June 19 – It’s all out there

It’s out and I can’t take it back.

I sent out my letter requesting infertility coverage. I emailed our HR department, submitted an electronic request and put it out there.

I feel hopeful that it might get added. I feel glad to not keep it secret. But I am terrified that everyone at my work will know. I can’t hide. People might have questions and opinions, suggestions and unwanted “advice.” Some people won’t care. Some will. Others will share their struggle with me. Others will stop hiding too.

What is courage? I am not sure, but I need it now.

Here is a copy of my letter without my employer’s name:

June 17, 2015

Dear Medical Benefits Review Committee,

I would appreciate very much if you will consider infertility treatment coverage for possible inclusion for 2015. This issue is very personal to me.  I was diagnosed with infertility and being very early in my career it is difficult for me to finance the treatment recommended for my diagnosis.

As a newer associate, I rejoiced in that fact that <employer> was well-known for being family-friendly. While adoption information is readily available, I was quite discouraged to learn infertility treatments were not covered by the health insurance. <employer> already offers health insurance plans that cover other aspects of family planning, such as treatment of adult sterilization, infertility corrective surgery and diagnosis, and birth control options including IUDs and diaphragms. Adding infertility treatment coverage to our policy is actually likely to result in reduced costs for <employer> and more successful outcomes for associates diagnosed with infertility.

Imagine sitting in your cubicle working the day away when someone on your team announces excitedly that they are having a baby. The team gushes and asks questions about due date and the baby’s sex. Now imagine that you cannot have children without treatment. There is an empty ache in your heart where the love for your future child waits. You haven’t seen the joy on your child’s face on Christmas morning. You avoid all social media and phone calls on another empty and hopeless Mother’s or Father’s Day. You feel the rush of emotions from knowing that it will take thousands of dollars to even try and grow your family. Maybe you have even been pregnant but miscarried. Maybe your partner is fine and you feel the guilt of being unable to do what you feel you should. Each smile and each question rings in your ears until you have to get up and walk away from your desk just so that you can breathe. This is how painful it can be to be infertile.

As much as this is a personal issue for me, it is advantageous for <employer> to help their associates reach their personal goals so that they will be more productive at work. I have met one other associate here at <employer> who financed his/her own infertility treatments. There are likely others at our large company who quietly struggle with their very private infertility diagnosis, as one in eight couples in the US will not conceive after a year of trying (http://www.resolve.org/about/fast-facts-about-fertility.html).  If we consider that <employer> employs approximately ##,### people that means we can estimate that #,### associates struggle with infertility. It is not just associates with infertility that could benefit from the coverage; for same-sex couples there are only two routes to grow their family: treatments such as IUI or IVF (which are necessary for infertile patients) or fostering/adoption.

In the US, 14 states mandate insurance coverage of infertility treatment. In those states, the rate of high-risk multiples births is lower than those that do not mandate coverage (New England Journal of Medicine, “Insurance Coverage and Outcomes of In Vitro Fertilization,” August 2002). Massachusetts mandated full infertility coverage, including In Vitro Fertilization (IVF), in 1987, and since then, the cost of infertility services as a percent of the total health premiums went down (Griffin and Panak, Fertility & Sterility, 1998). According to ReproductiveFacts.org, “infertility treatments, including IVF and similar procedures, account for approximately seven hundredths of one percent (0.07%) of U.S. health care costs.” (http://www.reproductivefacts.org/Infographic_Infertility_affects_1_out_of_every_9_women/). For the patients, coverage results in receiving timely and effective treatment of their infertility diagnosis.

When couples are forced to cover the costs of treatment themselves, they make riskier health decisions in order to maximize the probability of conception when financing the high cost of a single fertility treatment. According to the Society for Assisted Reproductive Technology, the average cost of one in vitro fertilization cycle is $12,400.00 (http://www.sart.org/awards/index.aspx?id=3012, “Frequently Asked Questions about Infertility”). The medications for one in vitro fertilization cycle can cost between three and five thousand (http://www.forbes.com/sites/learnvest/2014/02/06/the-cost-of-ivf-4-things-i-learned-while-battling-infertility/, “The Cost of IVF: 4 Things I Learned While Battling Infertility”).  Because of these high costs, couples often choose to transfer more than one embryo.  This decision can result in high-risk pregnancies, post-pregnancy complications and low birth-weight multiples– a cost that their health insurance providers and underwriters bear. A patient diagnosed with infertility can further try to minimize their out-of-pocket expenses by traveling to countries, like India or Thailand, for cheaper infertility treatments with more lax regulations about embryo transfer numbers than in the United States. Any infections or complications will be covered by insurance upon returning to the US. In states that mandate infertility treatment coverage, infertile couples are more likely to have one healthy child as they are not making medical decisions based on cost alone.

Another risk our associates will take to afford treatment is financial risk. Forced to cash out 401ks and IRAs with tax penalties or rack up debt in higher-interest medical loans and credit cards. Even with a health savings account it would take 3 to 4 years to accumulate with the IRS maximum contribution in 2015 at $6,650 for a family. Unfortunately, fertility treatment results are based on age. Time is of the essence. Three to four years of waiting can drastically change the outcome of treatment success.

As a firm that provides advice for long term investment solutions to our clients, how can we not help our associates with this financial burden? And what if the associate cannot raise the funds for infertility treatment without the assistance of insurance coverage? The hope of having a family can slip away. Please don’t let that hope slip away for our associates. Please consider adding infertility treatment coverage to our insurance in 2016.

Please let me know if you would like any additional information on this issue. I am happy to help in your research or to provide my personal testimony.

Thank you for your time and consideration in this matter,

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