insurance

IVF no longer covered where it all started

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The first IVF baby Louise Brown was conceived near Cambridge, England over 3 decades ago...

Now it turns out that National Health Service in Cambridgeshire will no longer cover IVF treatment in the place where it all began.

It is sad but true according the BBC...

The UK with its single payer government health system, like all other health systems, has limited funds and been forced to make a decision on where to cut. In Cambridgeshire, coverage for IVF was one of those cuts even though ivf treatment is recommended by the nhs' own guidelines.

In the United States, where we have a more fragmented system, some states such as New Jersey where we are located, mandate coverage. While the law remains intact and recently was amended to expand the definition of infertility, health care reform laws such as the Affordable Care Act (ACA, Obamacare) has actually reduced the number of women in our state who are covered for fertility treatment. When faced with multiple mandates, employers and insurers are forced to make decisions where to cut to control their premiums.

While there is plenty of talk these days about advocating a single payer government controlled system, it is not clear that such a change will benefit couples with infertility. While some countries with national health care systems do cover IVF and other treatments, it is often the first item on the chopping block when costs are getting out of control. It is certainly the case in Britain.

For those who advocate for the availability of treatment of infertile couples, be careful what you wish for. Increased access to medical care does not necessarily mean increaseD access to fertility care.

Rhode Island mandates fertility preservation

First state mandates egg freezing insurance coverage: Princeton IVF blog

First state requires fertility preservation coverage from insurers

Egg freezing insurance coverage

What is fertility preservation?

It refers to obtaining, freezing and storing eggs, sperm or embryos for future use. 

Why would one want to preserve fertility?

There are several reasons:

  • If you are undergoing treatment for cancer or other diseases that require treatments such as chemotherapy, radiation or surgery which are likely to cause infertility.
  • If you need to defer having a baby but are concerned you may be too old when you are ready
  • If you do not have a partner, are concerned about waiting but not ready to use a sperm donor.

What is the signIficance of the Rhode Island law?

This is the first time in the US that fertility preservation insurance coverage has been mandated by law. A number of states do require treatment for infertility but not necessarily fertility preservation. That could change in the future.

Where can I learn more about the mandate?

Here is a link to the Rhode Island law.

What do I do if I am about to get chemotherapy and want to learn more?

This is a discussion you need to have ASAP with your oncologist and a reproductive medicine specialist. Ideally the process should happen before cancer treatment starts, and your oncologist will want to delay treatment as little as possible. If you are in our area and would like to see us at Princeton IVF, please call at 609-896-4984 or 609-896-0777 to set up an appointment.

 

New Jersey updates Infertility Law

New Jersey fertility coverage mandate expanded: Princeton IVF

Governor Christie signs updated NJ fertility mandate

At least in the past, New Jersey has had among the most generous insurance coverage for infertility treatment in the US. The legal mandate for this, the New Jersey Family Building Act, passed over a decade and a half ago, required NJ employers with certain exemptions, to cover fertility treatment up to and including IUI and IVF.

Unfortunately, changes in the health care system, such the Affordable Care Act (Obamacare) have affected coverage. Fortunately, New Jersey state employees and most NJ teachers continue to be covered under the mandate. There are some gaps in this coverage, particularly for single women and those in single sex/lesbian relationships.

With an act of the NJ state legislature and the signature of Governor Christie, that has changed. The infertility mandate has been updated to reflect the new ASRM definition of infertility and includes the following:

  • A male is unable to impregnate a female;
  • A female with a male partner and under 35 years of age is unable to conceive after 12 months of unprotected sexual intercourse;
  • A female with a male partner and 35 years of age and over is unable to conceive after 6 months of unprotected sexual intercourse;
  • A female without a male partner and under 35 years of age who is unable to conceive after 12 failed attempts of IUI (intrauterine insemination) under medical supervision;
  • A female without a male partner and over 35 years of age who is unable to conceive after 6 failed attempts of IUI under medical supervision;
  • Partners are unable to conceive as a result of involuntary medical sterility;
  • A person is unable to carry a pregnancy to live birth; or
  • A previous determination of infertility pursuant to the law.

This update in coverage becomes effective in August 2017 and only applies to New Jersey state employee and teacher plans.

At Princeton IVF, we participate in the affected New Jersey State Health Benefits Program and School Employees Health Benefits Plan that are affected by these new rules, including NJ Direct  from Horizon Blue Cross Blue Shield and Aetna for NJ state employees.

New York: fertility treatment for all women?

NY Governor Cuomo expands fertility coverage: Princeton IVF blog

New York governor changes insurance rules

Governor Andrew Cuomo has instructed insurance companies in New York to cover infertility treatments on single women and women in same sex relationships.

New York is one of fifteen states, including our own, New Jersey, that requires insurance plans to include infertility treatment in their benefits. Typically, these mandates require a period of unprotected intercourse to kick in. In New York, the governor has eliminated that requirement for women in whom that is not an option.

It is unclear how impactful this change may be since New York's infertility mandate is rather limited. It has very limited coverage for IVF, and for insemination, the cost of donor sperm is high. Donor sperm is rarely if ever covered by insurance regardless on insurance mandates.