Friday, September 09, 2011

The Days of Exploration- and some research on the US healthcare regarding IVF


As I sit today for another one of my business trips to US, my mind wanders back to the days when we made the first trip.. We were quite confused, after the discussion with Dr. GHP, on what we should do. Should we cancel the trip and continue with the treatment, or should we go ahead and come back for the treatment?

Our decision was helped by Dr. GHP herself, when she mentioned that we could go and come back whenever we are ready for the procedure. And given that we had already committed for the trip, we decided to take the same. The next day, we were on a flight to US. But our minds, they never rest, do they?

Knowing the health care policies in US, we ended up doing some amount of research in doing this in US. As usual, our research starts with a search in Google. J The first thing to remember and know in US is that, if the Health Insurance firms do not cover the treatment, you probably would have to take multiple loans to cover the cost. ( I have heard stories of how some people had to sell off their properties in India to cover their IVF costs ). Anyways, in this line, there are 14 states who mandate that IVF procedures be covered in their Health Insurance Policy. Here is the page from National Conference of State Legislatures which list these 14 states

Here is also another page from fertility life lines.com – which lists 15 states. Louisiana is the state that is missing in the prev URL.

So, if your company is registered in the above 14 or 15 states then, your insurance policy will cover infertility treatments. But hold on before you get the smile on your face.. J - there is some small print: ( which is also listed in the fertility life liens page, but I thought I would add my own stuff )

  • 1.       Check if your employer’s plan is “fully insured” or “self funded” . If they are fully insured, the company has to follow state laws, and if they are self funded, they are exempt from the state laws and only need to follow federal regulations.
 The impact? Even if your company is registered in any of the 14 states, but is self funded, then they do not have to cover the IVF costs. So please check this with your company.


  • 2.       On a related note, I also heard from people that the employer’s policy should be written in one of the 14 / 15 states for it to cover the IVF costs.. But I couldn’t understand it too well.


  • 3.       AS the next step, even if your company covers Assisted Reproduction, please check on what all procedures do they cover. There are multiple ways of getting this done, and IVF is just one way of it.  In addition to this, IVF is done in multiple cycles. You should also check on how many cycles are covered in the insurance.


btw, INCIID provides a list of employers who are infertility and adoption friendly: http://www.inciid.org/article.php?cat=statemandates&id=243

Though our company is registered in New Jersey ( one of the 14/15 states mentioned above ), we realized ours is a self funded policy and hence does not cover IVF costs.  Anyways, since we were residing near Boston, MA, we were consulting with the Boston IVF  – Dr. Alison  Zimon, who not only confirmed the diagnosis, but also put us through the insurance person to get us properly counseled. Since our residency was in MA, ( once again, one of the 14 / 15 states above ), we could apply for a personal insurance from any providers – Blue Cross Blue Shield, MA Harvard Pilgrim, MA  and one more provider (I forget name) 

The counselor urged us to speak to each of the co. and get the policy that we felt was applicable to us.  She mentioned that my spouse could decline my employer’s insurance and get a personal insurance.
We first called the Blue Cross Blue Shield Office, and here is where we had a surprise waiting for us. The representative told us that as per the latest health care reforms law passed, if I do have an employer’s insurance, I cannot decline it and take a personal insurance! I couldn’t then ( and still not able to ) get any corroboration from any data sources in the net for this.. If any of you have any data supporting this, please feel free to comment…

Also, about the cost of IVF, we were told that each cycle of IVF would cost around $12,000 - $8,000 for the procedure and $4,000 for the medicines and pharmacy charges. (I am basing this on memory alone, I could be wrong. Request you to please check this up with verified sources). The cost for this treatment in Prashant Clinic was about 1.5 lac for each cycle with about Rs 30,000 for contingency ( that would be approx  $ 4,000 per cycle – with the conv rate of about 45 Rs to 1 $ )

This made our choice quite simple. We decided to do the procedure back in India with Dr. GHP. We started to plan for this – logistically and financially. J