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Oct 17, 2005

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Comments

sophie

Susan - I read your post to the writer of that blog - you are 100% right in all you are saying. I read that article too (at my RE's office believe it or not). On another note, I wish you the best. I am starting IVF this cycle and at the same time, I have started the adoption process (even though they frown on it). Both are hard. I just want a family. Good Luck in making your decision.

DD

AD HOMINEMS: appealing to people's emotions and prejudices instead of their ability to think.

That must have been the phrase of the day in the Health Business Blog, even if it wasn't true as you presented the side that the majority of people fortunately never experience in factual and a succinct manner. Bravo (aka poop-in-a-group).

Thanks for so eloquently standing up for the cause. And by the way, the comparison comment on the implants was my grin for the day.

David E. Williams of the Health business blog

Susan,

Thanks for your comments on the Health business blog post. I hope it was clear that I'm not attacking IVF, bur rather advocating insurance coverage for fertility treatment and trying to make the broader point that the availability of more information and consumer choice in health care --what the consumer directed health care movement is all about-- is not a panacea for cost or quality.

The comments about adoption, breast enhancement and so forth are not mine.

I wish you the best.

David Williams

B. Mare

I don't think you were incomprehensible at all. In particular I thought your knee injury analogy was good.

It chaps my ass too when people try to argue on the basis of "medical necessity". As if that can be so closely circumscribed in every case, and as if insurance should only cover life-threatening illnesses- because really, unless it's going to kill you, is anything a "medical necessity"? That's such a black and white way to look at life, and in my view, not a very realistic one.

B

I didn't go to the linked sites (where the debate is taking place), but I think you have done a tremendous job here in this post. I was wondering if I could have your permission to reproduce some of this work you have done to send to my Representatives? I've been fighting this battle (with Congress) for nearly 2 years now.

Jenn

Great position paper.

Wavery

Susan,

You sold me and I'd only like to add to the 'vanity issues' section of the argument.
In cases of endometriosis, pregnancy is looked at as the best chance for a cure and in my case (not unique) IVF is likely the only way to obtain that cure. Without a pregnancy, my endo will continue to grow unchecked by the normol hormonal cycle of a pregnancy leading to ongoing debilitating pain, more complex laproscopic procedures performed by only a handful of surgeons in the U.S., billed at even higher amounts than the $18,500 for the first one. I could develop incontinance, up my way through more and more potent narcotics and potentially face the loss of not only my tubes, ovaries and uterus but a kidney or two. Vanity. Just a folly of mine.

elle

Rock fucking on, Susan!!!!!!!!!!!

Lut C.

This one is going into my 'Keep' folder.

heleen

Maybe another issue... but what puzzles me is the enourmous difference in costs for IVF between different western countries. In New Zealand state of the art IVF costs a little less than US$5000, drugs included. My insurance does not cover it, but I can have two government funded cycles next year. Also in South Africa and Australia you can get state of the art IVF for a good price in private clinics. So until the insurance companies have changed their policies based on your great article, come over to this side of the planet, have a great holiday included and you still save money...

T

Excellent. Imagine telling an absurdly fat american who doesn't exercise that insurance won't cover their knee surgery? They'd go ballistic. Yet a lot of infertiles are paying every dime for their own treatment - ridiculous,despicable. Fyi - MA clinics charge insurance co's between $5,000 and $7,500 per cycle.

labia lady

I second Heleen's comment about coming down under....... I honestly do not know what we would have done if it wasn't covered by government subsidy & insurance company.

Jenny

You are so clever. Marry me? No, wait, adopt me?

akeeyu

In one year, my insurance company spent about $25,000 on surgery, drugs, doctors fees and tests to diagnose and treat my Endometriosis. If they have to, they'll jolly well do that every year until I hit menopause, making the bill for my treatment a cool half a million dollars.

They won't, however, spend $11,000 on IVF which (unlike trying 'naturally') has a good chance of slowing the progress of the Endometriosis, therefore actually SAVING my insurance company money in the long run.

Let's see. $500,000. $11,000. Tough choice.

Doctor Disgruntled

Susan,

I am more sympathetic than you might guess but still disagree with some of the assumptions that characterize your post. For example, Medicare's definition of "medically necessary" is not a universal one, from either a legal or ethical standpoint (meaning other third-party-payors like ins. cos. can set their own standards for 'necessity' and also meaning that reasonable people can disagree intellectually about how to define medical necessity).

Then, you are arguing about what insurance companies "should" pay for based on comparing infertility to other covered services - and by that standard, you aptly show there are many viable comparisons between covered treatments and not-covered fertility. The problem here is that companies "should" cover (1) what they promise to cover and (2) what they choose to cover, which we assume is based on their financial best interests - remember, they're trying to make a profit on your payment$ - and possibly on their social/ethical interests - probably they want to appear sympathetic and generous, so as to attract more clients.

You take the view that providing IVF is a money-saver for the companies, but I'm skeptical. Sadly, it's probably cheaper for them to let women with infertility just hang, and pay for their own treatments, especially because as you point out, women trying to conceive are highly motivated, often emotionally desperate, and many will make enormous sacrifices even for the chance of having a child. Thus, the company can sit on its cash and let you do all of the work. I'm not convinced that except in extraordinary cases (possibly as in endometriosis, but even this seems unlikely to me) that effectively purchasing a pregancy helps an ins. co. save money in the long run.

