I wrote an article yesterday about how hard it is to get individual health insurance after you’ve had fertility treatments. We got a comment on the post that mentioned how ironic the whole thing is, considering health insurance almost never pays for the actual fertility treatment, even if you have coverage while you’re going through the process.
That got me thinking. Should health insurance cover fertility treatment? Is infertility a disease that should be treated like any other medical condition? The basic premise of health insurance is the idea that major medical problems can be financially crippling, and that spreading the cost over a huge group of people makes treatment more affordable for everyone (ideally this group would include every American, with nobody uninsured). Another basic premise that a lot of people misunderstand is that health insurance was never meant to cover every little cough and sneeze. The idea is to protect assets and prevent devastating financial losses in the event of a medical crisis. But over the years, the system has developed to the point where people often expect that every doctor visit and prescription will be paid for by insurance. Health insurance companies were happy to comply – with ever increasing premiums, of course.
So how does infertility fit into this picture? It’s a lot more common than most people think, affecting roughly 1 in 8 American couples. And the medical bills can mount very quickly when a couple pursues treatment. So it does fall into a category of conditions for which health insurance coverage would seem to make sense. I do not know of any health insurance companies in Colorado that offer coverage for infertility treatment, although we do not work with large group carriers and there may be some options there. One of my best friends has been trying to conceive for 11 months, and has been seeing a fertility doctor for the last 6 months. She and her husband have spent $4,000 so far, and that’s really just been for testing – they haven’t gotten as far as AI or IVF, when the bills would really start rolling in.
My heart goes out to couples who are unable to conceive. But my honest opinion is that fertility treatment should not be included as mandatory under health insurance coverage. While I recognize that it is a medical condition, I just can’t justify putting it in the same category with heart disease or kidney failure. A person who has kidney failure will die in a matter of weeks without dialysis. A person with heart disease or Type 1 diabetes will also die without treatment. But a person who is unable to conceive will not die without treatment. And if there are no other underlying medical reasons for the infertility (eg, PCOS), the person should be able to lead a healthy life, albeit without biological children.
An infertile couple can adopt (granted, this can also be a pricey option), or they can choose to remain without children. Or they can decide to go ahead with treatments in an attempt to have their own biological children. But this is their choice, and not one that is required in order to fulfill basic health needs. Since it can be such an expensive process, it would place a high burden on health insurance carriers if it were required to be covered. In the individual health insurance market, premiums have been increasing at a rapid rate for years now – it’s not uncommon in Colorado to see rate increases of 10% or more every year. Adding a mandate that infertility be a covered condition would drive the prices even higher, and would likely lead to more people dropping their health insurance coverage as the premiums rise.
In an ideal world, we would have a single-payer health care system, with significantly lower cost structures for care, and payment required – in the form of taxes – from every American. Perhaps in this type of a system, infertility could be considered a disease like any other, and could be less of a financial burden on the individual couples who are struggling to get pregnant. But with our current system, it doesn’t seem feasible or fair to increase every one’s health insurance premiums in order to treat infertility.
