AB767: Why Insurance Should and Must Cover Infertility Treatment

Heather K. Haight
Head of RESOLVE: The National Infertility Association

Former First Lady Laura Bush wrote in her book Spoken From the Heart, “For those who deeply want children and are denied them, those missing babies hover like silent ephemeral shadows over their lives.”

For six years, those tiny shadows haunted me.

I was happy for my friends who joyfully announced they were pregnant. I celebrated the holiday with family, treasuring my nephews. But my husband and I had tried for years to have a baby without seeing a positive pregnancy test, and inside, my heart was breaking. After years of struggling, we decided to try in vitro fertilization (IVF), hopeful that it might be successful.

Though we had excellent insurance, our insurer dealt a second blow.

Infertility was not a disease, they claimed, so they weren’t legally mandated to provide infertility treatment as a “medically necessary service.” The cost of IVF, a 40-year proven infertility treatment most likely to result in a pregnancy in our circumstances, would have to be scrapped together from all we had saved. They “offered” it, they said, as required by California law – they just wouldn’t pay for it.

This is nonsensical, cruel and patently unfair — and it hurts families that, like us, yearn to start a family.  As a matter of health equity, California state law must be changed. The Legislature should pass Assembly Bill 767 (Wicks), which establishes that infertility is a disease and requires that large insurers not just “offer,” but pay for in-vitro fertilization and fertility preservation treatments, and Senate Bill 600, which clarifies the requirement for insurance plans to cover fertility preservation when infertility arises as a result or as a side effect of medically necessary treatment for a condition such as cancer.

Give the state’s vision on the role of healthcare to improve health and quality of life, it’s surprising that these policies are not yet law. In 2017, the American Medical Association voted to support the World Health Organization’s designation of infertility as a disease. That was a good start – after all, infertility is technically a disorder of the reproductive system, often the result of an underlying medical condition or conditions.

But in California, interpretation of the law governing infertility treatment is inconsistent. Coverage for infertility treatment varies from insurer to insurer and most insurers decline to cover IVF.

In my case, my insurer covered testing to confirm the suspected diagnosis, but refused to cover treatment. That seemed doubly cruel, like covering a diagnosis of diabetes but not insulin, or the cost of a lung scan without chemotherapy or medication for a diagnosed cancer.

Well-intentioned friends offered advice along the lines of, “Relax and you’ll get pregnant” (neither helpful nor medically sound) or told us things could be worse (which minimized our isolation and grief). Small wonder that up to 57 percent of individuals with infertility suffer anxiety, daily stress, and deep depression; nine percent of women with infertility report having suicidal thoughts. Ironically, most treatments for these depressive disorders are covered by insurance.

Although insurers warn of cost increases to justify their opposition to infertility coverage mandates, research shows the costs to policyholders, far from being exorbitant, are minimal. When Connecticut required infertility coverage, including IVF, for both basic and advanced infertility treatment, premiums increased only slightly, less than 1% total. And a recent analysis by the California Health Benefits Review Program (CHBRP) estimated costs in the California large employer market to increase by less than one half of one percent when infertility treatment is covered.  

When we learned IVF was excluded, we decided we would pay for IVF ourselves. But we quickly found the costs were much higher than we had anticipated. One round of IVF runs close to $15,000, and we, like most couples, would probably need more than one round. We sacrificed for years and finally raised enough money to travel to the Czech Republic for IVF treatment, where the cost of care was much lower than paying out of pocket for treatment in the U.S. Through financial sacrifice and medical expertise one of those treatments worked.

While we now have a son, I am deeply conscious of the families who, due to financial and insurance barriers, have not yet been able to begin their journey to parenthood. That is why I urge California lawmakers to pass AB 767 and SB 600. In doing so they will be telling thousands of California’s would-be parents: it’s not your fault, and there may be hope. You are not alone.

Heather Haight runs a local support group for RESOLVE: The National Infertility Association, which help individuals and families struggling with infertility across California. She and her family live in Carmel Valley, CA.

 

 

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