Finally Arrived

Is You're in a Bush-Bashing Mood, You've Come to the Right Place

Warning, this is not short and not related to infertility.

But it is funny....

...in an "ouch, it hurts so much I have to laugh" kind of way:

http://wwwthefrown.com/frowners/becomerepublican.swf

The World is Full of Ignorant, Judgmental Pricks, and I Would Gladly Hand Their Asses to Them if I Had the Energy and Time

To The Universe:

Why did you have to bring this fucked-up, homophobic, anti-adoption, racist, anti-ART manifesto to my attention today?  I don't care if it is by a columnist who is also a stand-up comedian (she calls herself "Comic Mom"), it is SOOOO not funny. 

Universe, how can you expect me not to leap into action when she says stuff like "...ask yourself how often you’ve capitulated to the rhetoric of this brave new world, how often you’ve called someone who’s never given birth and passed along genes a mother, or how often you’ve looked at an Asian child with two people who are clearly not her parents and believed that they are family."

Her thesis is so repulsive, so full of shit, that I have a gushing nosebleed from the stench.  Her position:  Are you infertile?  Well, suck it up.  Don't seek medical treatment and certainly don't adopt. You're not meant to have children because God doesn't want you to.  And I don't give a shit about the kids whose birthparents don't want to raise or can't raise them.  I offer no solutions or help for them.  Besides, what do I care? I'm fertile and have my kids!

This article is so ignorant, so misguided, that I feel compelled to give her a serious blog bitchslapping. But alas, just two days ago I published a long, embittered post arguing for infertility insurance coverage.  And before that was the whole Indiana situation. I do not have the energy, nor time, to rant about this as well.  I can only work up the necessary furor to write a diatribe every two weeks or so.

Why, Universe, why did you drop this in my lap today?  I am so very tired and I need to get some work done.

And why, WHY, did you let me find a second article by this same profoundly inhumane woman claiming those bitchy career women wouldn't need IVF if they were less busy (due to their careers and all) and had sex more often?

I hope you will be more considerate of my time and energy next time.

Regards,
Susan

[Thanks to Laura Christianson's Exploring Adoption blog  and JenUte of CHEW for the link. I know many of you saw it some days ago, but I just found it today.]

A Long Rant on Why Infertility Treatment Should Be Covered by Insurance

Note: Please excuse the weirdness with the comments.  Those before Oct. 16 belong to a related post that I moved to another location. I placed this post here because other websites refer to this permalink.  If you commented on the original post, I may have temporarily unpublished it to streamline a new conversation.

Also, please feel free to use this post in your own battle for insurance coverage.

============

Statcounter tells me many recent visitors to this blog are arriving via posts to the Health Business Blog and InsureBlog, the result of lengthy comments I left on the Health Business Blog’s post on IVF (in vitro fertilization) and its relationship to twin, triplet, and higher order pregnancies. In those comments, hgstern (the owner of the InsureBlog) and I had a vigorous debate as to whether infertility treatment should be covered by medical insurance.  Jenn, a nurse who formerly worked at an insurance company, also joined the debate and has an excellent post on her blog.

Here’s my position paper on the issue:

Executive Summary / Abstract (since this is a really long post)

Medical insurance should cover infertility treatment because:

• For most, infertility is a treatable medical condition
• Treatment meets the criteria for "medically necessity"
• Infertility is akin to other serious, life-limiting medical problems and not at all similar to having male pattern baldness or being less than endowed in the chest area.
• Providing coverage for infertility costs less that $2.50 per year per member
• It is indeed fair and right for other health plan members to subsidize infertility treatment, just as the infertile subsidize the child birth and pregnancy costs of more fecund members
• Not providing coverage for infertility treatment does not make macroeconomic sense; it costs the overall healthcare system more due to less effective surgical procedures and self-paid IVF cycles that result in multiple gestations.

