Pop quiz: what do these states have in common?
- New Jersey
- Rhode Island
- West Virginia
Answer: They are the only U.S. states that mandate infertility coverage as part of health insurance plans.
It’s a sad little number, in my opinion. Maybe this doesn’t seem like such a big deal, but it’s been front and center for me lately because two people I know are struggling with getting pregnant.
Both have great health insurance; their employers pay 100% of their premiums. But there’s more to it.
One (Lana) has great infertility coverage — up to $25,000 lifetime benefit maximum — while the other (Rachel) has a policy that explicitly excludes all treatments for infertility, regardless of the cause.
Both women have suffered through multiple miscarriages in the past six months. Lana’s doctor quickly ordered blood tests to determine if there is a “smoking gun.”
Rachel’s doctor warned her that the blood tests are “super expensive” and advised against them, so she is working with the doctor’s office to determine exactly how the blood tests would be coded in the bill to her insurance company. If she’s lucky, she can try to work around her insurance policy’s restrictions.
She shouldn’t have to do this. No one should.
At a time when Rachel is struggling to come to terms with an experience as painful as a miscarriage — and worse yet, multiple miscarriages — she’s got enough on her mind. She’s facing not just emotional and physical barriers, but thanks to her employer’s shitty insurance coverage, she’s facing a massive, maybe insurmountable financial hurdle, too.
There is so much that sucks about infertility. Personally, I had no shortage of failures to make me heartbroken, resentful, and just all-around pissed off. And that was without the adding money worries on top of the shit sundae.
The 11 states I listed above aren’t perfect — they have some caveats to their laws. In Montana and Ohio, the mandate applies only to HMOs. Connecticut excludes women over 40 (I think that’s a dick move; at least say 45.) In Maryland, businesses with fewer than 50 employees don’t have to offer infertility coverage, and in Illinois, fewer than 25 employees exempts a company. Two states’ coverage excludes IVF specifically (Those states must be pro-Octomom, because IVF is a safer, more controlled way to conceive than shooting Mom full of hormones and waiting to see how many babies she can make at once. It’s downright stupid to gamble like that.)
I understand that infertility treatments aren’t cheap, and businesses trying to control costs probably think of this as a no-brainer way to keep insurance costs down. In theory, eliminating fertility insurance might seem like a boost to the bottom line, but does it help the overall workforce in a company?
Take mental health for example: an area commonly excluded in health insurance plans. Depressed, unstable employees are great for business, right? (*rolls eyes*) Not so much. Mentally unwell employees impact the health of a business, and not in a good way. Women who are trying and failing to get pregnant, and can’t even look to their employer for support, will most definitely be mentally unwell. More so the longer it goes on.
Infertility coverage isn’t a luxury reserved for “Cadillac” health insurance. No woman undertakes assisted reproduction for fun. That’s like signing up for weekly dental visits, and aside from Bill Murray in Little Shop of Horrors, nobody likes the dentist.
I googled to find out what kind of companies are offering infertility coverage and discovered Robins and Morton, a small, family-owned construction company in Birmingham, Alabama, offers both unlimited infertility coverage and unlimited fertility medication coverage. (Which is awesome considering how much those damn shots cost.)
“We’re family-oriented with a company culture centered around supporting our people. We strive to care for our people because it’s the right thing to do. We also believe genuine concern and support often results in quality work and satisfied clients. It just makes sense to provide the very best benefits that we can for our employees and their families,” said CEO Bill Morton.
(I like this guy already.)
Other well-known companies are “getting it” just like Robins and Morton. Bank of America, AstraZeneca, American Express, Barclay’s, Black and Decker… and oh yes: Boston Consulting Group.
Now, why does BCG’s health plan matter?
Because Boston Consulting Group is the country’s top management consulting firm. That means companies pay BCG a ton of money to tell them how to run a successful, profitable business.
BCG has the creme de la creme of coverage: unlimited fertility treatments and unlimited prescription fertility drugs. No co-pay. Ignoring their example is like hiring a personal trainer to help you lose weight, and then refusing to follow a healthy diet.
They see the value in it, and they’re the experts. So business owners, if you’re reading this: trust them. Do as they do.
I’m sure some cheapskate CEO reading this is thinking I’m a moron. Fine, be that way. But the moment you find yourself in these shoes (and it’ll shock the hell out of you; few people expect infertility), or when someone you love can’t get pregnant and is forced to choose between a mortgage payment and having a child of their own, you’ll be outraged on their behalf. You’ll be wishing Obamacare had included a fertility coverage mandate.
Whatever your reason, make sure your employees have access to fertility coverage. Don’t do it for your bottom line, though. Do it because you’re a human just like me. Do it because, as Bill Morton says, “It’s the right thing to do.”
Interesting, to note, my doctor had to code my recent tests and procedures as “dysmenorrhea” to ensure coverage. It’s ridiculous this has to occur!!
Mine did too, early on, because she knew that as soon as she started coding as infertility, it would hit a different bucket of coverage. So she had to say the early treatments were just to get my period to start. Nuts.