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Facts about Infertility Treatment & Insurance Coverage

 

 

 

FACT: One out of every 10 couples experience infertility - 6. 1 million Americans suffer from this disease

FACT: Only 43% of these seek medical advice; of those who seek medical advice, 58.5% received further services

Less than 2% of those seeking treatment utilize high-tech procedures such as in-vitro fertilization (IVF). Of those who do pursue treatment, 65% succeed In having a baby.

FACT: In the state of Massachusetts, which provides the most comprehensive infertility coverage, the cost has been reported to equal 0.41% of the total monthly family premium, or $ 1.71 per contract in 1993. Massachusetts, with the most comprehensive state mandate, found that the cost of coverage was one of the lowest of all its mandated benefits.

FACT: Offering a comprehensive infertility treatment benefit with appropriate utilization controls may actually reduce costs and improve outcomes by eliminating the use of costly, inappropriate "covered procedures". Comprehensive coverage of infertility enables health plans to monitor infertility treatments and manage the true cost by eliminating unnecessary, repetitive, costly and ultimately unsuccessful treatments by replacing them with well-managed, cost effective treatments that are more likely to result in positive outcomes.

In the majority of cases, infertile patients can be treated with conventional medical techniques such as drug therapy or artificial insemination.

 

Rationale for the Inclusion of Medically Appropriate Treatment for Infertility
  • Infertility, a disease that affects 6. 1 million Americans, is the abnormal functioning of the reproductive systems of both men and women (approximately 1/3 women, 1/3 men, 1/3 a combination or unknown cause).
  • Infertility treatment coverage is an issue of fairness. How can other important medical problems such as knee surgery be included for coverage and the problems of an abnormally functioning reproductive system be excluded from a health care benefits package?
  • There is a misconception that infertility treatment is costly. This is due primarily to the mass media's focus on the new technology for treatment. In fact, only 1.6% of those seeking treatment move on to address their infertility through procedures such as in vitro fertilization (IVF). For women who have had diseases that caused the destruction of their fallopian tubes, IVF can be an appropriate and less expensive treatment than tubal surgery. In Massachusetts, where infertility insurance coverage has been mandated since 1987, the cost of comprehensive treatment represents only four-tenths of one percent of the total monthly family premium. (Massachusetts Division of Insurance, 1993).
  • There is a perception that infertility treatment is elective and it is often compared to cosmetic surgery. Infertility is a serious medical condition. It is discriminatory to eliminate coverage.
  • Why don't people just adopt? Individuals start off with a life-vision of having their own biological children. Adoption is a successful resolution for many yet it is not always an easy option to pursue as it can cost between $10,000 and $30,000. Most do not have this financial resource and for many individuals an inexpensive treatment can solve their infertility. Although 2.1 million couples confront infertility there are less than 50,000 children placed for adoption each year.
  • Our country places a great deal of emphasis on the importance of family. Families are the most important part of our lives and we should not have a national health care policy that deprives 2.1 million couples of having a family.

 

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