The Rationale

1) Infertility is a treatable medical condition, and therefore should be covered

Infertility is a medical condition. 95-100% of the time one or more specific medical causes can be identified.  Some causes are structural abnormalities in the reproductive tract, such as a hydrosalpinx, a septated uterus, or a varicocele. Other causes are disease or endocrine disorders, such as endometriosis, cancer, PCOS (polycystic ovarian syndrome), and amenorrhea.  As such, infertility has much in common with other medical conditions that are caused by structural abnormalities, disease, or hormonal imbalances.

Not only is infertility a bona fide medical condition from a medical point of view, it is from a legal one as well. The Americans with Disabilities Act and the US Supreme Court[1] have confirmed that the ability to reproduce is a “major life activity,” akin to seeing, walking, working, and caring for one’s self. With that context, a disability is defined as a physical condition that prevents someone from participating in a major life activity.

For the majority of infertile couples, infertility is a treatable medical condition, for which non-experimental, minimally invasive procedures, such as IVF and artificial insemination are very effective. In fact, in some instances, it is the only way for a couple to conceive.  In my case, for example, I no longer have fallopian tubes due to two ruptured ectopic pregnancies, probably caused by in utero exposure to DES (yes, I was appropriately monitored, but was just very unlucky).  The only way for me to conceive is through IVF, which bypasses the tubes.[2]

2) Infertility treatment is “medically necessary," and therefore should be covered

What is “medically necessary?” Well, on this point, hgstern and I seem to disagree. So, I did a little research.

Medicare defines “medically necessary treatment” as:

• safe and effective
• not experimental
• appropriate

I have no problem with this definition, and treatment of infertility with IVF clearly meets all three criteria.

IVF is safer, more effective, and less costly to the health care system than alternative surgical procedures (for tubal reconstruction, removing endometriosis, etc), even though -- ironically -- these more expensive, less effective surgical procedures are often covered under medical insurance where IVF is not.

IVF is not experimental. It has been around for 27 years and is recognized by the American College of Obstetricians and Gynecologists and the American Society for Reproductive Medicine.

Finally, because it is less invasive, less risky and more successful than alternate surgical approaches, it is often the most appropriate treatment.  In fact, sometimes it's the only treatment if you have tubal problems (like me), recurrent miscarriages, or sperm quality issues.

I’ve also seen stricter definitions of “medically necessary” that require that the medical condition be likely to get worse if left untreated. Infertility treatment meets this criterion as well, since fertility declines as time goes on for both men and women.

3) Infertility treatment is not “lifestyle medicine,” and therefore it should be covered

Some people (hgstern included) argue that medical treatment for infertility is “lifestyle medicine,” akin to dental veneers, breast implants, and hair replacement. As such, they argue against infertility treatment by saying it is not fair to ask other health plan members (or the government, via tax breaks) to subsidize treatment for the infertile.

First, the lifestyle claim.  This one really pisses me off because:

1. No one should compare the importance of children to the importance of breast implants or hair plugs.  Seriously, think about the absurdity of that argument.
2. The medical inability to have children has been proven to cause as much stress as a having a terminal disease such as cancer or heart disease.  Many scholarly publications compare the impact of the loss to losing one's arm or leg.  Sure, you can live without an arm or leg, but is it really a "lifestyle" choice to seek medical treatment for it?

In fact, let’s take a much lesser condition as an example: a knee injury. Say you play sports, twist your knee and require surgery on your knee ligaments. Now, you won't die if you don't have the surgery, but you might limp around for the rest of your life.  Most people, myself included, would say ABSOLUTELY that health insurance should cover the surgery:

• …EVEN THOUGH you won’t die without the surgery
• …EVEN THOUGH your desire to walk without a limp might be considered “vanity” or merely supporting a "lifestyle" by some
• …EVEN THOUGH you might have contributed to your own problems by playing a sport when you were perhaps too old and too out of shape

If you don’t support insurance-covered infertility treatment, where do you stand? Do you think insurance should cover the knee repair?

Because, I'll tell you what. I personally would take a permanent limp over never ever having children any day of the week. And I’m sure many (most?) infertile couples feel the same way.  And besides that, your knee surgery is likely more expensive to the the health care system than my IVF procedure.

