Association pushes for fertility coverage

Currently, only 12 states require insurance and managed care plans to offer employers the chance to purchase coverage of advanced infertility services. (See list, p. 32.) And many insurers are exempt from this, according to Sean Tipton, public affairs administrator at the Washington, DC-based American Society for Reproductive Medicine.

"Federal law says no state mandate can touch companies that are self-insured — and three-fourths of all insurers fall into this category," he says.

Therefore, the American Society for Reproductive Medicine is seeking federal legislation that would require all insurance companies to cover advanced fertility treatment.

"I fully expect Congress to pass this because it’s going to come down to, ‘What’s more important: shareholders of an insurance company or couples who want to be good parents?’" Tipton says.

In addition, Tipton points out that if major insurers don’t feel the necessity to cover infertility treatments, eventually it will lead to a downward spiral in cutting other types of benefits insurers don’t feel deserve coverage.

"Infertility is a legitimate disease," Tipton says. "What is more fundamental to human life than reproduction? But insurance companies counter with, ‘You don’t drop dead from it.’"

There is medical justification for the belief that infertility is a disease, says Stephen Corson, MD, reproductive endocrinologist, director of Pennsylvania Reproductive Associates and a clinical professor of obstetrics and gynecology at Thomas Jefferson University School of Medicine, both of which are in Philadelphia.

"Some insurers may compare infertility treatment to plastic surgery — like it’s an option," he says. "But it’s much more important than that."

Treatment is not entered into lightly

Ann Bowen, RNC, BSN, perinatal case manager of Women’s Center of Cox Health Systems in Springfield, MO, agrees. "Advanced infertility treatment is not an elective procedure," she says. "People don’t go into it without making a major commitment. It’s an all-encompassing process that is a tremendous time demand, as well as an emotional demand.

"And, it’s not an elective process because so many other diagnoses play into fertility issues," she adds.

At one time, insurers did not cover alcoholism or any mental disease, but they do now because of public pressure, Corson says.

"The irony," Tipton adds, "is that insurance companies are probably paying for a lot of infertility treatment anyway under other diagnoses. If they would cover it properly and put in appropriate restrictions in the number of times a couple could attempt it, then it wouldn’t be a burden."