Waiting on Infertility Insurance Reform? That's Risky

The issue of insurance coverage for the diagnosis and treatment of infertility has been a hot topic for many years. Just ask the good folks at RESOLVE and the American Fertility Association, the country's primary organizations that carry the advocacy banner for fertility patients into the halls of legislators. And while there is much discussion about hopeful possibilities for the majority of patients without infertility insurance coverage, there is still far more up in the air than nailed down in reality.

This article in the WashingtonTimes illustrates how hard it has been for states to decide what is an “essential health benefit” in accordance with the 2010 Federal health care law. These decisions must be hard-wired into place – ready for sale through insurance policies – by January 2014.

As of October 10, 2012, the state of Texas has not chosen a benchmark plan If you want to follow along, the Texas Department of Insurance maintains an updated page about thedetermination of Essential HealthBenefits. From that page, you can access a chart that shows the plans being considered, on the “Updated TDI Analysis of Essential HealthBenefits Benchmark PlanOptions”. If you're either a legislative or insurance expert, you might be able to discern from the TDI website whether or not infertility treatment will be covered. If, on the other hand, you're not an expert in those areas, you could be left simply confused and frustrated.

My opinion, after nearly 20 years of helping worried patients resolve their infertility: You can put off getting pregnant for years waiting for insurance coverage to be available. Eventually, some patients find that putting off fertility treatment for years equates to forever. I've never had a patient tell me that postponing treatment, sometimes to the point of making treatment no longer an option in terms of a woman's age, was worth it. I've also never heard a new parent say that they wouldn't do whatever they did to afford treatment all over again.

If you haven't sought help but need to, don't put it off by waiting for the states to figure it out. HoustonFertility Center has financial staff who can guide you, and time is of the essence.

~ Dr. Sonja Kristiansen MD

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