Insurance Coverage Facts
Myth: Adding an infertility coverage benefit to a health benefit package will increase health care costs.
Fact: Recent studies indicate that including comprehensive infertility coverage may actually reduce costs and improve outcomes.
According to a 2006 employer survey conducted by consulting firm William M. Mercer, and comissioned by RESOLVE:
- 91% of respondents offering infertility treatment have not experienced an increase in their medical costs as a result of providing this coverage.
(Click here to download the survey results in PDF format.)
- Often patients select treatment based on what is covered in their health benefit plan rather than what is most appropriate treatment. For example, a woman having trouble conceiving because of blocked fallopian tubes or tubal scarring may opt for tubal surgery, a covered treatment, which can cost $8,000-$13,000 per surgery. Many patients are forced to forgo in vitro fertilization (IVF) because it is not a covered service even though it costs about the same as tubal surgery and statistically is more likely to result in a successful pregnancy.
- According to William M. Mercer, “The decline in use of high-cost procedures like tubal surgery would likely offset the cost to include IVF as a benefit and provide improved health outcomes.” (William M. Mercer, Infertility as a Covered Benefit, 1997).
- In states with mandated infertility insurance, the rate of multiple births is lower than in states without coverage. (New England Journal of Medicine, “Insurance Coverage and Outcomes of In Vitro Fertilization,” August 2002). Couples with insurance coverage are free to make more appropriate decisions with their physicians based on medical necessity rather than financial considerations which often result in multiple births and a high rate of complications during and post-pregnancy. (For more on this study, follow this link.)
- Comprehensive infertility coverage may actually reduce premium expense by as much as $1 per member/per month. According to The Hidden Costs of Infertility Treatment in Employee Health Benefits Plans, insurance premiums that now indirectly provide coverage for “hidden” infertility benefits—surgeries to remove scarring in a woman’s fallopian tubes or varicose vein removal for men—were calculated to be adequate to cover more effective and often less expensive treatments such as ovulation induction, intrauterine insemination and in vitro fertilization. (Blackwell, Richard E. and the William Mercer Actuarial Team, 2000)
- The cost of infertility services as a percent of the total health premiums went down after the 1987 Massachusetts mandate. (Study by Griffin and Panak, Fertility & Sterility, 1998).
- According to a 2003 Harris Interactive Poll, 80% of the general population believes infertility treatment should be covered by insurance. (Harris Interactive Inc., Survey, 2003).
- In vitro fertilization accounts for less than 3% of infertility services. According to the American Society of Reproductive Medicine (ASRM), 85%-90% of infertility cases can be treated with conventional medications. (http://www.asrm.org/, Quick Facts About Infertility).