I understand that infertility is not usually life-threatening, but fertility coverage is generally pretty cost effective. I’ve laid out my case in this letter that I’ll be sending to Ben’s employer (I’ve blocked out the name) asking them to add infertility coverage to their health insurance policy. It comes from a skeleton letter provided by Resolve, which is a national infertility organization. It will be too late to get any coverage for us, but I’d like to lobby them to do it anyway. I’ve edited it to include some information specific to our situation. Any tips? Things to add? Points I should clarify?
If anybody wants to write to your HR department and encourage them to include IF treatment, the skeleton letter can be found here.
Dear [HR person] :
My husband has been an employee for the past six years. My spouse and I are suffering with the disease of infertility and request that you consider covering infertility treatment in [company name]’s health benefit package.
Often employers believe that adding an infertility coverage benefit will increase health care costs. However, recent studies indicate that including comprehensive infertility coverage in a health benefit package may actually reduce costs and improve outcomes.
For example, a recent employer survey conducted by the consulting firm William M. Mercer found that 91 percent of respondents offering infertility treatment have not experienced an increase in their medical costs as a result of providing this coverage.
As also proven in the following studies, the perceived cost of infertility treatment is typically overstated.
Often patients select treatment based on what is covered in their health benefit plan rather than what is most appropriate treatment. For example, a woman having trouble conceiving because of blocked fallopian tubes or tubal scarring may opt for tubal surgery, a covered treatment, which can cost $8,000 -$13,000 per surgery. Many patients are forced to forgo in vitro fertilization (IVF) because it is not a covered service even though it costs about the same as tubal surgery and statistically is more likely to result in a successful pregnancy. I have been faced with similar choices myself, and have had difficult decisions to make that might not have been necessary, given adequate insurance coverage.
[Company name]’s coverage specifically excludes IVF, yet it covers Gamete Intra-Fallopian Transfer (GIFT), a procedure that most fertility doctors no longer perform because it is invasive, expensive, and has lower success rates than IVF. So we have coverage for an expensive, invasive, outdated procedure that we cannot find someone to perform, but no coverage for IVF, which is the standard of care.
According to William M Mercer, “The decline in use of high-cost procedures like tubal surgery would likely offset the cost to include IVF as a benefit and provide improved health outcomes.” (William M. Mercer, Infertility as a Covered Benefit, 1997).
In states with mandated infertility insurance, the rate of multiple births is lower than in states without coverage. (New England Journal of Medicine, “Insurance Coverage and Outcomes of In Vitro Fertilization,” August 2002). Couples with insurance coverage are free to make more appropriate decisions with their physicians based on medical necessity rather than financial considerations which often result in multiple births and a high rate of complications during and post-pregnancy for mother and babies. Wouldn’t it be better to cover a $10,000 IVF procedure than a $2 million NICU stay for 3 babies?
Comprehensive infertility coverage may actually reduce premium expense by as much as $1 per member/per month. According to The Hidden Costs of Infertility Treatment in Employee Health Benefits Plans (Blackwell, Richard E. and the William Mercer Actuarial Team, 2000), insurance premiums now indirectly provide coverage for “hidden” infertility benefits such as surgeries to remove scarring in the fallopian tubes for women or varicose vein removal for men. The costs of those benefits were calculated to be adequate to cover more effective and often less expensive treatments such as ovulation induction, intrauterine insemination and in vitro fertilization.
The cost of infertility services as a percent of the total health premiums went down after the 1987 Massachusetts mandate that required infertility coverage. (Study by Griffin and Panak, Fertility & Sterility, 1998).
According to a 2003 Harris Interactive Poll, 80% of the general population believes infertility treatment should be covered by insurance. (Harris Interactive Inc., Survey, 2003).
In vitro fertilization accounts for less than 3 % of infertility services. According to the American Society of Reproductive Medicine (ASRM), 85%-90% of infertility cases can be treated with conventional medications. (ASRM website, Quick Facts About Infertility).
My personal experience with [company name]’s coverage has led me to start a state wide search for someone who does the GIFT procedure (skipping cheaper, less invasive procedures like intra-uterine insemination (IUI), which only cost about $1000), while living 10 minutes from two nationally recognized fertility clinics who do not do the procedure. Is that the kind of coverage [company name] wants to offer? Is that they kind of reputation they want to have about how they treat their employees? As the spouse of someone who works for [company name], I certainly hope not.
Please let me know if you would like any additional information on this issue. I hope [company name] will consider offering infertility coverage and support our family building efforts. Thank you for your consideration.