Fertility treatment costs scare off employers
But coverage may lead to some long-term savings
By Shelby Livingston, Business Insurance, 1/17/16
Kristina Diedrick and her husband, Brian, tried for a year to get pregnant with no luck. After visiting a fertility clinic in 2014 and being told nothing was medically wrong, the couple opted for three rounds of artificial insemination. Still, nothing happened.
So last October, Ms. Diedrick, a 29-year-old freelance wedding coordinator in Charleston, South Carolina, decided to try in vitro fertilization, the most advanced fertility treatment for many women struggling to get pregnant.
Finally, after a total of 32 months since they began trying, she found out she was pregnant two days before Christmas. The tally? About $18,000 out of pocket for IVF with chromosomal testing, roughly $3,000 for three artificial insemination attempts, and 60 to 70 doctor's visits' worth of copays. Her husband's employer, which provides the couple's health care benefits, did not offer coverage for fertility treatments or drugs.
Undergoing IVF, where ripened eggs are removed, fertilized externally and later implanted in the uterus, wasn't a difficult decision for Ms. Diedrick.
“We knew it would be a lot of money and super taxing on both of us, but we knew it was the next step” to having a baby, she said.
But employer coverage would have helped alleviate some of the burden. “It probably wouldn't have taken us as long to do (IVF) as it took us,” she said.
Like the Diedricks, many couples undergoing fertility treatments shoulder most of the cost.
While 60% of employers with more than 500 workers offer some type of fertility benefit, according to a Mercer L.L.C. November study, it can be limited to a consultation with a doctor. About one-third of those employers cover fertility drug therapy, 24% cover IVF, and 23% cover artificial insemination. Forty percent of employers don't cover any fertility services, according to Mercer.
What's more, of the 15 states that require insurers to offer coverage for fertility treatments, only eight mandate IVF coverage, according to Resolve, a McLean, Virginia-based infertility advocacy organization. And that doesn't apply to self-insured employers.
The cost can deter employers, experts say. For one, the average cost of an IVF cycle in the United States runs $12,400, the Birmingham, Alabama-based American Society for Reproductive Medicine says.
Some employers may question its value, while others find it to be an important investment.
At Southwest Airlines Co., employees are covered at 50% coinsurance for up to $10,000 lifetime maximum of medical expenses for fertility treatments after meeting a $500 deductible. Prescription drugs related to those treatments are covered at 50% coinsurance for up to $5,000 lifetime maximum. According to Judy Berger, Dallas-based Southwest's senior manager of benefits planning, more than 100 employees use the benefit annually.
“If we have happy employees, we will have happy customers and, subsequently, happy shareholders,” Ms. Berger said in an email. “Fertility benefits have value to employees. While fertility benefits aren't something all employees need, the impact this benefit can have on an employee's life is immeasurable.”
In October, technology company Intel Corp. quadrupled its fertility benefit coverage to $40,000 for medical services and $20,000 for drugs. In a statement, Ogden Reid, Intel's vice president of human resources, said offering the benefit is part of the company's commitment to being diverse, inclusive and supportive of the employees.
And for San Jose, California-based tech company Cisco Systems Inc., fertility benefits — $15,000 lifetime maximum for medical treatment and $10,000 for drugs — are offered simply because it's “the right thing to do,” a company spokeswoman said in an email.
Experts say an employer-sponsored fertility benefit improves healthy outcomes and could save medical costs long-term.
“When people are having to pay out of pocket and they are having to feel very pressured, they are making poor health decisions,” said Barbara Collura, president and CEO of Resolve. “When they have the insurance and they have the benefits that allow them to do (IVF) more than once and the financial burden is removed, they actually make far better health decisions.”
When drug treatments and artificial insemination fail and patients have only enough money to cover one IVF cycle, or no employer coverage for fertility treatments, they are more likely to choose to implant multiple embryos during IVF to increase the chances that they get pregnant, sources say. The cost is also likely to deter them from using technologies such as genetic testing to ensure against abnormalities that could result in a miscarriage.
But using multiple embryos increases the odds for a multiple birth, which brings high risks for the mother and children, and a giant price tag, data shows.
Through a partnership, Mercer and New York-based fertility health care provider Progyny Inc. are working to reduce that possibility. In January, they announced a fertility benefit for employers and their employees that is meant to reduce the number of multiple births by offering access to IVF, non-IVF fertility treatments and medications, and the latest technologies including genetic testing, to encourage transferring only one embryo.
By giving patients access to everything they need for each “cycle,” or round of treatment, patients are less likely to skip the technology that's typically offered “a la carte,” and they're less inclined to implant multiple embryos when the technology is available to increase the odds a single embryo transfer will be successful, said Karin Ajmani, Progyny's president of health care services.
Using technology to biopsy and test embryos to make sure they are normal raises the IVF success rate to 65% from 31%, she said.
Progyny's benefit also includes counseling and concierge services to help with the heavy emotional toll that comes with infertility, Ms. Ajmani said.
vDr. Mark Perloe, medical director at Atlanta-based Georgia Reproductive Specialists, said 35% to 40% of his patients foot the bill for fertility treatments without insurance. They confide in him about the cost burden, causing some to delay IVF, which weakens their chances of pregnancy as they age.
According to Dr. Perloe, an effective infertility benefit must include coverage for IVF, genetic screening and embryo evaluation, and it must mandate that only a single embryo can be implanted for a “safer, healthier pregnancy outcome, which is obviously the best thing for the employer,” he said.