CALL US AT: (877) 838.BABY


Archive for the ‘Infertility insurance’ Category

Important Infertility Insurance Coverage Issues for the LGBT Community in New York

By Tracey Minella

June 22nd, 2017 at 8:31 am

From Stonewall to date, the LGBT community has always had to fight for rights equal to those of the heterosexual community, often in an atmosphere of “us against them”. Persistence has always paid off…eventually. As we’ve seen from winning battles on openly serving in the military with the repeal of “Don’t ask. Don’t tell” and the legalization of same-sex marriage (#LoveWins), we can move mountains as a community united.

 

The latest major gay rights fight involves insurance coverage for infertility treatment in New York.

 

The subject of mandated infertility insurance coverage in New York State has been in the news lately, but before addressing an important pending bill that could positively impact the infertility insurance rights of all New Yorkers– heterosexual and non-heterosexual– we must examine and understand the existing obstacles to LGBT infertility treatment coverage.

 

Currently, New York State has a mandate which requires coverage for infertility treatments. It’s one of only 15 states to do so, which sounds promising, but it’s not. With so many existing definitions, restrictions, qualifications, and loopholes, the mandate in its current form does very little to benefit New York’s infertile heterosexual couples– and does even less for non-heterosexual couples or single women who need advanced reproductive technologies in order to start their families.

 

Some of the major problems with the current New York State infertility coverage mandate include:

 

  • It does not cover in vitro fertilization (“IVF”), but only applies to intrauterine inseminations (“IUIs) and other low-level/less successful infertility treatments, which are also riskier in terms of causing a multiple pregnancy (twins, triplets, etc.);
  • Small group employers can opt out of having to provide this coverage;
  • Insurance carriers may impose certain restrictions and rules that impact the employees’ ability to access the benefits.

 

Some insurance carriers that do offer IVF require both heterosexual and non-heterosexual couples to undergo 6-12 unsuccessful IUI cycles before moving on to IVF treatment (6 IUIs if the woman is over 35, or 12 IUIs if under 35, though some require less).

 

In addition to the above multiple-failed-IUIs prerequisite for IVF coverage, the employee must satisfy the insurance carrier’s definition of “infertility”. “Insurance companies define ‘infertility’ as the inability to conceive after one year of frequent, unprotected heterosexual intercourse, or six months if patient is over the age of 35″.

 

Applying this definition to heterosexual couples merely costs them 6-12 months of time before moving onto IVF treatment—provided they can somehow prove they’re doing it often enough and without protection. And while up to a year of time wasted really is a big deal to all infertile folks, the impact on non-heterosexuals and single women is far worse.

 

When applying this definition to a same-sex couple or a single woman, they not only lose valuable time, but they also lose money that a heterosexual couple would not. Because for same-sex couples or single women to meet the current definition of “infertility”, they would have to undergo six or 12 months of IUI with donor sperm treatments — in many cases, at their own expense –just to prove their infertility so that they could qualify for covered infertility treatments.

 

This issue was thrust into public view when two lesbian couples in New Jersey filed a federal lawsuit alleging that the language of the New Jersey insurance mandate “discriminates based on sex and sexual orientation”.

 

There is also disparity among insurance companies with respect to requiring authorizations for IUIs, requiring IUIs with donor sperm prior to approving infertility treatment, and coverage for the cost of donor sperm or thawing the sperm. In addition, companies offer different levels of coverage, which may be dependent upon copayments, deductibles and other restrictions on certain services like embryo cryopreservation, embryo storage, Pre-implantation Genetic Diagnosis or Pre-implantation Genetic Screening (“PGD” or “PGS”) of embryos, and more. To further complicate matters, even within the same insurance company, there are different individual plans that are chosen by the employer which provide different benefits coverage and different qualifications or benefits structure.

 

That’s why Long Island IVF assigns each patient a personal financial counselor to help guide them through the complicated insurance process to maximize any benefits to which they may be entitled.

 

Despite the obstacles that currently exist, there is good news to report and even more promising change on the horizon.

