Infertility Insurance Costs & Utilization, pg 2

Panak's interest in infertility insurance issues stems directly from his personal experience.

WP: "At one time our insurance was not paying for all of our treatment, and I needed to get some good cost data to convince the insurance company that the cost was not prohibitive. Eventually I found Martha (co-author Griffin); she had just finished a report on the cost data for the national RESOLVE office. She and RESOLVE were interested in getting the data published in a reputable journal, so she and I collaborated on rewriting the RESOLVE report into an academic article."

Panak and his wife were successful, with the help of the University of Iowa Hospitals and Clinics (UIHC) financial advisor Brian Allen, in obtaining optimal insurance coverage for their treatments. Dr. and Mrs. Panak are now the parents of three children resulting from infertility treatments that were fully covered by their insurance.

Brian Allen also did some localized research into issues addressed in the Panak/Griffin article. His results indicate that while complete generalizability of the specifics to every group plan is not possible, even in cases where demographics will create higher costs, the cost to treat infertility relative to fertility is still low.

WP: "(Allen) analyzed infertility cost data for the employees of that hospital. At the time, the hospital employees had a $15,000 per person lifetime cap on coverage, and the cost of infertility services was 0.8 percent of total premiums, more than double the average we found in Massachusetts in 1993. That makes sense, however, when you consider the insured group; hospital workers are predominantly female, and procedures like IUI and IVF are predominantly charged to the woman's side of the insurance bill. A group with more women will see a higher level of infertility charges, on average (although it needs to be remembered the groups that have predominantly more men will still see charges if any female dependents on the family policies use infertility services)."

"Also, the women worked in the same building that the clinic was located in; it was very convenient to pursue treatment, so more women did so. Women who work in hospitals, on average, are less afraid of needles, so they are more likely to pursue treatments that are more invasive."

"One additional issue is that (any given) group of hospital employees is, on average, healthier than a typical group; even though infertility accounted for almost one percent of total health care costs, the group's overall health care costs were lower than average. Because the total costs were lower than average, the cost for infertility was proportionally larger."

"Brian demonstrated this by showing that only about one percent of the employees ever used the entire $15,000 benefit. That showed that the benefit limit wasn't saving the plan any money; almost nobody ever went above the limit. Brian used these data to argue for raising the limit, and now the coverage level is $25,000 per person."

Dr. Panak combined his personal experience and what he learned from his and others' research to create Fertile Thoughts, a large and active online community focused on support, education, and advocacy.

TM: "From your website and personal experience, it appears that you are an advocate for people going through infertility. How do you answer those who say it isn't fair for everyone's premiums to increase just because some people are unable to have a baby?"

WP: "Yes, I do advocate for improved coverage and equity in infertility and maternity benefits that would be consistent with the Pregnancy Discrimination Act and meet the spirit of the law under the Americans with Disabilities Act. This is based on my knowledge of the cost to provide this coverage and the simple fact that it is affordable. We found that, in Massachusetts, mandated coverage actually reduces cost, so people who are worried about how their premiums are being affected by infertility treatment would actually be better off if more people had access to IVF services that are clearly cost-effective and reduce overall expenditures on infertility."

"It is sad that so many people have been misled by the popular press and their inaccurate statements about the 'high cost' of infertility treatment. The cost seems high only because lack of insurance coverage places the burden on the individual rather than spreading the risk over a larger group. The cost to provide the coverage is small, the incremental cost to improve coverage to include reasonable IVF benefits is minimal, and in fact IVF coverage may reduce overall costs. I do what I can to spread this information so that it can be used to improve the state of affairs for infertility patients."

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