mail on this) that there should be an age limit. I agree with Lisa above on that. Even with the miracles of modern medicine today I don’t think insurance companies should be paying for women trying to extend their fertility well into their 40’s. If we had insurance coverage for IVF I am pretty sure we would have tried another round, but we don’t, so we had to move on to something we knew that 100% would produce a baby for us which in our case is adoption.

23 Lut C. { 03.15.10 at 6:09 pm }

In my country number of HOM and twins went down immediately when coverage was introduced. The facts speak for themselves, coverage of IVF results in cost reductions down the line.

Why insurance companies don’t choose to cover IVF out of their own interest then? And they do cover Viagra etc.? Perhaps the board room is filled with men?

24 Calliope { 03.15.10 at 9:52 pm }

hells yes it should be covered. If anything to regulate the out of control insane rates that some clinics charge. For example- I needed a baseline ultrasound in one state that is not pro woman (Florida) and was charged $800. The same ultrasound performed in a state that has mandated infertility coverage was $100.

25 Michelle { 03.15.10 at 10:00 pm }

It is both sad and makes my blood boil to hear what people say about those of us who have infertility struggles. Do they say to someone who is a quadriplegic due to an auto accident or some other accident…well it is your own fault you should not have been driving the car so we are not going to treat you? No we do not. You would be ostracized for saying such things. Why is it then ok for people to say that to us. Unfortunately, I think that anyone who has not gone through this will never understand and will continue with their ignorant and judgmental comments. It i really frustrating.

I am thinking of moving out of my state to a state that mandates it. I do not know how I will ever afford to have the child I dream of and with the outrageous bills that the state of Michigan is trying to pass I may end up without a choice if I want to have a child.

The fact that I can not have a child is not my fault or anyone else’s who is going through this. We like to blame ourselves. I spend many a day beating myself up for things that I have or have not done trying to put an answer to the question…Why me? The fact is if we were at fault or this was something we deserved then there would be no crack addicts with babies and no child abuse because those people do “NOT DESERVE” children. If we all got what we deserved then I am sure all of us fertile and infertile would have nothing!

26 NotTheMama { 03.15.10 at 10:40 pm }

Ouch, ouch, and OUCH! Because of bad genetics, I “don’t deserve” children? I suppose, then, that if an accident is deemed “my fault,” my insurance should not cover any resulting injuries? Ridiculous.
One of the reasons we are opting out of TESE/ICSI/IVF and moving straight to adoption is an insurance issue. On our own, we can afford EITHER one attempt at treatment OR adoption, and are even pushing it for that one chance. If our insurance covered even one IVF attempt, we would at least have the opportunity to try.

27 Jacksmom { 03.15.10 at 11:10 pm }

I am with Heather. I am so hurt by what people have said about infertile people, and honestly, feel as if they are discriminating that I don’t have anything coherent to say. Perhaps if they were the ones who wanted to have children so badly, but for whatever reason were unable to, they would feel differently. I am so upset by the comments those people left that it is unreal.

28 S.I.F. { 03.16.10 at 4:31 am }

I honestly would have said no to insurance companies funding fertility treatments before this. I didn’t think it was the responsibility of anyone else to pay higher premiums so I could have that coverage (even though I would love it!) but I had no idea it could actually be cost saving… that is amazing! Thank you for giving me something to think about Mel!

29 Natalie { 03.16.10 at 7:13 am }

Wonderfully written, Mel.

30 Bea { 03.16.10 at 8:12 am }

I grow weary of this argument.

Conception is such a tiny slice of a person’s resources. Instead of preventing funding for IVF, let’s just sterilise all those who unnecessarily drive SUV’s, who teach their children that it’s ok to drive SUVs. Or go on international holidays. That sort of thing. That’ll have more impact on our environmental problems. Make everyone use cloth nappies and ban bottles. Medical reasons for not being able to breastfeed? Fund wet nurses. The obvious solution.

