INFERTILITY: Patients Battle Insurers For Coverage
Yesterday's New York Times reports on the unwillingness of insurers to cover a growing number of advanced infertility treatments, which has outraged couples who cannot otherwise afford them. According to many patients and doctors, insurers who choose to deny such coverage are actually discriminating because they believe "[i]nfertility ... is a disease, like diabetes or emphysema, whose treatment should be covered by any basic insurance policy." They argue that such denials force patients to "go without crucial medical care that could lead to pregnancy," or to otherwise pay huge out-of-pocket expenses or to resort to "inappropriate care." However, others contend that it is not clearly defined whether infertility is "a medical condition or a social problem," and question whether society should cover the expenses for a "narrow group of people when growing numbers of others lack insurance for even basic health care."
Attempts At Control
"Thirteen states ... require health plans to offer some coverage of infertility treatments," however, these regulations exempt self-insured plans from jurisdiction. Consequently, many women who work for big companies do not have fertility coverage. "About 6.1 million women in the United States ... are infertile." In vitro fertilization is a common method to bring about pregnancy and "most couples try several times before they succeed," but "most insurance companies don't cover such assisted technology." Doctors point out that insurers are prone "to correct a physical problem rather than to address infertility," which results in many women getting coverage for low-success rate procedures such as tubal surgeries but not for in vitro fertilization. George Annas, chair of the health law department at Boston University's School of Public Health said, "Not having these treatments covered is unfortunate, but is not unfair. In fact, people don't have the right to any health care in this country except emergency care." He added, "Not that people shouldn't have access to these procedures. ... But to mandate it, given the growing numbers of uninsured people, makes no legal, economic or health care sense."
The Times notes that, faced with an insurer's denial of coverage, "some people resort to measures that can be dangerous." A number of couples go through the steps of "exhausting their savings ... signing up for a host of credit cards" and finally "borrow[ing] from relatives or friends." Others seek out fertility drugs from overseas pharmacies, and some people may even scavenge drugs "from other women who have leftovers from their own prescriptions." One woman resorted to driving south of the border into Mexico to find drugs which cost "one quarter to one sixth the price at her local pharmacy." Another "sent her prescription to relatives in Israel, who filled it for a third of the cost locally." Dr. Richard Grazzi, a fertility specialist in New York City, noted the difficulty in seeing "how often money issues intrude between him and what he thinks is the best treatment for his patients." Faced with a mounting debt in covering fertility treatment for too many uninsured patients, Grazzi arranged a system of "infertility loans" with a local Citibank branch. Grazzi noted, "Nobody who hasn't experienced infertility can understand what these couples go through. It's a medical crisis, a personal crisis, a sexual crisis, religious, existential and marital crisis" (Fein, 2/22).