Insurance and Infertility: Is There A Loophole?

Articles on Insurance | Topics: insurance, insuring

by Gena Matthews

Insurance and Infertility: Is There A Loophole?

Not to long ago there were many loopholes that existed for infertility treatments for women. Most insurance carriers found loopholes where the patient would have to pay for these services and most of these women couldn't afford them. Some insurance companies even would try to underwrite them under different things to get away with out paying for them. Luckily many state governments and the federal government stepped in and put a stop to it. There are still some gaps but more and more women are getting the coverage they need.

One of the biggest loopholes was that the states didn't want to cover vitro fertilization as it could get quite expensive and might not work all the time so insurance companies would balk at this added expense. Now most states have listed this as a non-necessary expense and covered it under maternity coverage. Many states have balked at this idea and only a handful of states are providing coverage for maternity expenses. Some people even consider this practice of not giving coverage as discrimination and they want the government to step in. Most of the basic health plans have no coverage at all for this type of medical treatment, which makes it hard for infertility patients to get any help at all.

With only 15 states having any kind of laws on the books to help patients with infertility the problem just seems to be getting no better. There is some new house bills that may or may not be passed. The hardest thing is when women groups are going up against the big insurance companies and all their money it makes it hard to get any laws passed. Progress has been slow so far but they continue to push on. Approximately over 5 million Americans have an infertility problem and about only 20 % actually can get any help with the problem. Many insurance carriers are reluctant to pay for any treatment.

Historical Quote

Before I get through with you, you will have a clear case for divorce and so will my wife. Now, the first thing to do is arrange for a settlement. You take the children, your husband takes the house, Junior burns down the house, you take the insurance and I take you!

—S.J. Perelman, U.S. screenwriter, Arthur Sheekman, Will Johnstone, and Norman Z. McLeod. Groucho Marx, Monkey Business, terms for a divorce settlement proposed while trying to woo Lucille Briggs (Thelma Todd)

Fertility treatments can run upwards of over $30,000 dollars, which makes it non-accessible to many Americans. Some states are mandating more money for treatments but it's slow in coming. Many companies are also reluctant to step forward and talk about it as they fear it would spawn an increasing demand and more expenses then companies want to cover.

Many insurance companies have exclusions on infertility treatments and this is something you will have to check on as it varies by each carrier. Certain carriers will cover one thing while another won't. The worst part is that there really is no universal set of guidelines that the insurance companies are following to make it easier for consumers. What many people don't realize is the cost isn't really that much more for insurance companies. So why won't they do it then? The answer is that it would bring a flood of different fertility treatments to the forefront. In other words what ones will they pay for and which ones won't they? That's a very fine line and the insurance companies don't want to go there and confront this issue.

What recourses to women have left? First thing to do is check their health care policy. Many companies still don't exclude treatments in their policy. If it's not excluded then they have to cover it. Also look under the pregnancy section to make sure they don't limit what they will cover. Your last recourse is of course to sue them and go to court and present your case to the judge. He may or may not rule in your favor.

The only other real option is contact your congressman and see if you can get the laws changed to make fertility treatments mandated in all 50 states. This is the only way anything will probably get done. Many people won't realize, until the loophole is totally closed up, that money is always the insurance company's number one goal. And since fertility treatments are so expensive, they will shun away from coverage. Hopefully one day soon the loophole will be closed and every woman can get the treatment she deserves when she wants it. This is one problem that has an easy solution and now if we can only convince congress to give the women of America a law that will help them instead of hurting them.

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