So, where do you stand on treatment for other illnesses and conditions that are not life threatening but can limit your life in ways both more and less insignificantly than infertility? For example: epidural anesthesia, medication for migraine headaches, sports medicine surgeries, treatment for eye disease, artificial limbs, hearing aids, treatment for skin rashes, surgery for back pain, treatment for Alzheimer's, normal vaginal childbirth, etc… If you accept that infertility is a treatable medical condition, you cannot logically support medical coverage for these other conditions but not for infertility.

As far as the “not fair to the fertile” argument… First, adding fertility coverage to an insurance plan would cost less than $2.50 per member per year. Second, by virtue of fewer childbirth procedures and fewer pregnancies, the average infertile couple and their progeny cost the health care system less than the average fertile couple, even if the infertile couple partakes in an IVF procedure or two.  The medical costs associated with the typical pregnancy and birth make the cost of an IVF cycle look like chump change.  So perhaps the question should really be, is it fair for infertile patients to subsidize fertile patients' medical expenses?

Furthermore, why is it fair for the young to subsidize nursing care for the elderly? Or for nonsmokers to subsidize the emphysema treatment of smokers? Or for women to subsidize the prostate cancer treatment of men?

Why is it fair?  Because it’s INSURANCE, which by definition spreads the risk of one among many, THAT'S WHY.

4) Not providing infertility insurance coverage is penny-wise, pound-foolish

Above arguments not withstanding, lack of insurance coverage for infertility treatment results in sub-optimal outcomes and higher costs to the overall system.  Insurance coverage for infertility makes macroeconomic sense.

First, IVF is not actually that costly (to the whole system, not to the patient) when compared to treatment for other common medical conditions.  Although people claim that IVF is extremely expensive (in fact, "costly fertility treatments" is practically a cliche), this is true only from the uninsured patients' point of view because they must pay the full, retail price of $10K-$15K per cycle (those are the prices in the ultra-expensive SF Bay Area).  But bring the bargaining power of an insurance company to the table, and the total payment (insurance payment + patient copay) is a much more reasonable $2-$3K[3], less than minor outpatient surgery.[4]

Second, from a view of total-system costs, IVF is far less costly and more successful than patients' attempts to correct their reproductive abnormalities via surgery.  It is also far less risky because IVF is not a true surgical procedure.  However, because IVF is not typically covered by insurance, patients are left optimizing THEIR side of the cost equation. This frequently leads them to opt for insurance-covered surgical procedures, such as a laparoscopy to remove endometriosis or unblock fallopian tubes.

Third, saving a few pennies on IVF coverage ends up costing the health system many times that with the increase in twin and triplet pregnancies. 95% of patients are uninsured for IVF.  The $10K+ retail price for an IVF cycle mean most couples are severely financially pressured to have their IVF cycles result in pregnancy. Also, like most would-be parents, infertile couples want to ultimately raise more than one child. So, couples undergoing IVF often hope for twins, to get “two for the price of one.” End result? Pressure to transfer at least two embryos, if not three.

This leads to dramatically more twin and triplet pregnancies, each of which are several times more expensive and risky in terms of prematurity and complications than normal singleton pregnancies. In fact, French researchers quantified the difference: twin pregnancies cost 3x singleton pregnancies, and triplet pregnancies are 8x. It would therefore make financial sense for insurance companies to cover 2 or 3 lifetime IVF cycles per patient, which would give couples the financial ability to opt for single-embryo transfers. As an example, I am personally fortunate enough to have coverage for 3 lifetime IVF attempts .  I therefore opted for a single-embryo transfer at age 34, and I did get pregnant with a singleton as a result (although I later lost the pregnancy[2]).

So, in closing, let me summarize by refering you to the "Abstract" at the beginning of this post.

And that's all I have to say about that.  For now at least. 

I will go take my chill pill now.

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[1] See the U.S. Supreme Court case Bragdon v. Abbot, 1998.

[2] If you want to read the gory details of my history and struggle with infertility, you're in the right place.  Check out posts in the "Complete Infertility Saga" category.

