As I prepare for my first visit with the reproductive endocrinologist, I have been examining insurance coverage. Currently there are 15 states that have some form of mandated coverage for infertility, but that isn’t really as good as it sounds. Ohio is one of the states on the list but there are large gray areas. Ohio Rev. Code Ann. Section 1751.01(A)(7) mandates the following[1]:
Requires HMOs to cover “basic health care services” including infertility services, when they are medically necessary.
Diagnostic and exploratory procedures are covered, including surgical procedures to correct the medically diagnosed disease or condition of the reproductive organs including, but not limited to: endometriosis; collapsed/clogged fallopian tubes; testicular failure
IVF, GIFT and ZIFT may be covered, but are not required by the law.
So according to the state law nothing beyond diagnostic and exploratory procedures is required to be covered. However, insurance companies always know how to play the cards in their favor. Personally my claims for several diagnostic procedures were denied because my exclusions stated that infertility care and treatment was not covered. So although it was not treatment, they considered it care and could do as they wished.
I understand the controversy on infertility coverage, in most cases it is not a life treating disease but it is life altering. As I try to educate myself and decide what the most economical decision is for our family, I am struck by the argument of those opposed to infertility coverage. Many believe that insurance coverage for infertility will drive up premiums, which seems to me to be the most logical concern. However, reality is the opposite. “Comprehensive infertility coverage may actually reduce premium expense by as much as $1 per member/per month.”[2] Part of the reason for this is that those that have insurance coverage are able to make the best medical choice not only the best financial choice. Services that those without infertility coverage (myself included) chose are ones that carry higher risks once pregnancy is achieved. Often insurance companies that do not offer infertility coverage can experience higher costs related to multiple births and complications, risks that may have been prevented if other procedures were available to patients.
There were a couple of things that trigger this post. The first being that Maine is currently considering mandated infertility coverage, and I am struck by the misinformed and even hateful comments that people make against it. Many of them are too hurtful to repeat. The second is that Monday I will pay a few hundred dollars, to hear a specialist’s opinion. I’ve been spending the past few days making sure that they have every piece of information they can about me, so that I can get the most for my money. What would you do if it cost that much for you to see a doctor?
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