Around 1 in 5 women will struggle to become pregnant and IVF treatments have become a common way to become a parent. The demand for services is growing, but insurance coverage in the US isn’t catching up
Insurance cover is growing, with 27% of companies with 500 or more employees covering IVF in 2020, up from 24% in 2015, but it’s still not enough. And it’s fraught with stress and concern. And expense.
For one Florida couple, Brenna Kaminski and her husband Joshua Pritt, this is painfully true
The company that Joshua’s works for, an energy firm, has insurance that would cover the couple. But after two unsuccessful cycles of IVF, the couple are still $15,000 out of pocket.
Brenna and Joshua were informed that the maximum they would need to pay was $2,700 per cycle. 37-year-old freelance marketer and writer Brenna says, “This whole thing has been a nightmare. The stress has been unbelievable”.
For in-network care, they were informed that they would be expected to cover 20% of costs, or 40% of out-of-network care. The couple chose an in-network provider in the Spring of 2020 at an office in nearby Viera, Florida from a list provided by insurer Blue Cross and Blue Shield of Illinois.
However, after seeing a doctor, they were told that they’d have to travel to Miami, 3.5 hours away, for three separate visits for treatment. The couple paid about $2,700 out-of-pocket for the medicines alone. They also paid an additional $500 because the fertility clinic required them to use an out-of-network lab for blood tests.
Dr Kara Goldman, associate professor of obstetrics and gynecology at Northwestern University says, “Infertility is a disease and should be treated as such, and insurance coverage should reflect that. Coverage is often incomplete because people too often don’t see infertility as equal to other diseases.”
After an unsuccessful round, Brenna and Joshua decided to try another clinic in November 2020
They chose from within the same insurer network, an hour away at Winter Park in Florida, the Center for Reproductive Medicine. The facility that they would have treatment in, the Orlando Avenue Surgery Center, was in the same building – but it wasn’t in the insurer network.
The couple were informed that the Center was “likely to be added soon” and were told that they would get a waiver for the treatment to be considered in-network. This was a verbal agreement, not a written one.
They were required to pay $2,700 plus separate medication costs but they were issued a bill for more than $6,000 in addition to almost $4,000 for medication
After this cycle also failed, Brenna spent almost a year trying to get their insurer to treat their cycle as an in-network procedure. She says, “It’s unfair for Blue Cross to have listed the Winter Park fertility clinic in its provider network if its doctors performed the actual IVF procedure in an out-of-network surgery center. The surgery center is owned by some of the clinic’s doctors.”
In a statement, the Centre for Reproductive Medicine’s executive director, Stephen Brown, wouldn’t address Brenna’s case specifically even though she had given permission for him to discuss it. In an email, Brown wrote that the clinic was transparent with all its patients that its surgery center was not in Blue Cross’ network.
About a month after the couple had finished their treatment, the Winter Park center was added to the insurers’ network. Thankfully, within two weeks, the insurer considered the treatment in-network and paid their bills in full.
“It’s finally making logical sense,” Joshua said after learning that their billing dispute was resolved. “It’s good to know we won’t be getting any more bills.”
But for it to take a year, when the couple have undergone such a traumatic experience only adds to their stress and upset
A new federal insurance law, the No Surprises Act, came into effect in January. It says that patients don’t have to pay more than the in-network cost-sharing amount if the insurer’s provider directory gave inaccurate information.
Betsy Campbell, chief engagement officer at Resolve: The National Infertility Association, a patient advocacy organization says, “Infertility treatment is a series of very complex procedures involving lab work, surgery, anaesthesia, and it needs to be provided in a way that the insurance system has not always respected”.
“Too often, insurance makes a couple jump through hoops to get the care they need. Everyone should have the right to build a family, and it should not matter what employer you work for, or what state you live in or how big a check you can write.”
Have you had a similar experience? Would you like to share your story? We would love to hear from you at firstname.lastname@example.org.
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