 

As a result of New York Governor Cuomo’s mandate to New York State insurance companies, they may no longer exclude same-sex prospective parents or single prospective parents from infertility coverage. While this is a victory, the sticking point for true reform and open access to appropriate infertility coverage for both heterosexual and non-heterosexual patients requires a redefinition of “infertility” and direct access to IVF.

 

There have already been noticeable changes in policies and the provision of coverage for IUIs with donor sperm in same-sex couples, presumably collectively-driven by Gov. Cuomo’s mandate, along with the New Jersey lawsuit, and forward-thinking, large-scale employers like Facebook and Google now offering high-end infertility insurance coverage for egg-freezing services. But the bottom line is that until a patient meets the “infertility” definition, they still have to self-pay.

 

That’s why we need the definition of ‘infertility’ to change. And we need access to IVF, which is the more successful treatment in terms of a singleton birth outcome.

 

And it is within our grasp right now.

 

As this article is being written, a bill that would revolutionize the infertility insurance law in New York for the benefit of heterosexuals, same-sex couples, and single women is awaiting consideration by the Senate after having passed in the Assembly this week.

 

The Senate Bill S.3148A known as the “Fair Access to Fertility Treatment Act”, or (“FAFTA”), if enacted, would not only mandate coverage for IVF treatment, but it would change the application of the definition of “infertility” to:

 

“a disease or condition characterized by the incapacity to impregnate another person or to conceive, as diagnosed or determined (I) by a physician licensed to practice medicine in this state, or (II) by the failure to establish a clinical pregnancy after 12 months of regular, unprotected sexual intercourse in the case of a female 35 years of age or older.”

 

According to Long Island IVF co-founder and reproductive endocrinologist, Dr. Daniel Kenigsberg, who has been advocating for the passage of the FAFTA bill, “the current mandate’s specific exclusion of coverage for IVF has resulted in much emotional and financial cost spent on inferior or inappropriate treatments which ARE covered by the mandate when, for over 50% of infertile couples, IVF was the best or only treatment.” He further notes that “IVF is far safer in terms of reducing multiple pregnancy risk than less successful and often inferior treatments like ovulation induction and intrauterine insemination (IUI). There has been waste and needless sacrifice for insured couples denied IVF.”

 

It is time for both the heterosexual and the LGBT communities to get active and push our respective representatives to pass this legislation. You can find your local senator here or can access their phone number here. Armed with Senate Bill number S. 3148A, a simple phone call expressing your support of the bill may make all the difference. It takes less than one minute to help support this latest gay rights fight for fair access to appropriate infertility treatment and insurance coverage. Do it now.

 

There has never been a better time for non-heterosexuals to fulfill their dream of parenthood. If you would like more information on the many available LGBT family-building options, we encourage you to join Long Island IVF and our partner, The LGBT Network, on June 29, 2017 for a special free seminar entitled “Building Families in the LGBT Community”. Pre-register here.

 

This progressive legislation not only opens the door to IVF access for all, but it changes the definition of infertility to one that encompasses everyone, regardless of sex or sexual orientation. Instead of “us against them” it’s “one for all”. Its passage would put everybody suffering from the disease of infertility one giant step closer to our common dream of parenthood– and maybe, just maybe, a step closer to us all being one united community.

 

 

 

 

 

 

 

no comments

Long Island IVF Joins Lobbying Efforts for Mandated IVF Coverage in New York State

By Daniel Kenigsberg,MD

June 7th, 2017 at 10:10 am

 

Dr. Daniel Kenigsberg, Co-Founder Long Island IVF

 

I am lobbying for passage of Senate Bill S3248, a bill sponsored by Sen. Diane Savino of Staten Island, N.Y. which would mandate In-Vitro Fertilization (“IVF”) coverage in New York State –just as it is in neighboring states including Massachusetts, New Jersey, and Connecticut.

Our patients and other New Yorkers struggling with the significant emotional and financial burdens of infertility are under the impression that they live in a progressive state, but little do most know how poorly served they are by existing New York law.

Currently, the law mandates coverage for “correctable” medical conditions causing Infertility–but specifically EXCLUDES coverage for IVF. This has resulted in much emotional and financial cost spent on inferior or inappropriate treatments which ARE covered when, for over 50% of infertile couples, IVF was the best or only treatment.