[3] I am fortunate enough to have insurance coverage for IVF, and can tell that my insurance company pays only $2500 for each IVF cycle, due to the discounts they have negotiated with providers. 

[4] It makes sense that IVF cycles cost the system a lot less than most any outpatient surgical procedure (save wart removal?) because the procedures are comparatively non-invasive.  IVF cycles include the following procedures over the course of a month:

• 3 or 4 transvaginal ultrasounds. 
• An “egg retrieval” procedure, where eggs are gathered from the ovaries via a long needle.  It takes 3o minutes to an hour, is performed in the doctor's office, and does not require incisions or general anesthesia.
• An “embryo transfer” procedure that is similar to a pap smear
• Preparation of the sperm (basically, spinning it in a centrifuge for 30 minutes)
• Embryologist time
• Fertility drugs
• A pregnancy test

All told, this is a lot less than a typical surgical procedure, which requires tons of drugs, OR time, and staffing by multiple physicians and nurses. 

YES! (Indiana Update)

Great News!  Indiana State Senator Patricia Miller has withdrawn her severely misguided bill!

She released a one sentence statement: “The issue has become more complex than anticipated and will be withdrawn from consideration by the Health Finance Commission.”

I am SURE that we all had something to do with this!  Thanks everyone for spreading the word, sending emails, and calling!

Power to the Infertile!

We Must Stop This Indiana Bill!

Update:   It is unclear with this poorly written bill requires straight, married couples to undergo a homestudy prior to ART if they don't use donor gametes.  The bill contradicts itself in many areas.   But even if the homestudy requirement can be set aside for some, it does not lessen the outrageousness of this attempt to legislate state control of your private parts.  Please continue to spread the word!
=========

Holy Shit.  We must stop this. 

Did you know that Republicans have put a bill in committee before the Indiana General Assembly requiring that any woman who wants to partake in any kind of ART (Assisted Reproduction) procedure -- IVF, donor sperm, donor egg, IUI -- be married????   (Full bill text here.)

And that, married or not, prior to undergoing any kind of ART procedure, you'd have to first be approved to do so by your local probate court?

And to get this approval, you'd have to complete an entire domestic adoption homestudy? It would no doubt take at least 6-18 months to complete, would only be good for 2 years, and would cost a pretty penny. See the bottom of this post for the extensive list of documentation you will need to gather so that some social worker can evaluate you and decide whether you're fit to go through ART. 

This bill contains even more anti-ART atrocities:

1. Egg donors could not be compensated
2. Using a gestational carrier would be illegal unless you proved to the court that your uterus is fucked up beyond the shadow of a doubt.
3. It'd be illegal to use a gestational carrier who has not been pregnant before.  So even if childfree your sister offers, forget it.

And if you do not obey, well, that's a Class B misdemeanor!

==========

Those are the facts. Now my commentary.

This is outrageous.  They are putting up impediments to couples receiving medical treatment for their medical problems.  For what other medical condition do you need court approval to receive the standard-of-care treatment?  You know that it will take 6-18 months for all this paperwork to be completed and approved.  All while your medical condition is getting worse every day, as your biological clock runs out.

The complete lack of respect for your privacy is shocking.  That they would require that you list your entire pregnancy history, your reaction to any pregnancy losses, the details of what is and is not wrong with your private parts, before a COURT decides whether you are eligible for medical treatment for your medical condition. 

And don't get me started on the obvious anti-gay, anti-single agenda of this bill.  Bigotry enshrined.

At this point, there should be no doubt in anyone's mind that there is a Battle Royale on for control of every American woman's uterus.  The Republicans think that we feeble-minded women are not able to make our own decisions as to whether we can or should bear children.  Please help stop them.

We must band together and stop this now.  Please spread the word - post something to your blog, email your friends. Everyone, write to the members of the Indiana Health Finance Commission. Let them know your story. Their phone numbers and addresses are listed below.

