Tag Archives: Insurance Coverage

Infertility Insurance Coverage

I’ve been sitting on writing this post for a while because I recognize it won’t be a popular opinion in the community.  Though a recent piece by Pam of Silent Sorority expressed a similar opinion. My hope is that people will hear me out and won’t take offense to it.  

One of the challenges people face in going through infertility is how to pay for the expensive cost of treatments.  Many in the community say that infertility should be covered by insurance.  Resolve and other infertility organizations advocate for infertility coverage.  Advocacy day is an annual event where Resolve goes to DC to meet with elected officials to advocate for infertility with one of the topics being infertility coverage.  My personal opinion is that advocacy is misplaced.

I don’t believe that infertility treatments should be fully covered by insurance.  Before the rage starts at me, please here me out.  I’m not against people having the opportunity to become parents.  I’m against infertility being covered because it doesn’t address the issue of why infertility costs so much to treat.  If infertility were to be covered by insurance the cost to fund it would be placed in insurance premiums.  Thus though it would be covered the overall cost for insurance would be higher.  Either way people would be paying for it.  

Instead of advocating for infertility coverage we should be asking the fertility industry why does treating infertility cost so much?   Now I’m not saying that the fertility industry doesn’t deserve to be fairly compensated for their work but they should at least provide an explanation of why it costs so much and what can be done to lower costs.  

The way medical providers are paid now is that they charge based upon the services and/or procedures they provide.  Regardless of whether the health care provided cures the patient the provider gets paid the same amount.  For them the financial incentive is to conduct as many procedures as possible.  This is where the major issue is with how health care is delivered today.  

To me providers should be paid based upon the outcome of the services they provide (Outcome based payment model).  For instance a couple who goes to an RE for an infertility diagnosis would be charged a flat fee.  From there rather than the couple being charged for every IVF, ICSI or IUI administered the provider would be paid one dollar amount if no pregnancy was achieved and a high dollar amount if a successful pregnancy was achieved.  This will incentivize the provider to first conduct a full proper diagnosis and second recommend the most effective treatment.  The good providers would be the most highly compensated ones while the weaker ones wouldn’t be.  

Overall the cost of providing infertility services would decrease thus making it more likely to be covered and lower any out of pocket costs to patients.  The bonus is couples would be more likely to be properly diagnosed helping greatly in the emotional department.

So instead of advocating for infertility coverage I believe we should instead advocate for the model that providers are paid by change from a Service Fee based model to an Outcome based model.  I hope this piece leads to a good dialogue and gives us all food for thought.