Written By: Gina As some of you may know, we now have an “Infertility Hurts” page on Facebook. Several people have brought up the issue of insurance coverage in regards to infertility treatments and testing. The coverage varies by state and by how each union or organization purchases plans for their employees. Every plan is different and coverage ranges from 0-100%. In my case, I was covered at 50% for infertility testing and 0% for “experimental” testing..which included IVF. This has proven to be yet another issue regarding infertility as many believe if pregnancy does not happen naturally, people should have to pay for what they want. There has also been a lot of media attention on multiple births. According to the research Alicia and I have done that is present on http://www.friendinreach.blogspot.com/, and in our upcoming book, “A Girlfriend’s Guide Through Infertility,” several factors can affect fertility including many environmental factors and common personal and household products people use every day. My infertility issue was labeled “unexplained,” so there was no official medical reason as to why I could not become pregnant on my own. How treatment for this was defined as “experimental” I will never know. Once I found an infertility specialist, she was not covered under my insurance plan. If I wanted to deliver in a hospital with some sort of insurance coverage, I had to find an OBGYN who was affiliated with my hospital of choice so I could get that partial coverage. Since I was over 35 and considered high risk, I was required to also see a Perinatal Specialist as well. He was supposed to be partially covered by my insurance. I received 2 bills from this doctor, one for $67k and one for $32k and I started to hyperventilate! Thank goodness I understood insurance and how to identify each code charged to get the coverage and payments I was entitled to. Many people do not understand what is truly covered by their insurance- especially when dealing with a grey area such as infertility and many times, insurance companies will deny claims even though they are supposed to pay. Once I found an OBGYN to deliver my twins (he was an in-network provider under my plan), I was now covered at 80%. However, this also translated to the hospital I chose and their fees. If I were having a regular delivery without having used an infertility specialist, I would have been covered at 100%. But my doctor was an OBGYN who specialized in high risk births so he was an obvious choice. Since he was covered at 80%, then so was the hospital. I had to pay the rest out of pocket…the 20% left over for my OBGYN fees, 20% of Perinatal Specialist fees and 20% of the hospital and delivery fees. I am discussing this because even after the enormously large costs of IVF, there could still be some hefty fees to pay once you become pregnant. I believe every couple should be aware of these fees prior to starting any fertility treatments so they are prepared if they become pregnant. I found the following article on-line the other day and found it so interesting. A lot of times, people’s issues with IUI and IVF relate to multiple births and parents and doctors accepting responsibility for the large multiple growth rates we are seeing. “Public release date: 5-Apr-2011 Contact: Karen N. Peart karen.peart@yale.edu 203-432-1326 Yale University Fewer multiple births in states with insurance coverage for infertility Faced with the prospect of costly in vitro fertilization (IVF) but with no help from insurance coverage, some infertile couples feel pressure to transfer multiple embryos in an attempt to ensure that the IVF is a success. This can lead to higher rates of twin and triplet births and prematurity. But having insurance coverage could curtail the costs associated with these multiple births, according to a new study by researchers at Yale School of Medicine. Published in the current issue of Fertility and Sterility, the study found that the 15 states, including Connecticut, that provide insurance coverage for infertility saw significantly lower multiple birth rates. The authors say this translates into tremendous savings on the costs of maternal/fetal complications. In 2005, it was estimated that the economic impact of preterm birth was $26.2 billion nationally. IVF is an effective treatment for the reported 7 million women who are infertile, but it is unaffordable for many infertile couples. Since 1998, more states are providing IVF coverage. Connecticut, for instance, covers up to two IVF cycles under state mandate. In this study, Yale researchers analyzed assisted reproductive technology cycle data from 2006 provided by the Centers for Disease Control and Prevention and the Society for Assisted Reproductive Technology. They categorized that year's 91,753 fresh, non-donor cycles by age group and by whether the cycles were performed in states with or without a mandate for IVF coverage. States with mandates for insurance coverage of infertility treatment not including IVF were characterized as non-mandated states. The study showed that pregnancy rates, live birth rates, twin and triplets are higher in states without mandated insurance for IVF because they transfer significantly more embryos than states with coverage for IVF. In contrast, insurance coverage for IVF is associated with a significant reduction in the incidence of multiple pregnancy, particularly among younger women under the age of 35. When IVF is not covered by insurance, physicians often feel pressure from patients who have financial incentive to maximize the per-cycle success by requesting the transfer of more embryos and willing to take the risk of multiple pregnancies, according to senior author Pasquale Patrizio, M.D., professor and director of the Yale Fertility Center in the Department of Obstetrics, Gynecology & Reproductive Sciences at Yale School of Medicine. "Increasing the number of states that provide coverage for IVF would lead to improved maternal-fetal health and lessen the economic impact that multiple births have on the health system and it would also reduce physician pressure to transfer more embryos," said Patrizio. "It does not make economic sense to see insurance not covering IVF but then pay for the costs associated with maternal and neonatal morbidity." "By reducing the patient's financial burden, state mandates may lead to a reduction in embryos transferred," said first author J. Ryan Martin, M.D., assistant professor at Yale, who sees patients at Yale Fertility Center's new facility in Westport, Conn. "Patients and insurance companies will both benefit from a reduction in multiple pregnancies." Other authors on the study included Jason Bromer, M.D, and Denny Sakkas.” ~Citation: Fertility & Sterility Vol. 95, No. 3 This article makes perfect sense. What are the odds though, of insurance companies deciding to pay for these treatments and procedures? If multiple rates continue to rise, maybe this issue will be addressed. I will admit that my husband and I chose to implant 3 embryos to ensure a successful pregnancy. If our insurance had covered our IVF treatments, I am not so sure that would have been the decision we would have made. Insurance companies can deny fertility claims in a few ways. They label infertility issues as pre-existing conditions (PCOS, non-ovulation, etc), or they state treatments for infertility are considered experimental which protects them from having to pay…but the costs to insurance companies on the back-end with preemie births, additional hospital staff needed at deliveries and ICU stays are hefty and may outweigh what they could potentially be saving. Food for thought. Should they pay or not? Gina