Or we could kill off those we don’t like, or those who aren’t useful enough, or who don’t live up to some sort of other standard – I’d rather have some IVF-conceived people than some non-IVF-conceived people I could name. Or make everyone apply for a license to have each child and redistribute all children according to parenting merit (and I get to decide what constitutes “merit”. Serious points loss for gay bashing). Or make everyone pass a genetic test, and only give breeding rights to those who rate most highly – as if infertility is mostly inherited (anyone ever think about that statement? because at 1 in 8 couples, those infertility genes have been getting passed down at one heck of a rate for centuries before IVF treatment was available considering you can’t pass them down because… you’re infertile and can’t have children). Or let’s go all Big Brother on everyone’s lifestyles and make them earn brownie points for being health-conscious and only reward them with healthcare to the extent we can absolve them of responsibility for their problems. Because that won’t get scary or ridiculous beyond a certain point (also: hint – infertility treatments would be well covered under this scheme).

Honestly, I don’t really care for the moral debate here, at all. It’s going to save you money on your premiums. But ok, here’s the thing – it’s not just going to save you money, you who can afford to pay your premiums still, it’s going to mean the difference between health care and no health care for some. But here I am getting all moral again. So let me put it another way:

If there’s a problem with the law, talk to the lawmakers. Let the actuaries do their thing in peace, since it’s not hurting anyone. Meantime, if you don’t like IVF, don’t do IVF.


31 Bea { 03.16.10 at 8:17 am }

I want to repeat this one:

Yes, no one will DIE if they don’t have children. No one will DIE without a wheelchair to assist their mobility. No one will DIE if their eyesight is not corrected. Society does not deem most diseases and conditions as worthy of insurance coverage based on whether a person will DIE without treatment.

(This is where my arguements get a little radical.) And if having children is elective, then why do we cover childbirth with insurance dollars? Why should my premiums go toward the “treatment” of someone’s elective condition of pregnancy? Why do I have to pay real estate taxes to support schools when my family has no means to participate in public education?

32 Bea { 03.16.10 at 8:18 am }

I don’t find the argument (above) radical at all. It’s only the logical counterpoint.

(Sorry, hit post by accident a little too early on the last one.)

33 Kir { 03.16.10 at 8:21 am }

as always, it’s wonderfully written. I read this yesterday and so was so affected by it, I cried and ranted all the way home. John was honestly worried about me, because I was so inflamed.
I wrote about this on my blog before we tried IVF and I still feel the same.
For everyone that thinks that my children are NOT MIRACLES, well I can’t get past anyone thinking they are not. My heart hurts after reading some of the comments in this post from small minded and selfish people.

thank you for writing this, maybe someone who needs to will read it and have a change of heart.

34 Kir { 03.16.10 at 8:24 am }

oh and Bea..as usual…I adore you!

35 Hope in Briarrose { 03.16.10 at 8:44 am }

It physically and mentally hurts me to see any woman who wants a child not be able to see that dream because of money. It is heartbreaking. I *wish* that insurance would cover IF treatments, even IVF, for infertile couples. I know women who have had IVF but could only afford 1 cycle and that cycle failed and now they have nothing…..just a 10K bill that they don’t know how they are going to pay for.

I wish there was something they could do.

It just breaks my heart.

36 Karen { 03.16.10 at 11:27 am }

Heh. In my case, my insurance company paid about $20K for their mandated IUIs and still paid about $150K for a month long NICU stay for my triplets. Of course, if they’d just let me skip straight to IVF, they would have had a much less likely chance of paying for triplets and a NICU stay. I think my total costs (including my out-of-pocket costs) for the IVF attempts this time around came to about $80-90K for treatments, monitoring, and drugs. But there’s only one kid in there this time – and a much lower chance of a $150K NICU bill in a couple months.

37 Heather { 03.16.10 at 11:39 am }

All I know is, if my insurance did not cover infertility, I wouldn’t be pregnant right now. I am so grateful that we had coverage because I know that many, perhaps most, don’t have that option and that just adds to the heartache they have. It’s the waiting that is so hard, and waiting to save up money to conceive is beyond what I can comprehend. Why can women across the country so easily abort, and that is widely supported, but those who want to be mothers are finding it very hard to do so? I think that is outrageous.

38 Lavender Luz { 03.16.10 at 4:33 pm }

Humans will always have needs/wants that exceed their resources. The way we reconcile the two is by setting priorities. Basic economics.

And the most efficient way to set individual and group priorities is with a free market system. People spend their own money on what matters most to them. When people spend other people’s money, they are not near as careful.

An insurance program at its most basic is merely a way to share risk among members of an opted-in population.

