Mandatory Fertility Coverage!

lrose7 · 12-08-2007, 02:58 PM

Did you know 15 states have mandatory feritlity coverage? I just found out tonight.

I dont know if this is posted anywhere on this forum, but I found it and thought it was pretty important.
I would like to encourage anyone to send this letter to their local legislation. Its a form letter all ready to send off, just fill in your information.

If enough of us start to speak out maybe we can make a difference.

Sponsor Infertility Coverage Legislation
Dear [Decision Maker],
I am writing to request that you sponsor legislation that would require insurance companies to provide coverage for infertility treatment. Currently, 15 states throughout the country require or encourage some type of infertility treatment.

Infertility is a medically recognized disease that affects men and women equally. Still, many insurance companies do not provide coverage for treatment to overcome this disease, but single out infertility for exclusion. I find this to be discriminatory. Well-managed insurance coverage will not place a large burden on insurance companies. Studies have shown that infertility coverage may actually reduce costs by limiting costly treatments that have low rates of success in treating the underlying problem.

In fact, a recent employer survey conducted by the consulting firm William M. Mercer found that 91 percent of respondents offering infertility treatment have not experienced an increase in their medical costs as a result of providing this coverage.

Insurers argue that bearing children is a lifestyle choice. In fact it is. But it is not a choice to have a disease that prevents a person from having the option to bear children. Insurers raise concerns about some treatments and the possibility of multiple births and the associated costs. Reproductive doctors are careful to help couples minimize the risks associated with multiple births. A study published in the New England Journal of Medicine (Aug 29, 2002) concludes that the incidence of multiple births is actually lower in states that have enacted an infertility insurance requirement than in states without coverage. Why? Because couples with insurance coverage are free to make purely medical decisions when pursuing some infertility treatments, as opposed to other couples who must also weigh financial considerations that often result in medical risk taking, multiple births and a high rate of complications during and post-pregnancy.

In 1998, the United States Supreme Court ruled that reproduction is a major life activity under the "Americans with Disabilities Act." This ruling demonstrates the importance of reproduction and the impact that infertility, in which the ability to reproduce is impaired, has on the lives of men and women.

Many affected by infertility do not feel comfortable speaking publicly about this very private struggle, but we represent all racial, religious, and ethnic groups, as well as both sexes. We are neighbors, co-workers, friends and relatives, and we just want to experience the joy of raising families without having to bankrupt ourselves in the process. Please support infertility coverage legislation and help fulfill the dreams of thousands of couples waiting for a family to love.

Sincerely,
[Your Name]
[Your Address]
[City, State ZIP]

lrose7 · 12-08-2007, 03:02 PM

For some reason it wont let me add the source URL.... Im I doing something wrong?

I got this from

RESOLVE - The National Infertility Association's website.

Tummy · 12-08-2007, 08:54 PM

Interesting... do you happen to know which 15 states require coverage? I'm in Texas, and I don't know what the law mandates, but my insurance covers only $2000 per calendar year, which we all know is gone within a cycle and a half at most. So I wonder what the laws in those 15 states require as far as how much coverage one gets... like everything?? Wouldn't that be incredible...

SnowFlower · 12-08-2007, 10:18 PM

I was wondering the same thing.. I am in VA

lrose7 · 12-08-2007, 11:17 PM

From what I read it states that options for fertility must be offered, each individual state has its own requirements as to limits, etc.

I tried to post the source URL but it wouldnt let me... Its from RESPOND 's website. They list the 15 states....

See if this link works... Click on your state. COME ON EVERYONE SEND IN THE LETTER! LETS GET IT MANDATORY FOR EVERY STATE!!!!!!

http://www.resolve.org/site/PageServ...=ta_ic_stintro

Ella831 · 12-10-2007, 12:17 PM

That is definitely interesting.I know 4yrs ago the insurance we had covered all of the fertility treatment and drugs except IVF. We were blesssed to find that out and try fertility then,but unfortunately we did not end up pregnant. Now our insurance covers no fertility expenses. Even some of the diagnostic tests are not covered by our insurance.We also have to make sure if we see a doc. that is working with my PCOS that they do not use infertility as a diagnosis code on any of my visits or billing otherwise nothing will be covered. It is very frustrating. Although for us now we at this point will most likely not try fertility treatments again. It was too emotionally difficult and draining for me.

