Wed 14 Nov 2007
Did you know that last week was National Infertility Awareness Week? Or that infertility affects 12.5% of the US population? I saw a few blog posts about it, but didn’t get organized to add my $.02 until now.
I hesitate to declare myself part of the “infertility community.” I don’t have PCOS, I haven’t had any miscarriages, it only took me five cycles of trying to get pregnant with Noah.
On the other hand, getting pregnant is the same big, expensive, medical deal for me as it is for someone who spends six months or a year having sex with the intent of getting pregnant, and not succeeding. We go to the same doctors and we take the same drugs.
I’ve been lucky.
Since we’ve been trying to get pregnant, I’ve had jobs with great health insurance that included at least some infertility treatment. Still, here’s a rough breakdown of our out-of-pocket expenses:
From the beginning to Noah’s birth:
- 10 vials of Our Anonymous Donor’s sperm: $2850 in 2004. If we were buying the same category of donor today, it would be $405 per vial, so I’m glad we bought when we did. Also, we paid for this through my flexible benefit plan health savings account, the $5k you can withhold pre-tax. Who knew that sperm would be a “qualified medical expense?”
- ClearBlue Easy Fertility Monitor: $175, plus sticks to test with, $40/pack of 30, roughly $160.
- Doctor visits when we lived in DC: Roughly $1000. The doctor was out of network, we did three rounds of unmedicated IUI.
- Getting the sperm from the cryobank to the doctor’s office: Roughly $85 each time for 5 cycles = $425.
- Storing the sperm from January 2004 through May 2007: $1155
- Doctor visits after we moved to Atlanta: Roughly $500. I had coverage, the doctor was in network, but I had a $400 deductible and a 10% co-pay.
- Drugs: Roughly $50.
Total cost of infertility treatment resulting in Noah: $6315.
Total cost so far in the effort to have a second child:
- Evaluations etc for Jill, when we thought she was going to have baby #2: Roughly $1000. The doctor/facility was out of network, and we have a $1500 deductible EACH.
- Storage with the non-profit facility Jill was going to use: $10/m for 3 months = $30. (Because of the 3 ring circus of sperm transportation that I went through to move it to my RE’s office, they don’t seem to have entered it in their storage billing system.)
- Doctor’s visits for me: Roughly $1500. They finally agree that I’ve met my deductible, so we have to have hit that, but I can’t explain it all.
- Drugs: $105
- Bloodwork while out of area: $913 that I am still fighting with the insurance company about. Either they should pay it, or they should count it against my deductible. They should quit erasing it from their computers when they get confused.
- Second opinion doctor who was out of network but I have awesome insurance so that was still 70% covered: $560. (I haven’t gotten that 70% back, so I’m counting the whole amount. It’s still out of my pocket.)
- EDITED TO ADD more ovulation predictor kits and sticks for the Clear Blue Easy Monitor. And pregnancy tests. Not to be icky, but we in the ttc blogosphere call all of that gear “peesticks.” I would guess roughly $20/cycle, including the canceled & skipped cycles, let’s say $80.
Total cost of infertility treatment so far in round two: $4188.
Also? Add parking to most visits (all DC and the convenient Atlanta ones, but not the ones where I have to drive halfway to Tennessee). Let’s say $10 for each DC appointment and $3 on average for Atlanta. Call that $60 in DC and $45 here, or $72 in round one and $33 so far in round two.
That brings us to a current $10608.
If I get pregnant this cycle or the next, while it’s still 2007 and we’re still doing IUI, our additional out of pocket costs should be minimal, say $250 or less.
If we don’t, we’ll have one vial left and have to have a serious discussion of IVF. My insurance doesn’t cover IVF at all.
The RE practice with whom we had the second opinion consult told us, in great detail, that if we did IVF through them, it would cost between $12,000-$20,000.
November 14th, 2007 at 6:40 am
And the IVF drugs cost a fortune.
November 14th, 2007 at 12:12 pm
I have to say it, I can’t believe that medical insurance pays for any of it. This is, in my eyes, a completely optional procedure that would probably be cheaper if it didn’t have the insurance subsidy to fall back on.
A good example of what I mean is Lasik surgery. I don’t know of any insurance plans that will pay for it, yet each year the technology gets better and less expensive. Without being able to pull money out of the blue cross coffers, doctors who provide Lasik have had to keep the cost down to what the market will bear.
When I started on Empire Blue Cross three years ago my plan was fully paid by my employer. Now I pay $500 every quarter and my coverage has gotten worse. (Don’t get me started on the fact that I pay the same for Karen and myself as someone with 3 kids who is at the doctor every other week.)