In years when you’re lucky, you pay a lot of money in premiums and don’t need to get your money’s worth — you are a net contributor to the pot. In years you’re unlucky, you have a situation that requires you to pull out more $$ than you put in. The healthy subsidize the unhealthy. Or, the you in healthy times subsidizes the you in unhealthy times.

If you’re super unlucky, you weren’t able to opt in and contribute to the pot and you have no group to cover you.

I do not believe that the government should mandate that IF treatments should be covered by insurance. I DO believe, however, that insurance companies should be free to offer an inferitility rider for people to buy before they have reason to need it. If an insurance company thinks that there will be more $$ going into the pot (#-opting-in x $-amt-of-added premium) than there will be people pulling out of the pot, then the company should offer it out of self-interest.

Much the way you can get dental and vision add-ons now.

One reason there have been so many advances in IF treatments is that people are willing to pay THEIR OWN MONEY for it. Like LASIK, incredible advances have been made in recent years because it’s a problem that people have made a priority. They have forsaken other wants and needs in lieu of family-building pursuits.

As for “pursuit of happiness,” no one is saying that infertiles can’t pursue what makes them happy. Just that they have no claim to the fruits of other people’s labor to do so. Those other people may have their own priorities, their own troubles to solve.

As I said at the beginning, there will always be more wants/needs than resources. Covering every one of them would collapse any human system, as Lisa says above.

39 Bea { 03.16.10 at 7:00 pm }

Lavender – healthcare is actually a really good example of where free market theory breaks down. First of all, you get orphan diseases (rare ones the free market doesn’t care about, which affect those individuals greatly). Then there is the fact that a person’s desire to pay is often inversely related to their ability to pay. Lastly, free market theory is only worth a damn insofar as it’s good for the economy, and it is, on balance, worse for the economy to delay or deny medical treatment to those who could otherwise be productive members of the workforce and whose ailments might otherwise be minor and cheap to repair, also to those who would otherwise produce wanted and productive members of society for the future (ie, infertile people).

That said, throwing out the free market entirely doesn’t work wonders, either. There’s a balance.

I have no problems with a fertility treatment rider (I, for one, would pay the extra $2/yr just in case) but only if maternity care is offered on a similar basis under the same policy – fair is fair.

Also, note that countries like Australia – with some of the best coverage in the world for IVF – hit well above their weight in terms of advances in treatment, probably because of the generous coverage – so I don’t think making people pay out of pocket is at all what the advancement of science needs, either.


40 Liddy { 03.16.10 at 8:54 pm }

I take a different perspective seeing that I am a wife of someone who has male-factor infertility. I can scream not fair all I want, but then I have to remember that in our IF journey, it is ‘we’ and if I blame him in one instance- he has every right to leave me.

I should be demanding IF coverage. Hell, my husband had surgery at 16 to stop his testicles from twisting in order to preserve his fertility. So the insurance company will cover ‘preserving’ his fertility but when the ‘preserving’ methods did not work and he was presented with infertility- the insurance company wanted nothing to do with us. We ended up switching companies since I took a new job and they will cover the IUI.

When the book of ‘American Priorities’, I think that is what it was called (the thing Obama’s group did before he took office in 2009). I wrote the infertility coverage should be covered. When I stated that our infertility was because of a male-factor issue, I was instantly pounced on with comments of, “You should have married someone else.”

I don’t understand the who decided why insurance companies are paying for Viagra. I am curious how many members of congress have visited the IF island of hell or even know such a place exists.

I could write more but I think I will save it for a blog post.

Thanks Mel, as always, a great perspective.

41 Missy { 03.16.10 at 10:27 pm }

A couple of thoughts. First, about covering IF through a rider. This won’t work. The fact is, most people in the US get their insurance coverage through their employer, where you either take what is offered or don’t. There is no option to get a rider for an additional disease or procedure should you need it in the future.

Second, the problem with assuming that the free market will take care of assigning our limited resources to our priorities is that the efficient market theory assumes that people are rational actors. We are not. We make irrational decisions all the time (just look at how great the market was for assigning risk to sub-prime mortgages). There is an entire field of behavorial economics devoted to how people do not actually behave in ways that support the idea that the market knows best.

