Monday, July 14, 2008

That Pesky Insurance Coverage for Infertility Argument

Ahhhh, all is right with the world. A recent post on a message board I frequent regarding whether or not insurance companies should cover infertility or not had me worried. The vast majority of the replies were yes! And this was not a board full of infertiles. Finally, someone said "as long as the world's population continues to explode, I'm not going to change my mind on increasing my premiums to pay for someone else's uncontrollable desire to have a baby with their own DNA." I was getting worried they were all going soft with this bizarre support for us infertiles until that sweet little princess posted that comment.

I've considered posting about insurance coverage and infertility for quite a while, but have always stopped myself for some reason. It is a cause near and dear to my heart. I even created an online petition a while back to send to Congress as they reviewed HR 2892 which would mandate infertility coverage nationally (this bill has been introduced 6 times and never made it to the voting stage...this year was no exception). We had over 2,000 signatures last I looked. Shitty thing is, my Congressperson ignored the petition (all 50 pages I sent her), and the other Congresspeople I sent it to (those on the committees reviewing the bill) didn't give a shit either, since I couldn't vote for them. Gotta love America.

At any rate, it's a volatile argument on both sides and I really wish we could just take the emotion out of it and debate it rationally. That means no "uncontrollable desire to reproduce their DNA" argument from the NO side and no long drawn out stories from our side about how painful it is to go through infertility and all that. No one cares. Let's just talk facts, shall we?

The reason infertility should be covered is because it is not fair to not cover it.

Does that do it for you? Good enough? Because that really is it in a nutshell.

My parents did a good job and didn't overly indulge me as a child. When I said something wasn't fair, they were quick to swing around and growl "LIFE'S NOT FAIR!", something I never really understood since I felt that was just validating my point. But I don't believe infertility should be covered just because it has cost me a shit load of money. I don't think it should be covered because it really sucks to go through it, and then turn around and realize you're going to have to spend your life savings treating it. Talk about adding insult to injury. But still, that isn't reason for me to think that an entire (cough *corrupt* cough) industry should change their policies. I understand they're in it for the money. I understand covering infertility would cost them money. I understand they really don't give a shit that I have to spend my life savings treating my disease even though I have full medical coverage. I get it. And I wouldn't fight it...IF it was fair across the board.

My point has always been this: infertility should be covered because it is a disease. It is specifically excluded from insurance policies for reasons unknown (besides the cost factor). Now, if all diseases were excluded, I wouldn't agrue. Hey, even if all non-life threatening diseases were excluded, sure, I get it. Not covered. Or even all reproductive issues. OK, got it. Or hey, anything that has to do with vaginas, ok, no problem. Or diseases that start with the letter I. See my point? I'm not asking for special treatment. I'm asking for the same treatment as any other disease.

You see, when I reviewed one of my company's insurance policies that was available to me, I thumbed to the "what is not covered" section. In addition to the regular non-medical things that aren't covered with most policies - dental work, vision exams, cosmetic surgery, etc. - there were three other items listed. Inexplicably, these three were singled out:
  • Infertility
  • Diagnosis and/or Treatment of HIV/AIDS in excess of $15,000
  • Prosthetics
Honestly, I couldn't make this shit up.

So I concluded that infertility and the cap put on HIV/AIDS had to do with moral or religious issues. I decided the Catholic church had somehow infiltrated the insurance industry. Infertility treatment could include IVF, which the Vatican has adamantly opposed and they feel it is just soooo wrong. HIV/AIDS - well, it's a gay disease isn't it? Can't be too obvious about discriminating against them, so give them a little bit of coverage. Not too much though, not enough to...oh you know, keep them alive. $15K may sound like a lot to you, but the medications to control HIV/AIDS are beyond expensive and $15K doesn't go very far.

I have yet to figure out how the amputees have offended the religious right or the ultra conservatives. I'd be really interested in hearing anyone's theory about that one.

Once I heard a semi-rational reason for excluding infertility: it was considered experimental, and insurance does not cover experimental treatments. Now, I would have been okay with this since infertility isn't being singled out, it's just part of experimental treatments. But, that's old news and not applicable anymore. The AMA (American Medical Association) has not categorized infertility treatments as experimental since the 1980's. Next. Gotta give me something better than that.

Because I can give you something better. Beyond infertility being a disease and should be covered because it is such, I can also throw a Supreme Court case at you. In case you don't like my disease argument, how about this: In 1998, Bragdon vs. Abbott, the United State Supreme Court rule that reproduction is a "major life activity." Any person with substantial limitations to reproduce meets the definition for disability under the Americans with Disabilities Act and should, therefore, not be denied medical treatment for his or her condition. Excluding coverage for infertility treatment would be a violation of the ADA according to this decision. Ha! I win!

