My company recently added comprehensive fertility benefits, including IVF. But I was diagnosed with poor egg quality and IVF is no longer a good option for us. My doctor recommends donor eggs as the treatment for my diagnosis. I followed up with my insurance company and they said that donor IVF is excluded. I contacted HR but I'm still waiting to hear if they will change it. I don't have the kind of money to pay the donor's compensation in addition to a whole round of IVF. What should I do next?
Desperately Needing Donor
Dear Desperately Needing Donor,
Thank you for emailing me with this issue and sorry that you are going through infertility.
The short answer to your question is that I wish I could offer you a better or guaranteed solution but as you know fertility treatment coverage is a sadly complicated issue.
So here's the long version of my take on your situation- First- you have done an awesome job going through the right channels asking for coverage. I would continue to make contact with your HR representative to ask about removing the exclusion for donor egg therapy. Emphasize that this is a very effective treatment for the disease of infertility and that the treatment is prescribed by your doctor to overcome your specific diagnosis of infertility. Healthcare benefits are meant to cover employees heath concerns so that they will be better and more productive at work. When they have covered health benefits, they are treated for their conditions in a timely manner, they spend less time distracted about the medical and financial concerns. It is important for employees to have access to medical treatments prescribed by their doctor for their diagnosis. Instead, you could still undergo IVF instead of donor egg and it would be a far less effective treatment for your diagnosis, but again that would mean more time that the employee is undergoing medical treatments when a far more statistically likely treatment is available but not covered.
Be specific about what exact limitation you want removed and what exactly you want covered. Do you want the donor's IVF and medications to be covered? You should also inquire if the transfer or FET is excluded even if they are donor eggs (for example, they may not cover the donor's IVF, but would they cover the transfer and drugs for you?). You might also suggest that they could cover the costs of a FET of donated embryos. This is likely to cost far less to them and a cost that they might be much more willing to consider (although it may not be an option you want).
That being said- this is an issue that I have been struggling with: how far should we expect employers/insurance/state mandated coverage to go with respect to fertility therapies? Today, we are only just getting companies to cover IUI and IVFs for infertile people. Donor therapy is almost always an out of pocket expense. What if you were born without a uterus? Would health insurance pay for a surrogate's labor and delivery? For LGBTQ people, would health insurance pay for IUIs, Donor IVF's and surrogates? In a perfect world, the answer to all the questions is yes- cover it all! But realistically, I just don't know how far they'll go. Some companies do something like an "Adoption benefit" where they will give you $5,000 for adoption expenses. Maybe an equitable solution, and a suggestion to your company could be like a "Family building benefit" that could be like $5,000 towards donor IVF, surrogacy, or something like that.
The last thing you can do is advocate for infertility at the state and national level. The more people know about infertility and its treatment, the more likely that coverage will become accessible to everyone who needs it. This includes voting on legislation that is "friendly" to infertility therapies. I'm starting to lobby NC for coverage and I am also going to Washington DC on May 11th for Advocacy Day where RESOLVE gets us meetings with our representatives so that we can make coverage for infertility a reality one day. This is a strategy for the long term goals- we have to help all the infertiles- the ones who come after us, so that they won't have to go through the financial struggle. I hope if you are able, you could meet me at Advocacy Day.