Third, the argument that some diseases are deserved and who gets to decide which those are reminds me of something a college professor told me. He studied the increasing presence of learning disabilities in the past few decades and how it is linked to income levels. In short, children who are low achieving and poor are considered slow or not very smart. Children who are low achieving and rich are labeled learning disabled. Likewise, high achieving poor kids are labeled hard-working while high achieving rich kids are labeled gifted.

How you perceive “deserving-ness” and the labels you give to people are influenced by where you sit.

42 Bea { 03.17.10 at 12:05 am }

(From Missy:)

“A couple of thoughts. First, about covering IF through a rider. This won’t work. The fact is, most people in the US get their insurance coverage through their employer, where you either take what is offered or don’t. There is no option to get a rider for an additional disease or procedure should you need it in the future.”

This is true. It is a good example of where the free market *should* be allowed to prevail, in that people should be able to choose a level/type of cover that suits them as an individual. For eg, I do think an opt-out/in for infertility or maternity is a good idea, also people could choose different levels of copay to share the risk according to their financial priorities/level of cash flow/taste for risk, or they could *gasp* even choose a company by themselves, like they do for other types of insurance. This whole take-what-you’re-given stuff is rubbish. So is the shop-for-a-job-with-insurance-that-suits stuff. People should be working where they work best. The insurance system should allow this.

(This is kind of a side point – really, there are strong arguments for bundling infertility with maternity cover. First of all, it’s fair, although I have no problem with splitting it up and allowing opt-in/opt-out for the infertility part if the company wants to do the paperwork for a $2/yr difference in premium to keep customers who feel that damned strongly about it happy, as long as the individual policy holder gets to choose, not the employer. But there’s also an economic argument – if you cover maternity, but not infertility, you are going to pay for it in NICU bills and people are going to die, because you promote risk-taking behaviour. You can re-balance this risk by bundling both together. No infertility – no maternity. Maternity – and infertility.)

Of course, Missy is right that free market theory assumes rational choices, and people fall short of that. But to some extent people do generally respond in certain, arguably rational ways to various situations and incentives, and to that extent it does still have a useful (limited) role to play in constructing a health care system. Letting patients choose their insurer, their level/type of cover, and their doctor puts the free market to good, efficient use. Making patients pay out of pocket for specific, arbitrarily-chosen conditions whilst covering other conditions is missing something somewhere.


43 Guera! { 03.17.10 at 8:00 am }

Your post and the comments that follow were all very interesting. Working in the insurance industry (but not for an insurance company!) I see all the time where certain treatments are not covered until other treatments and methods are tried first. This often results in expense , time off work, loss of productivity and use of valuable resources only to circle back to the original recommended treatment. It burns me up that my insurance company presumes to know more about what I need than my doctor. However, insurance does not exist to pay for everything under the sun. It offers protection in the event of a catastrophic medical occurance. Yes, it’s imperfect. Yes, it’s unfair sometimes. Yes, it has it’s crazy loopholes, exclusions, limitations etc. Yes, people sometimes find themselves the victims of insurance greed and stupidity. As long as imperfect human beings are in policy-making positions nothing will ever be perfectly designed. Having or not having children regardless of the reasons is viewed as a “lifestyle” and not a “medical” circumstance or choice. I am not saying I agree with this. (I wrote a post about it once a long time ago). Not having good tires on your car could lead to a fatal accident. But car insurance does not pay for tires, nor car washes, nor oil changes. Forgive the comparison…I know it falls woefully short. Insurance was not meant to enhance or improve our lives. It was meant to protect us in the event of a catastrophe or prevent astronomical future claims. With regards to gastric bypass surgery for obesity. This surgery was once covered routinely. It’s expensive, risky and not always successful. The insurance carriers had to weigh the benefits, risks and expense. In the past I have helped a handful of clients successfully get this surgery approved for coverage only to have one of them die from complications. A couple of others had complications that sent them to the ICU. Many patients suffer from malnutrition afterwards and lose their teeth and/or hair. It is a very risky, expensive surgery and not a sure fire cure for obesity. Ultimately most carriers decided to stop covering it. If infertility treatments were covered by insurance I’d be the first in line. I do however, understand why they are not.

44 Rachel { 03.17.10 at 10:32 am }

Brilliant. Thanks so sending out calm, rational thought about this topic. It is so needed!