I can’t help but wonder how much money could be saved (and how many more people insured) if insurance only paid for necessary procedures and preventative medicine?
I fully support you and Jill wanting children, I just don’t see why anyone else should have to help pay for it.
November 14th, 2007 at 1:35 pm
Sean, you know there are probably thousands of different kinds of insurance, right?
I don’t have a problem with you and Karen choosing a “preventative/emergency only” type plan, and I agree, something like that should be comparatively inexpensive.
I made a different choice. I pay a bit over $200/month for the premium health insurance option available from my employer, for all 3 of us. On top of that, I’m taxed on the $544/month my employer pays towards Jill’s coverage, because our marriage isn’t recognized by the tax code. (I think it’s interesting that your insurance apparently only has “single” and “family” options — mine distinguishes between a 2-person family and a family of 3 or more.)
Personally, I don’t see how any kind of comprehensive health insurance can justify not covering at least some infertility treatment.
Of course people are free to choose to not have children, but they’re also free to choose not to have cochlear implants and instead to learn ASL and become involved in the Deaf community if they lose their hearing.
Still, I wouldn’t consider that “optional” or “elective.” If someone wants to have children and there are medical options that can treat their situation, I think they should be covered by any comprehensive insurance plan. Both of those situations affect a major area of life that most people want to participate in. (Not that there’s anything wrong with making a different choice.)
I also don’t see anything wrong with insurance companies offering much more minimalistic plans for people who only want to be covered for an annual exam and an emergency. I don’t happen to want that plan, myself.
November 14th, 2007 at 1:54 pm
I think it makes fiscal sense for insurance companies to cover infertility. If someone drains their retirement to pay for fertility treatment, they are much more likely to take risks which could result in multiples because they have only a few chances.
And the NICU stay for the resulting kids? Covered by insurance and a whole lot more money than the ART.
I have a modest amount of infertility coverage now. And I pay a whole lotta money to get health insurance plus the whole “imputed income.”
November 14th, 2007 at 10:38 pm
Well, if I had my druthers your marriage would have the same benefits and rights as mine. Why they are different in the eyes of the state I will never understand.
Having said that, I wasn’t given much of a choice in my coverage but it is what you would call comprehensive. If I looked into it I’m sure some degree of infertility treatments would be covered.
You seem to be confusing my use of necessary with emergency. Nobody would be well served if their treatments were limited to the emergency rooms.
What I’m talking about is the difference between a woman having reconstructive surgery after beating breast cancer and one who doesn’t “feel pretty” without C cups. They each have the same procedure but the reasoning behind them (in my mind) makes only the first medically necessary the second is a choice. It’s about context.
Context can be a tricky thing though. Don’t forget that some deaf communities consider cochlear implants a form of genocide against the deaf culture.
But I digress. Having a child is a choice, plain and simple. If you can’t have a child for whatever reason, you can choose to adopt (legal issues aside), or attempt infertility treatments, or choose to find happiness another way.
Your lifespan won’t be shortened, your day to day existence won’t be made more difficult.
And Brooke, I maintain my position that by operating in a no-insurance market value economy the prices of infertility treatments would have to come down to meet a price point that the market would bear.
November 15th, 2007 at 5:27 am
Sean, that’s why I picked cochlear implants as the example.
While having children is a choice, there’s almost nothing pure and simple about that choice. I think that’s true regardless of whether it is to have them, attempt to have them, attempt to avoid having them, or making a commitment not to have them, whatever that might take. It’s culturally and psychologically loaded like almost no other choices we make.
Also, I think Brooke’s point stands even in a theoretically competitive marketplace.
Speaking of children, mine is waking up.
November 15th, 2007 at 9:40 am
Well, as long as you’re not offended by the fact that I consider you part of the infertility community… I think there’s two sides of IF–reproductive health where something is functionally wrong with the body and biological limitations where you are infertile due to the limitations of our bodies–GLBT, but also post-chemo or spinal cord injuries. I guess I go with the idea that if you want to have children and you’re not “fertile” in the sense that you can conceive on your own, you are “infertile.” A pretty broad definition, but you hit it on the head–it doesn’t matter why you’re going through treatments, the end result is the same. They’re expensive, emotional, physically painful/uncomfortable, etc. Whether you entered life knowing you’d need to utilize treatments or whether it came as a shock. But that’s just my take.