IVF is far safer in terms of reducing multiple pregnancy risk than less successful and often inferior treatments like ovulation induction and intrauterine insemination (IUI). There has been waste and needless sacrifice for insured couples denied IVF.

Further, not covering IVF treatment has a disproportionate effect on women (name one male treatment not covered by medical insurance). In Massachusetts, 5% of births result from IVF. In New York, it’s 1.5%. That is how dramatic the current arcane New York law hurts the population it is supposed to protect.

You can help right this wrong. And it won’t take more than 5 minutes of your time.

Call, write and email your state senator. You can find your senator here. Please note that mine is John Flanagan of Smithtown, Senate Majority Leader.

Also, contact Senator Savino of Staten Island because it is her bill to push and prioritize (or not). You can contact her here.

If you are currently suffering from infertility, it can be an overwhelmingly difficult time, but if you have a moment to reach out to your senator and Senator Savino, and any other local representatives, the combined effect of all of our voices can make a big difference. Or if your infertility journey has already been resolved, please reach out as well for the benefit of all that are now– and will someday be– following in your footsteps. And please share this with your family and friends so they may do the same. Thank you.

no comments

Teachers, Take Note: Long Island IVF is the “A+” Answer

By admin

May 22nd, 2016 at 3:22 pm

Everything is better in the summer. Even IVF.

This is especially true if you are a Long Island teacher or NY State or local government worker with infertility coverage through United Healthcare’s Center of Excellence (UCOE) provided under the NY State Empire Plan (NYSHIP).

We have some exciting news to share: Although Long Island IVF has previously been one of only a few designated United Healthcare Centers of Excellence (UCOE) infertility providers through the NY State Empire Plan – effective June 1st, we’re now the only UCOE infertility services provider with practice offices and laboratory facilities on Long Island. And that’s great news for Long Island’s insured teachers and others who want to take advantage of the substantial financial benefits that come with choosing a UCOE provider for your fertility care and have those services provided exclusively on Long Island.

Even those who aren’t able to take advantage of the Empire Plan’s UCOE benefits, can confidently trust Long Island IVF with their fertility care. Our doctors are consistently voted Top Docs and Super Doctors by their peers and the practice has been voted “Best In Vitro Fertility Practice” by the public for the past two years straight–ever since the category was added to the Long Island Press contest. We brought Long Island its first IVF baby and many other firsts in the field.

Summer is just starting. The sun is bright and the mood is as relaxed as it ever gets. We’d love to help you start your family this summer. Call today for your consultation.

* * * * * * * * ** * * * * **

Are you planning to have fertility treatment during the summer?

* * ** * * ** * * ********

Long Island IVF-WINNER: Best in Vitro Fertility Practice 2015 AND 2016

It is with humble yet excited hearts that we announce that Long Island IVF was voted the Best In Vitro Fertility Practice in the Best Of Long Island 2015 and 2016 contest…two years in a row!

The doctors, nurses, embryologists, and the rest of the Long Island IVF staff are so proud of this honor and so thankful to every one of you who took the time to vote. From the moms juggling LIIVF babies… to the dads coaching LIIVF teens…to the parents sending LIIVF adults off to college or down the aisles… to the LIIVF patients still on their journeys to parenthood who are confident in the care they’re receiving…we thank you all.

We love what we’ve gotten to do every day more than 28 years…build families. If you are having trouble conceiving, please call us. Many of our nurses and staff were also our patients, so we really do understand what you’re going through. And we’d like to help. 631-752-0606.

no comments

Attention Long Island Teachers and Government Employees!

By Tracey Minella

April 24th, 2016 at 2:22 pm

 

 

Long Island IVF is a designated Center of Excellence for the Empire Plan, the insurance provider for many local Teachers as well as other NY State and Local Government Employees.

 

In addition to the assurance of working with a program that has achieved high quality measures, our COE designated program affords our Empire Plan patients an additional financial advantage — once treatment is approved by the Empire Plan, you receive full benefits with no co-payments or co-insurance requirements for the services covered by their insurance plan.