45 Rachel { 03.17.10 at 10:32 am }

Pardon…meant to type “Thanks for sending out…”

46 wifey { 03.17.10 at 10:25 pm }

To all who care about this issue, I urge you to visit the RESOLVE website and use their form to write to your legislators.

The issue of whether or not infertility treatments should be covered by insurance is something I feel deeply about. The fact is that I have a medical condition, and do not have access to the treatment my doctor thinks will resolve my condition. My mother – whom I love dearly – is obese. Her insurance company is paying for her to have a lap band surgery, and for all of the pre-anesthetic testing required. I am glad that she can access a treatment for her condition, but it burns me up that she has coverage for this – for a condition that her lifestyle did indeed cause – and so many infertiles are denied coverage. It just plain sucks.
From an economic point of view: my husband and I – and I’m sure many other infertile couples – are forced to scrimp and save every penny so that someday we may afford treatment. Those are dollars that will no longer be boosting the local economy: dinners out are on hold, as are purchasing a new car, hiring contractors to repair/remodel our home, visits to local museums and other cultural events, etc. We are no longer donating to charities or taking vacations. We are, in short spending less, which means less in sales tax revenue for our city and state. We are willing to make these sacrifices if we must, but multiplied across the many infertile couples who must do the same to afford treatment, the impact on the economy is huge. Everyone suffers when infertiles are discriminated against.

Just my two cents 🙂

47 mrs spock { 03.20.10 at 6:36 pm }

I work for one of the largest insurers in the US. Most people do not buy and choose their own insurance- it is not so much a free market per se. Employers choose the benefit packages, and with the recent economic downturn, they are choosing more scanty packages. A free market also means that you have the option to choose something or not freely, and it is available to everyone who can pay. Traditional insurance is NOT available to everyone. You can and will be turned away if you are deemed too great a risk. Ask my sister. She spent one night in the psych ward at 18 and has been denied insurance ever since. The only reason I, with my heavy medical use and multiple physical problems, can maintain my insurance, is because the law requires it. Should Mr S and I both lose our jobs and the ability to pay for the premiums under COBRA, I will be SOL in perpetuity.

I cannot see traditional insurance offering infertility riders. In order to have a great enough risk pool, people with normal fertility will have to be scared in large enough numbers to purchase that coverage, thereby making the cost affordable to those who need it.

In my own situation, my insurance, back by New York law, covered everything up to injectable/IUIs. The best, most medically sound choice for us, should these Femara cycles fail, would be IVF with a single embryo. IVF is not covered. And, yes, I am tempted to risk multiples on a $55 cycle instead of a $15000 cycle.

48 Battynurse { 03.25.10 at 1:18 am }

Very well stated.
It is difficult when you are having to pay out of pocket for everything. It also sucks when you have to make decisions on family building based on the number in your checking/savings account. There will still always be people who say that treatment shouldn’t be covered just as I’m sure there will always be people who say gastric bypass shouldn’t be covered because it’s my own fault I got here. As far as other people’s comments? Those just piss me off. Until you’ve walked in someone’s shoes, statements like the ones you listed are just cold.

49 nonlineargirl { 03.25.10 at 10:37 pm }

From what I have read about fertility clinics being willing to or even pushing for transferring multiple eggs as a way to ensure higher “success” rates (and then use that data as marketing to get more clients use their clinic instead of some other) I am not convinced that coverage for IVF would reduce the occurrence of multiples. As someone who has gone through multiple rounds of IVF and who works in health policy I am not sure whether it is a good policy idea. I just can’t separate my emotions from the equation. I do think that it might be worthwhile if insurance coverage was paired with a limit on how many eggs could be transferred at once. (and I say this as someone with twins – I would not give them back, but still.)

50 Anna { 05.13.10 at 9:06 am }

To those who say that “it’s our fault,” and all that garbage, how would you feel if the shoe was on your foot? Oh yes…no one ‘DIES’ from it, as it was cruelly stated in the article. Well, I have uterine fibroids. My insurance won’t cover the cost of them being treated because it’s “non-essential.” Non-essential? How would they like it if they hurt so bad every month they wanted to die? Oh, but they’ll cover viagra.

Yes, I would love to have a child. My husband and I would make great parents. We are going to look into options and see what can be done. (My fibroids can cause infertility).

I guarantee that if the shoe was on the other foot, we’d all be hearing the opposition whining about how their insurance doesn’t cover them.

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