November 15th, 2007 at 5:01 pm
I’m not sure what was more informative…your original post or these comments. Very interesting.
Thanks for sharing.
And best of luck!
November 17th, 2007 at 7:34 pm
Late to the thought-provoking party. I’d have to say, Sean, while I see your overall point, that a baby is unlike breasts or even better eyesight.
Think of it this way: The whole purpose of DNA is to replicate itself. So while reproduction might not be medically “necessary” for Liza and Jill’s immediate lifespan, it is entirely necessary for the capital-L Life.
Not that it should be a mandate for every couple, but if you got the urge, there is a biologically and daresay medically sound reason for it.
And their infertility is no different than if Liza were married to a man with poor sperm. Except I’m sure that she occasionally gets to hold the remote.
November 18th, 2007 at 5:45 pm
I’d like to hold the remote! Lol.
I was blessed in that I didn’t have to go thorough any of this.
So all I have to say is GOOD LUCK! I hope it happens for your family and I hope it happens soon.
November 18th, 2007 at 11:22 pm
I’m a little uncomfortable throwing in an opinion supporting Sean, since I don’t want this to turn into a men vs. women kind of thing.
Though my opinion is less specific to Liza and Jill’s particular situation, then to infertility in general.
For insurance companies (one for which I work, and therefore feel quite sleazy) there’s obviously a bottom line of income/payout. If we fail to cough up the dough for infertility treatments, could we perhaps have paid for more diagnostics for a patient who passed away while waiting for insurance to cover additional treatment?
Our data warehouse has a brief 500 character description of customer’s health situations. I’m continually surprised, shocked, and exceedingly depressed at the sorrow that can be conveyed in 500 characters. If I didn’t drink excessively already, I probably would start.
There are bad, bad situations out there that insurance could help cover. But can’t because there isn’t funding. Funding which MIGHT be available if infertility treatments were not being paid out.
I’m certainly not pig-headed enough to think that I’m completely right on this subject. I’d welcome any dissension to my opinions. And I’ve been hypocritical enough to have my insurance pay for part of my vasectomy - which obviously is fertility-related.
-> Richard
November 19th, 2007 at 11:42 am
Thanks, Leanne & Isabel!
Carrie, you would be shocked by how little I get to hold the remote. Practically never.
Richard, I totally understand that insurance companies need to set coverage priorities and make decisions, but it seems like a false dichotomy to set up “infertility treatment” vs “something fatal that might have been caught by more testing.”
Surely infertility treatment isn’t the only medical care that some insurance plans cover that doesn’t directly save lives. My insurance covers X# of chiropractic treatments and Y# of accupuncture treatments, for crying out loud. Personally, they’re saving lots of that money on me, because I haven’t used a dime of it.
And *that* is precisely the point of insurance. Dump lots of people into a big pool, combine their money, cover their medical treatment. Some people will be profit centers, some people will break even, and some people will cost more than they contribute.
Also? Here’s my big insurance tirade. One of my occasional readers, married to a more regular reader, is a family practice doctor.
About a year ago, while we were chatting about insurance, she told me that her practice, which is pretty big, has to spend $0.30 on administrative costs related to getting money out of insurance companies, for every $1.00 they actually get paid by insurance.
Of course you’ll never get administrative costs to zero, but good grief! If it’s that hard to get insurance companies to pay their bills, something is wrong. And I’m not convinced that the poor insurance companies are running out of money.
November 19th, 2007 at 8:09 pm
For employer-sponsored plans, it is the employer, not the insurer, that decides what is a covered benefit. The insurance company then sets premiums based on what the plan includes and what rates it’s been able to wrangle with local docs/hospitals, which may vary dramatically even within the same city.
So unless it’s one of those mandates we keep hearing about, like, say, mental health parity, it’s really up to employers. And luckily you have a good one.
December 30th, 2007 at 5:59 pm
I think insurance should cover infertility testing and treatment. We spent $40,000 in a 9 month span to concieve our son. This does not include many of the items you listed (parking, fetility monitor, etc.). That is what we paid directly to the RE in that time span and also does not incldue the 4 years prior of trying with limited medical help. If people start picking and choosing what gets paid by insurance how long will it be before we stop paying for cancer treatment for those who smoked, or high blood pressure medications for those who refuse to lose weight, and other obesity related medical conditions? If my employer had covered my treatment it would have cost each employee less than $3 per YEAR! So I get to pay for the cancer treatment for my co-wokers smoking related terminal lung cancer but no one want sto pay for me to be able to ahve a child. Doesn’t seem quite right.