For those of you that don't want to pay for me to choose to treat my disease, I get it. (I won't bore you with the research that shows that it would actually cost as little as $3 per person per year and would actually lower premiums in many respects because it would lower the risk of multiple - especially high order multiple - pregnancies). But I didn't create the system. I don't want to pay for Bob to get his ingrown toenail worked on because I think had he just cut his toenails properly from the start, it wouldn't be an issue and I don't think I should have to pay for that. But that's how insurance works. We all pay in so that when we need it, it's covered. I would be all for a reform where your premium, even in a group health care setting like an employer plan - was reflective of how much you utilize the service. I don't think it's fair that my co-worker that never goes to the doctor - ever - should have to pay the same monthly premium as me, someone who is like Norm from Cheers at my doctor's office, just in case he needs medical care sometime in the future. I don't agree that's fair. But it is the way it is, and I didn't make the rules.

And I really have to giggle when people say coverage for infertility would raise their premiums, blah blah blah. Because the cost of my IVF (that we paid out of pocket for) was a tiny drop in the bucket compared to the amount I've sucked out of the system with my high risk pregnancy. All of my pre-natal care is 100% free with my insurance policy. I don't even pay a co-pay. So do the math. Weekly appointments since I was 4 1/2 months pregnant, all free. Four trips (so far) to Labor & Delivery, all free. My delivery will cost a $500 co-pay, that's it. My pregnancy could raise my company's premiums, but no one complains about maternity coverage.

Incidentally, I should point out that I have tendencies towards hypochondria, so pregnant or not, infertile or not, it's highly probably I can raise any company's premiums just being me. Giggle, giggle.


Diana said...

Very well written and thought out. Bravo!

sara said...

This is the most thorough written post I've ever seen on the issue. Well put - I couldn't agree with you more. My husband and I were just laughing over the point of how much our high risk pregnancy was costing my insurance company compared to all of our IUIs and IVF we totally paid out of pocket for. And how no one questions covering all of this, while our infertility stuff wasn't covered at all - how bizarre. Thanks for sharing that thoughtful post!

kjames106 said...

Here is a petition to sign to the gov't regarding fertility coverage. You should sign and pass on.

Patty H. said...

Wonderful, I completely agree and commend you for putting all this out there. You have written something truly researched and thought-out. I'm off to sign the petition above.

Jen said...

yes, yes you've said it best! On other news I had apg similiar to yous with the contractions, I now have a beautiful 8 wk old.

Jen said...

sorry my comment looks all weird, I'm typing with baby in my arms

Adriane said...

So well said. Insurance is such an effing racket. I can't even BEGIN to put together my thoughts on the subject of IF coverage - and you did it so well.

I particularly liked the list of three things that aren't covered. What a crock. The cap on AIDS? Not covering prosthetics? INSANE.

I am typing this note to you from hospital bedrest. I can't begin to imagine the cost of me being here for 2 weeks, but it's covered. Like you, my entire high-risk pregnancy has been covered. What morons.

Anonymous said...

I just can't agree. There are children who die of hunger, and there are would-be parents who spend thousands and thousands of dollars to make a baby. If you want to make a baby for the love of children, it just doesn't add up. There are "rights" as defined by our society, and then there's good old common sense. Oh so often, the two sides don't line up.

IVF 4 Dummies said...

Anonymous, you aren't making any sense. If insurance covered infertility treatments, I wouldn't have had to pay out of pocket and thus would have had thousands and thousands to spend feeding hungry children. But since my insurance didn't cover it, I'm all tapped out.

If you are against fertility treatments, that's each his own. But try and make just a little bit of sense, ok?

Tammy said...

This is how I look at it. They are willing to cover Alcohol/Drug addiction but infertility is considered out of the realm of reality? Ho about allowing me to take the cost of rehab for 6 weeks and letting me apply it to IF treatments? That only seems fair. I don't do drugs and I rarely drink so as far as I am concerned I will never need that covereage. I should be able to use it elsewhere.

BTW, I loved your post.

Anne said...

Anonymous, I'm not sure what the plight of children worldwide (which is indeed very sad, and I assume you yourself have adopted several of these children and donate much of your disposable income to this important cause) has to do with infertile people getting treatment for their DISEASE.

The original post is wonderful, a beautifully written and clear rendering of an excellent and logical argument. Bravo!

Piccinigirl said...

wow, that was amazing. You said that better than anyone I've ever read. *standing ovation*

Amber said...

Damn, girl! Preach on!

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