Infertility Insurance Costs & Utilization

For many, the term “infertility insurance” is a paradox; it is also a heated topic of public debate. From federal court to Bill Maher’s “Politically Incorrect”, people are offering their opinions on the value of financial coverage for assisted reproductive technology (ART). Even the most casual listener will pick up from these debates that treatment for infertility is considered very, very expensive, and this belief places a great bearing on the listeners’ own opinions regarding insurance coverage. However, those of us (the vast majority) without coverage for reproductive assistance find these debates almost pointless in the face of our reality — the technology exists for many of us to achieve a successful happy ending, but few of us have financial access to such.

In the July 1998 issue of Fertility & Sterility, the official journal of the esteemed American Society for Reproductive Medicine, an article was published that shed new light on the actual costs of infertility insurance, and the findings may offer leverage to consumers wishing to find new or expand current coverage.

For their article,

The economic cost of infertility-related services: An examination of the Massachusetts infertility insurance mandate

, co-authors Martha Griffin, M.S.N. and William Panak, Ph.D. concentrated their data collection in Massachusetts, where access to infertility insurance has been mandated by law since 1989. The authors examined infertility services costs and outcomes in Massachusetts during a resulting time of expanded use of assisted reproductive technology (1986 through 1993) by looking at cost data from nine large group insurance plans. I interviewed Dr. Panak about his research and the results as they apply to the average infertility patient…..

TM: “Tell us a little about the information you gathered for this research…”

WP: “Well, the core data are…provided by insurance companies to the Massachusetts Division of Insurance Rate Setting Commission…which has the responsibility of reviewing expenditures on an impartial basis and approving premium increases. So in a sense, the cost data were provided by insurance companies. We think that lends credibility to the findings because the insurance companies have no interest in underestimating the cost of infertility coverage.”

TM: “What were the specific conclusions drawn from your research?”

WP: “First, the cost to provide insurance coverage for all aspects of infertility is approximately 0.4 percent of total health care costs. Assuming a $5000 per year family policy, that translates into about $1.71 per month to cover all infertility services, including the very generous IVF services mandated under Massachusetts law.”

“Second, we analysed trends but looking at data from both before and after the mandate. We found that costs actually went down after the mandate was enacted, even though the use of IVF has increased dramatically. This is consistent with other studies showing that IVF is cost effective relative to alternative therapies such as tuboplasty. We also think that competition among clinics and HMO’s leads to market forces that lower costs. Clinics cut their fees to attract the HMO contracts, so that in the end more people get access to treatment while the cost for everyone is reduced.”

“Third, we looked at success rates in Massachusetts for IVF and GIFT. We found that the success rates were lower in Massachusetts than in the rest of the United States and Canada. We are now examining this more closely and it appears that the reason for this is that fewer embryos are being transferred per procedure (which) has the added benefit of reducing the incidence of triplet and higher order multiple gestations.”

TM: “Your data came from the state of Massachusetts. What do these conclusions mean to people in the rest of the United States?”

WP: “There was a (1998) supreme court decision that procreation is a major life activity and that substantial physical or mental impairments on procreation constitute a disability (which deserves) protection under federal civil rights law. Although the case before the court was not an infertility case, the justices specifically cited a previous infertility court case in deciding that procreation is a major life activity. Some legal scholars now think this will compel employers to provide better infertility coverage for their employees.”

“One barrier to this, however, would be if the insurance cost is an undue financial burden for the employer. Our data suggest that comprehensive coverage which gives patients access to ART services is associated with reduced cost to provide insurance coverage. This undermines the argument that the insurance coverage is an undue burden and, in my opinion, greatly enhances the likelihood that the ADA (Americans with Disabilities Act) can be used to compel employers to accomodate infertility patients with regard to an important aspect of employment, namely health insurance coverage for the disability. I look forward to seeing how the courts and the insurance companies respond to this issue.”

(For further analysis of these issues, see Dr. Panak’s discussion of the Bragdon v. Abbott decision).

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