| Insurers and infertile couples always seem to be | | | | BlueShield plans cover much of the diagnostic testing. |
| battling over infertility costs. Until infertile couples | | | | As long as the insurance company can justify a |
| took on the roles of advocates, few, if any, insurers | | | | treatment as leading up to the diagnosis of an illness |
| automatically paid for infertility treatment. In the last | | | | or condition, the company will reimburse you for |
| several years, however, infertile couples have been | | | | surgeries, blood tests, diagnostic tests (like the HSG |
| successfully lobbying state legislature to pass laws | | | | or endometrial biopsy), and ultrasound scans. |
| requiring insurers to cover their medical bills. | | | | Insurance companies do not consider infertility to be |
| As of April 2000. Twelve states have enacted | | | | the illness itself; their argument is that most |
| infertility insurance legislation: Arkansas, California, | | | | procedures bypass rather than cure the problem and |
| Connecticut, Hawaii, Illinois, Maryland, Massachusetts, | | | | are "experimental" in nature. |
| Montana, New York, Ohio, Rhode island, and Texas. | | | | But don't lose hope or make assumptions. There are |
| Specific information about legislation for each of | | | | various ways to find out definitely what, if any, |
| these twelve states can be found at the Web site | | | | infertility tests and treatments your policy covers. |
| of the American Society for Reproductive Medicine. | | | | There was a couple, for example that assumed that |
| If you live in any of these twelve states, you | | | | their insurance would not reimburse them for $700 of |
| probably have a better chance of having some of | | | | out-of-pocket expenses for Lupron during an IVF |
| the costs reimbursed than if you live elsewhere. But | | | | cycle. The insurer had initially turned down their claim, |
| if you do not meet all the requirements set forth | | | | but the couple resubmitted it, pointing out that the |
| under the law (i.e. length of time you've been trying | | | | FDA had recently approved Lupron for the treatment |
| to have a baby, medical condition, or use of your | | | | of endometriosis, a recognized contributor of |
| own gametes), the law may work against you. On | | | | infertility. The argument was convincing enough that |
| the other hand, insurance may in fact cover your | | | | the insurer reimbursed their $700. |
| diagnosis and treatment, even if you live in one of | | | | At some point you may decide that "enough is |
| the other thirty-eight states. | | | | enough". The money crisis may be the straw that |
| The majority of insurance carriers cover between 50 | | | | breaks the camel's back. Spending your last penny or |
| percent and 80 percent of "conventional" infertility | | | | borrowing money you may never be able to repay |
| treatments. In terms of vitro fertilization, 41 percent | | | | may just be more than you can handle. If you are |
| of commercial health insurance carriers provide | | | | unable to continue treatment because the infertility |
| coverage. One in four do so as a standard practice, | | | | costs are beyond your means, you are not giving |
| and the remainder do so on a case-by-case basis. | | | | up-you are merely being realistic. |
| For lesser, low-tech procedures, most BlueCross and | | | | |