Also, if you live in Indiana, the next meeting of the Health Finance Commission will be held at the Statehouse on October 20, 2005 at 10 am in Senate Chambers and is open to the public.

• Sen. Patricia Miller (R) (317) 232-9489 [email protected]  (the author of this bill)
• Sen. Gregory Server (R) (317) 232-9490 s50@in.gov
• Sen. Gary Dillon (R) (317) 232-9808 s17@in.gov
• Sen. Beverly Gard (R) (317) 232-9493 s28@in.gov
• Sen. Ryan Mishler (R) (317) 233-0930 s9@in.gov
• Sen. Connie Lawson (R) (317) 232-9984 s24@in.gov
• Sen. Marvin Riegsecker (R) (317) 232-9488 s12@in.gov
• Sen. Billie Breaux (D) (317) 232-9849 s34@in.gov
• Sen. Vi Simpson (D) (317) 232-9849 s40@in.gov
• Sen. Connie Sipes (D) (317) 232-9526 s46@in.gov
• Sen. Timothy Skinner (D) (317) 232-9523 s38@in.gov
• Rep. Vaneta Becker (R) (317) 232-9769 h78@in.gov
• Rep. Robert Behning (R) (317) 232-9981 h91@in.gov
• Rep. Timothy Brown (R) (317) 234-3825 h41@in.gov
• Rep.Mary Kay Budak(R) (317) 232-9641 h20@in.gov
• Rep. Da vid Frizzell (R) (317) 232-9981 h93@in.gov
• Rep. Donald Lehe (R) (317) 232-9648 h15@in.gov
• Rep. Richard Dodge (R) (317) 232-9729 h51@in.gov
• Rep. Charlie Brown (D) (317) 232-9676 h3@in.gov
• Rep. David Orentlicher (D) (317) 232-9991 h86@in.gov
• Rep. Craig Fry (D) (317) 232-9994 h5@in.gov
• Rep. Carolene Mays (D) (317) 232-0243 h94@in.gov
• Rep. Scott Reske (D) (317) 232-9695 h37@in.gov

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Homestudy requirements, before you can petition the court for ART:

1. The intended parents' purpose for the assisted reproduction.
2. The fertility history of the intended parents, including the pregnancy history and response to pregnancy losses of the woman.
3. An acknowledgment by the intended parents that the child may not be the biological child of at least one of the intended parents depending on the type of artificial reproduction procedure used.
4. A list of the intended parents' family and friend support system.
5. A plan for sharing any known genetic information with the child.
6. Personal information about each intended parent, including the following:
   • (A) Family of origin.
   • (B) Values.
   • (C) Relationships.
   • (D) Education.
   • (E) Employment and income.
   • (F) Hobbies and talents.
   • (G) Physical description, including the general health of the individual.
   • (H) Birth verification.
   • (I) Personality description, including the strengths and weaknesses of each intended parent.
7. Description of any children residing in the intended parents' home.
8. A verification and evaluation of the intended parents' marital relationship, including:
   • (A) the shared values and interests between the individuals;
   • (B) the manner in which conflict between the individuals is resolved; and
   • (C) a history of the intended parents' relationship.
9. Documentation of the dissolution of any prior marriage and an assessment of the impact of the prior marriage on the intended parents' relationship.
10. A description of the family lifestyle of the intended parents, include a description of individual participation in faith-based or church activities, hobbies, and other interests.
11. The intended parents' child rearing expectations and values.
12. A description of the home and community, including verification of the safety and security of the home.
13. Child care plans.
14. Statement of the assets, liabilities, investments, and ability of the intended parents to manage finances, including the most recently filed tax forms.
15. A review of the local police records, the state and violent offender directory, and a criminal history check.
16. A letter of reference by a friend or family member.
17. A written consent from each donor, if known, to use of the donation in the assisted reproduction medical procedure.
18. The [homestudy agency's] recommendation for participation in assisted reproduction.

Get Me Outta Kansas

I am leaving for the Kansas City airport in approximately 10 minutes. 