Finally, dictating what MUST be covered by an insurance company tends to raise the costs of insurance - laws that mandate psychiatric coverage or birth control pills, both of which have been the subject of popular legislation, with politicians happy to crusade against rich companies "discriminating" against women or the mentally ill, force people who don't want or need those services to subsidize the care of those people who do. That may be ok with you (and reasonable people may disagree about this philosopical issue), but an alternative would be to free the industry of restrictions, and allow smaller players to explore niches like, say, FERTILITY insurance.

This is currently impossible under laws mandating what "Should" be offered, and prevents a solution that really would help lots of women like you - selling fertility insurance to women in their 20s that would cover IVF and whatever else they might need in later life.

Just some thoughts. My best wishes for you in your quest, truly.

Doctor Disgruntled

kate #2

You are my hero. I love the passion with which you approach this debate. Just last weekend, I mailed off yet another round of letters to my Sentators demanding insurance coverage. My DH say it and said, "Oh No! What are we going to get arrested for now?" lol

Joie

Well said! It is incredibly painful for my husband and I to accept that the only reason we don't have a child right now may be that we don't live in a state that requires insurance to cover infertility treatments. We are hoping to find a way to raise the $12,000 to fund an IVF on two teachers' salaries. It is SO not fair!

Rich

What about the higher rate of birth defects associated with birth defects? I'm not arguing on the basis of economics for the insurance companies. I'm arguing that it's not fair to the child that is potentially conceived, to bring him into the world with the significantly higher likelihood that they are going to have birth defects.

There was an article at Popular Science called "Sally has 2 Mommies and 1 Daddy", that might be interesting reading.
http://www.popsci.com/popsci/medicine/17e2c4522fa84010vgnvcm1000004eecbccdrcrd.html

Lisa

Great argument. Let me know if there's any way I can help you fight for coverage.

Cyndi

I just wanted to say thanks and respond to the comment that an infertility mandate would "force people who don't want or need those services to subsidize the care of those people who do". Isn't that what all infertility patients are doing? We subsidize the care of pregnant women, because insurance is mandated to cover prenatal care. This is a service we will never use.
That is all insurance companies and subscribers do, subsidize the care of others. We pay for triple heart bypass for people that ate fattening foods for decades and refused to exercise. We pay for surgery to correct shattered limbs following a bungee jumping incident. We pay for chemotherapy, surgery, and radiation therapy to treat lung cancer, caused by nearly 30 years
of smoking. We pay for prescriptions for Viagra so a man can engage in sexual activity.
Insurance and we as a society are symbiotic, yet somehow the infertile got the short end of the stick.

Doctor Disgruntled

Cyndi,
Yes, that's exactly my point - you and I are forced to subsidize the care of other people precisely because of mandates that force companies to offer specific types of coverage. If we weren't, the companies would be free to offer insurance products that would be much cheaper for most people, freeing up lots of $$ for you to buy what care you choose, and also allowing for the existence of a "fertility insurance" product I described above. You're saying the solution is "force coverage for more stuff" (which would raise the cost of medical insurance for everyone). I'm saying is "force coverage for nothing," and let the free market work. Then you would be much more likely to afford coverage of the type you want.

Again, best of luck. This argument pales in comparison to the stress and difficulty you're experiencing. My best wishes.

Doc Disgruntled

Blue Cross of California

Treatment shall be covered by health insurance as health coverage should be covering all health related events.

Erin

I agree with what you are saying. However, I'd like to point out that a vast majority of the insurance plans out there do NOT cover hearing aids...I should know, in the past few years I have shelled out $3K for mine.

Infertile Canadian

Here is a silly one for you... here in Canada, we have socialised medicine, which covers most medical procedures, but obviously not cosmetic ones.

My partner is sperm challenged, as as a result we require IVF/ICSI to get pregnant. However, as the insurance see it here *I* am not infertile, and therefore do not qualify for this now "elective" procedure.

Ahhh...Sexual discrimination in the insurance biz...

Fendra

I love the fact that I found this web site!!

I live in Massachussetts, where it is supposedly mandated that the insurance policies covers infertility. Well I have been trying for years. I am 32 years old and was diagnosed with PCOS. I have seen doctors after doctors and all say to me that I need to see a reproductive endrocronlogist to treat my PCOS which is the cause of my infertility, BUT they say (the doctors)that my insurance will not cover. I have Medicare for insurance, which I did research and found that they do cover infertility under the policy manual, also the rep I spoke to said that "as long as it is medically necessary, I can be treated". Well, I do believe PCOS would be medically necessary. What should I do. Medicare states that they didn't put a hold in the system to prevent me from further treatment and the doctors office says otherwise. Now the RE told me that Mediace does cover the infertility treatment, but not the IVF. Hello that sounds like shit!! I am seeking treatment for my infertility, but I still have to sign a self pay waiver and pay $450.00 out of my pocket for the consult. A consult that Medicare pays. Can anyone help? Suggestions? This is so upsetting!!!

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