Tracy1078 · 12-10-2007, 12:29 PM

this is really interesting.. it should be mandatory. it's not fair how much it costs literally go broke from this.

lrose7 · 12-10-2007, 06:00 PM

Quote:

Originally Posted by Ella831

.We also have to make sure if we see a doc. that is working with my PCOS that they do not use infertility as a diagnosis code on any of my visits or billing otherwise nothing will be covered. It is very frustrating.

Ella - how did you make sure the clinics did not bill the visit as fertility? We are having the same problem with our visits as well. Our insurance covers ZERO fertility, if the word is even mentioned it seems you will pay for the entire visit out of pocket. Let me know if you have any tips regarding that.

Everyone... PLEASE SEND IN THIS LETTER!! Wouldnt it be great if we could change this to make it mandatory for every state!?!?!?

sunshine_4_jt · 12-11-2007, 04:31 PM

My insurance, through the state, only covers up to $5,000 for diagnoses only! Once a diagnoses for infertility is made it will cover no more! That really stinks too, because I was just dx'd with PCOS

although I'm glad to have a dx, I'm sad because from now on everything comes out of pocket (except the metformin)

lrose7 · 12-14-2007, 10:36 PM

Quote:

Originally Posted by sunshine_4_jt

My insurance, through the state, only covers up to $5,000 for diagnoses only! Once a diagnoses for infertility is made it will cover no more! That really stinks too, because I was just dx'd with PCOS

although I'm glad to have a dx, I'm sad because from now on everything comes out of pocket (except the metformin)

Thats too bad, but thats more coverage that most have. I dont have anything.. zippo, zilch, nada!

I wonder how it works when you work in a different state that what your employer is based in... anyone know this?

Jenn-Loves-Chris · 12-14-2007, 11:42 PM

Quote:

I wonder how it works when you work in a different state that what your employer is based in... anyone know this?

Our insurance (BCBS) is through DH's employer which is headquartered out of IL, a mandated state. We are in GA and have NO fertility coverage at all. They will cover some testing and some drugs, but absolutely no procedures. His company underwrites their own policies, so I guess thats how we got screwed. Its tempting to request a transfer to a mandated state just to get treatment and then move back

Kathy2579 · 12-14-2007, 11:52 PM

States that require coverage of at least some infertility treatments:
Arkansas
Hawaii
Illinois
Maryland
Massachusetts
Montana
New Jersey
Ohio
Rhode Island
West Virginia

States that require insurers to offer coverage, but employers don't have to accept:
California
Connecticut
New York
Texas

I am in MA I know I am very very very lucky. I signed it and will pass it on to my friends in MA

VivC · 12-15-2007, 01:29 AM

I live in Maryland. Insurance companies here have to cover everything except InVitro - it's a start. I believe they can limit the number of cycles for other IF treatments, though.

guineapig · 12-17-2007, 05:16 AM

I live in GA and work in GA and our insurance does not pay for squat, not even Clomid. The only thing you can sneak by them is ovarian drilling for medical condition PCOS.

As for diagnostics, they pay some of the female's and none of the males.

"Family" friendly "values" state my tail! That insurance pays for elective abortion and viagra, to add insult to injury!

beamommy08 · 12-17-2007, 06:51 AM

I found that out only when we began our journey of ttc with a Doctor when we moved back to my Husbands home of Hawaii. Turns out that Hawaii has a state law that fertility coverage be offered. My DH has a wonderful job and great insurance. We are on our 5th cycle and all that we have had to pay for is the $14.00 co-payment. The rest is covered!!! amazing!! In Colorado where we came from it would have been boo- coo bucks that we couldn't afford. I feel so lucky to have this coverage.