I have just enough time to discuss an Official Kansas Phenomenon, the teaching of so-called "Intelligent" Design in public schools.  The concept riles me for a multitude of reasons, but this lovely article in Slate explains my disgust better than I ever could. 

It is a good article. Read it. Here's the link again.

And in other news, I am pleased to tell the entire Internet that my Period arrived today.  It's okay, it won't be expecting a ticket-tape parade when "we" arrive back to San Francisco, but it will probably hold a press conference tomorrow morning.

Save a monster ovarian cyst or two, injections for IVF #4 start tomorrow.

Quote of the Day: My Feminist Dilemma and ART

"But for me, there is another uncomfortable truth: my own pro-abortion-rights politics defy me. Social personhood may be distinct from biological and legal personhood, yet the zing of connection between me and my embryo felt startlingly real, and at direct odds with everything I believe about when life begins. Nor have those beliefs -- a complicated calculus of science, politics and ethics -- changed. I tell myself that this wasn't a person. It wasn't a child. At the same time, I can't deny that it was something. How can I mourn what I don't believe existed? The debate over abortion has become so polarized that exploring such contradictions feels too risky. In the political discussion, there has been no vocabulary of nuance. "

-- Mourning My Miscarriage, BY PEGGY ORENSTEIN

Pro-Choice Should Mean More

In my last post, I promised a post responding to a non-IF bloggers criticism of leading-edge ART treatments.  In my fantasies, it was articulate, well-reasoned and further enlightened the knowledge of people outside Planet Infertility.

Problem is, I am too mentally exhausted to craft a reasonable argument or write a hard-hitting response.  I'm suffering from Paxil withdrawal.  And I'm out of Oreo Double-Stuffs. How can I think, never mind be trusted to drive a car, under these circumstances?

What I wanted to write about was the following:

1. I am a die-hard feminist and extremely pro-choice. 
2. I notice that most of the energies of the feminist movement are in preserving the "NO" part of the pro-choice CHOICE, that is the right to NOT become pregnant.  There is very little focused on the "YES" part of the CHOICE, the "right" TO become pregnant. 
3. OK, it's debatable as to whether it is a RIGHT to become pregnant - I don't know how to resolve that one.  To me, it certainly feels like women should have the RIGHT to pursue the most technologically advanced treatments for their medical conditions, infertility included. 
4. I was about to write that the Pro-Choice focus on the NO over the YES is understandable because more women are affected by unwanted pregnancy than unwanted infertility. But, on second thought, I am not sure that is even true.  I'd have to research the stats, and I am far too lazy.  But I'll bet that the numbers for these two groups are not so different. The main difference is that TODAY, poor women have access abortions but not infertility treatment.
5. I maintain that you cannot be a TRUE feminist or a GENUINE Pro-Choicer unless you are in favor of state-of-the-art, universally accessible treatment for infertility, and unless you condemn efforts that would block women from receiving the standard of care for infertility. Such as that fucktard Kentucky legislator's bullshit bill that would make it a felony to fertilize more than one egg per IVF procedure, and therefore reducing a couple's success rate with IVF to LESS than natural conception. Or the pathetic state of health coverage in the US and UK for an acknowledged MEDICAL condition that affects millions.
6. Therefore, some of the people who claim to be feminists or pro-choice are NOT.  Some of them truly scorn those who CHOOSE to have children.  Witness: the comments in this entry from I Blame the Patriarchy (my favorite feminist blog, mandatory reading for those who like their feminism served up with lots of snark). 
7. The arguments from this crowd of Pro-Abortion, Anti-Feminists are often:
   • classist and racist ("she's too poor/uneducated to raise a child")
   • diminishing of other women's lifestyle choices ("she wants to throw away her mind/career just to have a child", "there's so many unwanted kids that you could adopt instead")
   • disregarding of a woman's ability to make her own decisions about her body ("maybe Mother Nature is trying to tell you something")
   • agesit ("do we really want 50-year-old women having babies?" to which I say, why the fuck not? 50-year-old men do, even though they die, on average, 7 years earlier than women.)
8. These attitudes are not so different from the anti-abortion fanatics who put the alleged "rights" of fetuses above the rights of women to control their own bodies.  At the core is a belief that women (or at least "some" women) are not capable of making their own decisions or evaluating for themselves whether or not they are able to bear or raise children.  That's why this crowd must be called out as Anti-Feminist and Anti-Choice.

