 unilabofdade
Unilab of Dade is a reproductive medical laboratory serving mainly South Florida for over 20 years. Please check out our services at http://www.infertilitylab.com/
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The votes have been counted and the Healthcare Reform Bill has been passed through the House. Now we are one step closer to this bill becoming a law, for better or for worse. But how will this affect the day-to-day costs of the thousands of couples in America that are facing fertility difficulties? Will it be any better than the current coverage for hopeful couples trying to have a child?
By current standards, most couples seem to be facing this financial feat on their own with slim to none coverage from their insurance providers. It’s bad enough that hopeful parents have to carry the emotional and mental burden of not being able to have a child, but they also are forced to confront the high cost of fertility diagnosis and treatment which can be thousands of dollars every month (and that’s just for the medication). To make matters worse, there is no guarantee that the treatments or medication will even be successful, leaving the couple with broken hearts and empty wallets.
However, approximately 15 states mandate all health insurance providers to either include infertility coverage in every plan offered OR at least carry some plans that include infertility coverage. But the deductible and amount covered obviously varies, as it always does. It also must be noted that some plans include diagnosis versus treatment and vice versa. The more technically advanced and EXPENSIVE procedures like In-Vitro Fertilization are rarely covered. When going over your current health plan or thinking about switching to another one, always look at the actual contract to find out about specific infertility exclusions. It is usually safe to say that if infertility treatment isn’t specifically excluded it is most like covered to some degree. Here is a list of the mandated states below, as well the included coverage in each state:
State Infertility Coverage at a Glance
State Date enacted Mandate to cover Mandate to offer Includes IVF coverage Excludes IVF coverage IVF coverage ONLY
Arkansas 1987 X(1) X
California 1989 X X(2)
Connecticut 1989 X X
Hawaii 1987 X X(3)
Illinois 1991 X X(4)
Maryland 1985 X(5) X
Massachusetts 1987 X X
Montana 1987 X(6)
New Jersey 2001 X X
New York 1990 X(7)
Ohio 1991 X(8)
Rhode Island 1989 X X
Texas 1987 X X
West Virginia 1977 X(8)
(1) Includes a lifetime maximum benefit of not less than $15,000.
(2) Excludes IVF, but covers gamete intrafallopian transfer (GIFT).
(3) Provides a one-time only benefit covering all outpatient expenses arising from IVF.
(4) Limits first-time attempts to four oocyte retrievals. If a child is born, two complete oocyte retrievals for a second birth are covered. Businesses with 25 or fewer employees are exempt from having to provide the coverage specified by the law.
(5) Businesses with 50 or fewer employees do not have to provide coverage specified by law.
(6) Applies to HMOs only; other insurers specifically are exempt from having to provide the coverage.
(7) Provides coverage for the "diagnosis and treatment of correctable medial conditions." Does not consider IVF a corrective treatment.
(8) Applies to HMOs only.
*This chart and definitions is from the official American Society for Reproductive Medicine (ASRM) website
So what could be in our near future if the Healthcare Reform bill becomes a law? Thus far, the only clause that pertains to reproductive treatment specifically is on page 1451, line 3 of the Healthcare Reform Bill, it sates; ‘‘A community clinic, including a mental health clinic, substance abuse clinic, or a reproductive health clinic.” To put this into context, this clause is described as an “Additional Inclusion” versus a “Required Inclusion” of the proposed Community-Based Collaborative Care Network program. To put that more clearly, it seems that as the bill currently stands, reproductive health is not on the top of the list, or even close to it as it is labeled as an “addition” and not a “requirement”. Of course revisions, additions, and deletions are bound to be made before (or if) the law is passed. I encourage everyone to inform themselves on this very serious topic that can and will affect both patients and physicians in the near future, by browsing the actual bill in its entirety at http://docs.house.gov/rules/health/111_ahcaa.pdf
We should all remain hopeful that Congress pays closer attention to relieve the financial burden of infertile Americans, as they already face enough day-to-day woes. Keep your fingers crossed and read up.
http://infertilitylabblog.com/infertility/will-the-healthcare-reform-bill-cover-infertility-treatment
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