 

Now is the perfect time to start planning for infertility treatment this summer—especially for teachers! Free from the stress of a teacher’s rigid schedule, the summer months offer the flexibility to do IVF (or IUI) in a more relaxed frame of mind.

 

If you are not already a Long Island IVF patient and would like to jump start your family-building plans, call us today. With six offices across Long Island and Brooklyn, there is sure to one that’s conveniently located near you.

 

We look forward to welcoming brand new patients as well as patients transferring from other practices for insurance reasons. Let’s start building that family together this summer.

 

Call our New Patient Coordinator at 877-838-BABY to schedule your initial consultation today or contact us through http://bit.ly/1OehXlr.

 

* * * * * * * * *** * * * * * * * *****

 

Are you a teacher or government employee who may need help conceiving—or do you know of someone else who does? Please share. You never know if that great teacher who your child loves is secretly longing for a baby of her own.

 

* * * * * * ** * ** * ** **  ** *

 

Long Island IVF-WINNER: Best in Vitro Fertility Practice 2015 AND 2016

 

It is with humble yet excited hearts that we announce that Long Island IVF was voted the Best In Vitro Fertility Practice in the Best Of Long Island 2015 and 2016 contest…two years in a row!

 

The doctors, nurses, embryologists, and the rest of the Long Island IVF staff are so proud of this honor and so thankful to every one of you who took the time to vote. From the moms juggling LIIVF babies… to the dads coaching LIIVF teens…to the parents sending LIIVF adults off to college or down the aisles… to the LIIVF patients still on their journeys to parenthood who are confident in the care they’re receiving…we thank you all.

 

We love what we’ve gotten to do every day more than 28 years…build families. If you are having trouble conceiving, please call us. Many of our nurses and staff were also our patients, so we really do understand what you’re going through. And we’d like to help. 631-752-0606.


 

 

 

no comments

Infertility and ObamaCare

By David Kreiner MD

October 21st, 2013 at 7:07 pm

 

 

photo credit: David Wagner/publicdomainpictures.net

Have no fear ObamaCare is here!

For those of us hoping to increase accessibility to health care for the uninsured, the passage of ObamaCare…the administration’s own term for the Affordable Care Act… provides us with hope that this much sought after right to obtain health care for all Americans might soon become a reality.

Well, unfortunately, we are not quite there yet especially as it relates to fertility care. There still remains concern about the out-of-pocket expenses for fertility medications and treatments.

Apparently, on January 1, 2016, the federal government is withdrawing support for mandated fertility coverage in the six states where such coverage does exist… including in New York.  That day, Uncle Sam says “you’re on your own” to those mandated states.  It will be up to the states to foot the bill or else eliminate the mandated coverage.  I think we know how that will go.

On other fronts, we have more bad news.  Medications covered by the new state- supported exchanges require much higher co-pays.  Fertility medications are estimated by some to cost as much as $1,300 per covered cycle under these exchanges.   Considering the goal of ObamaCare was to make health care more accessible, I understand why the administration has stopped referring to the new law as the Affordable Care Act.

The exchanges can be purchased at different levels with increasing cost correlating with a lower percentage of out-of-pocket expense.  Those interested in fertility treatment (or for that matter anyone with a preexisting condition) should and presumably will purchase the better coverage, if able. If one can afford the coverage of the Gold plan, the 10% co-payment, and the enormous co-pay for the medications, then IVF will be a possible option.  Unfortunately, these costs may be prohibitive for many who otherwise, under the current insurance system, are financially able to afford IVF.

So you may ask what the ramifications of ObamaCare are to the infertile seeking treatment.   As it stands now, for most it will prove to be the Unaffordable Care Act which will prevent access to care which could otherwise allow them to build their family; a right that is denied them due to their infertile medical condition and ObamaCare.

 

* * * * * * * * * * **

What impact, if any, do you think ObamaCare will have on your fertility insurance and care?

 

Photo credit: David Wagner/ http://www.publicdomainpictures.net/view-image.php?image=11517&picture=barack-obama-11

no comments


The Fertility Daily Blog by Long Island IVF
© Copyright 2010-2012