And then, with the context set, I wanted to discuss the use of aborted fetuses as egg donors.  Yes, you read that right.  Predictably, everyone -- pro-"choice" and pro-"life" -- seems disgusted by this concept.  But for today I'm out of time. We'll discuss tomorrow.

PS - I'm not doing the TrackBack thing because I don't need the incredibly brilliant Dr. Bitch or Twisty Faster ripping me a new one over a half-baked post like this.

Update on Annie and the Insurance Company

Thanks, everyone, for the advice for my friend Annie, who has been denied insurance coverage for IVF even though she is a habitual aborter and her company resides in Massachusetts, a state with an infertility insurance coverage mandate.

Annie has already appealed through her insurance company and lost.  The insurance company pointed her to the text of the Massachusetts state mandate at http://www.mass.gov/doi/Legal_Hearings/211_37.pdf).  The mandate defines "infertility" as follows:

Infertility: The condition of a presumably healthy individual who is unable to conceive or produce conception during a period of one year.

This insurance company was kind enough to point out to her, in writing no less, that Massachusetts's definition of infertility covers conception, but only conception.  There is nothing pertaining to the inability to carry a pregnancy.  Ergo, the insurance company said that according to Massachusetts state law, Annie is not infertile.  Therefore, they won't cover her for any infertility treatment.

With the terrible wording of the Massachusetts mandate -- which is totally not in line with the official medical definition of infertility -- it seems that the insurance company has a strong case. I cannot imagine WHY Massachusetts did not include the inability to carry a pregnancy in their definition of infertility, but they didn't.

In light of this new information, I'm thinking Annie has to appeal to the state or find a lawyer.  I've been scouring the Internet for her, but I'd appreciate any leads.  Thanks again for all your help.

PS - In my research, I found this excellent article about the true cost of providing universal infertility coverage.

Effing Insurance Companies (and Questions on Massachusetts IF Coverage Mandate)

I am fortunate indeed to have insurance coverage for infertility treatment, including IVF and medications.  In fact, I am double-insured through both my employer and my husband's.  As a result, so far we've only paid about $300 for 2 IVF attempts, one with ICSI and Assisted Hatching.  (Of course, there are still bills pending even though the cycles were last October and November, so it is still possible we'll end up paying a lot more eventually).

I am lucky.  My good friend, "Annie," is not.  Annie thought she had incredible insurance coverage for infertility: 3 life-time IVF attempts plus drugs (her employer is based in Massachusetts, which mandates insurance coverage for infertility).  But her insurance company is totally screwing her.

Unlike me, Annie has no problem conceiving.  She is a "habitual aborter" and has had 4 miscarriages because she is a carrier for a genetic translocation.  The doctors are 100% certain that this is the issue.  She needs to do IVF with PGD to identify and transfer embryos that do not have this translocation.

First her insurance company demanded that she do at least 3 IUI's before they would agree to an IVF cycle.  Even though this course of treatment makes absolutely no sense given her situation, she complied. And sure enough these IUIs resulted in 2 more miscarriages - the results of the genetic translocation, again and again. 

At last, she was finally on deck to start an IVF cycle.  And then her insurance informed her they would not be paying for her IVF cycle.  "You can conceive, so you're fertile." they said, "Therefore, you're not eligible for infertility treatment.  In fact, you're lucky we don't back-bill you for the 3 IUI cycles that we already paid for, since you weren't eligible for those either."  She protested, but they say that their determination is in full accordance with the coverage mandate enacted by the great Commonwealth of Massachusetts.

UNFUCKING BELIEVABLE, I say.

So, I ask you, especially those of you with insurance coverage in Massachusetts, is this true? Bullshit? A lie? I have no idea. I am irate on her behalf.