Even for Consumers Whose Health Insurance Covers IVF, Challenges Await

By Consumers for Quality Care, on June 1, 2022

For the lucky few whose health insurance covers in vitro fertilization (IVF), consumers are still met with challenges and obstacles when seeking these services, according to Kaiser Health News.

Brenna Kaminski and her husband, Joshua Pritt, attempted to use in vitro fertilization to become pregnant. Although they don’t live in one of the 15 states that currently requires insurance to cover fertility treatments, their employer-sponsored insurance covers this care.

The couple is among the very few consumers who receive insurance coverage for IVF. In fact, only about one in four companies with 500 or more employees include fertility treatments with their health insurance plan.

“Infertility is a disease and should be treated as such, and insurance coverage should reflect that,” said Dr. Kara Goldman, associate professor of obstetrics and gynecology at Northwestern University. “Coverage is often incomplete because people too often don’t see infertility as equal to other diseases.”

The couple expected to pay their insurance’s maximum out-of-pocket, $2,700, but found themselves paying $15,000 for two rounds of IVF. “This whole thing has been a nightmare,” said Kaminski. “The stress has been unbelievable.”

The couple not only paid their $2,700 maximum out-of-pocket for two separate calendar years but also had a procedure done in a surgery center that was out-of-network, leaving them with a bill for $6,000 and an additional $4,000 for out-of-pocket medication related to the treatments. The couple was eventually able to get their insurance to consider the surgery center bill as in-network, since the couple was told the surgery center would be added to their insurance’s network soon.

About one in five women have trouble getting pregnant – they should not have to bear such a financial and emotional burden when trying to have a child. CQC urges lawmakers and insurers to work together to address confusing policies that force consumers to jump through hoops to get the care they need.