Many patients are dismayed to learn that insurance coverage for their infertility treatment does not exist.
According to the American Society for Reproductive Medicine (ASRM), infertility is indeed a disease affecting men and women.
“Infertility is a disease defined by the failure to achieve a successful pregnancy after 12 months or more of appropriate, timed unprotected intercourse or therapeutic donor inseminations. Earlier evaluation and treatment may be justified based on medical history and physical findings and is warranted after 6 months for women over age 35.”
Current estimates are that 1 in 8 U.S. couples struggle to conceive and needed medical treatment. The management of infertility may require diagnostic procedures, surgical or drug treatments, and/or various levels of assisted reproductive technology (ART), including intrauterine insemination and in vitro fertilization (IVF).
It sounds like a medical problem. Unfortunately, the reality is that benefits for infertility evaluation and treatment are often excluded from managed-care plans because infertility is perceived as a social problem.
Fortunately, social pressure is turning some of this around and many employers are adding fertility coverage to their health plans as a way to entice workers. Today, about a third of U.S. employers offer some degree of infertility coverage, and a smaller proportion of that includes coverage for IVF. (See our list of Louisiana employers who offer some form of fertility benefits.)
Many states have laws mandating that insurance companies provide, or offer to provide, coverage for some fertility treatments but the scope varies widely among them and many categorically exclude IVF, the most effective treatment. These state mandates are not binding on self-insured or small-scale employers. Companies that are headquartered in states with a mandate must extend benefits to employees working and living in other states. (See a current list of state infertility mandate information at Resolve: The National Infertility Association)
Louisiana law does not require insurers to cover the very treatments that will help a woman conceive.
What is the situation in Louisiana? By law, insurers must cover underlying medical conditions but are not required to cover fertility medications, IVF, or sterilization reversal. If a medical condition exists, evaluation and management of that condition is generally covered. The law reads, in part, as follows:
“Any health insurance policy, contract or plan… contracted for in this state on or after January 1, 2002 shall not exclude coverage for the diagnosis and treatment of a correctable medical condition otherwise covered…solely because the condition results in infertility.” (Louisiana State Law Subsection 215.23, Acts 2001, No. 1045, redesignated from R.S. 22:215.23 by Acts 2008, No.415, effective January 1, 2009)
The key issue is that infertility itself is not considered an underlying medical condition. Therefore, the most common scenario for most Louisianians is no insurance coverage for diagnosis or treatment of infertility. While this may sound discouraging, it does give patients the freedom to choose their provider and pathway themselves.
Some good news for Louisiana residents: A bill was proposed in 2022 that would mandate fertility preservation coverage for patients with a medical condition or who are undergoing medication therapy, such as surgery, radiation, or chemotherapy, that may directly or indirectly cause infertility. This means that these individuals at risk of losing their fertility may soon be able to have insurance coverage when they choose to freeze eggs or sperm.
At Fertility Answers we help patients experiencing infertility face that hurdle. We strive to manage each patient individually, using state-of-the-art, evidence-based evaluation and treatment strategies which helps to keep costs down for all patients, with and without insurance coverage. We work closely with each patient to help them use their available resources wisely. Together, family-building dreams become reality.