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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.

 

 

 

 

 

 

 

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Everything You Always Wanted to Know About LGBT Family-Building Options at Long Island IVF

By admin

June 16th, 2017 at 2:37 pm

 

Whether you are lesbian, gay, bisexual, transgender or queer/gender-fluid, you aren’t any different than heterosexuals who want to start a family but need medical intervention to do so.

You have the same dream of becoming a parent, the same longing in your heart for a baby of your own, the same frustrations and embarrassment about needing medical intervention for such a private matter, the same worries about affording and financing the treatment, and the same paralyzing fear of it not working.

And yet, you are different from the heterosexuals who are suffering from infertility. Your treatment needs are different. Your emotional needs are different. We understand that.

Long Island IVF pioneered IVF on Long Island, bringing Long Island its first IVF baby, first baby from a cryopreserved embryo and first donor egg baby. For almost 30 years, we’ve been serving both the heterosexual and LGBT communities on Long Island. Several of our staff are members of the LGBT community as well and many staff members were former patients—so we really do understand where you are coming from.

The easiest way to illustrate the differences between heterosexual and LGBT family-building is to begin with the similarities.

In heterosexual family-building, any number of factors may be causing the couple’s infertility. It could be female factors like poor egg quality, blocked fallopian tubes, uterine issues like fibroids, endometriosis, hormonal disorders like polycystic ovarian syndrome, recurrent miscarriage, and more. It could be male factor infertility due to poor quality sperm. Or it could be a combination of male and female factors—or simply be due to the frustrating diagnosis of “unexplained infertility”. When a couple is unable to get pregnant after 6-12 months of trying (the number of months differs based on age), they are considered to be infertile. Sometimes less aggressive medical approaches—such as intrauterine insemination (“IUI”) with or without ovulation induction do result in pregnancy. Oftentimes, more aggressive Assisted Reproductive Technologies (“ART”) like in-vitro fertilization (“IVF”) are in order.

Here’s a crash course in IVF 101.

In IVF, the goal is to have the woman develop more than the one mature egg she would normally produce in a typical monthly menstrual cycle. To accomplish this a woman’s ovaries are stimulated through the use of injectable hormone medications and careful monitoring by ultrasound and bloodwork so that at just the right time, the multiple eggs that have matured are retrieved from the ovaries transvaginally through needle aspiration under sedation. Then the eggs are either frozen or are combined with the partner’s sperm to produce embryos. The resulting embryos are then either transferred back into the woman’s uterus where they will hopefully implant and result in a pregnancy, or are frozen for future use, or a combination of the two options. Because the number of embryos transferred back into the uterus is both limited and controlled, IVF minimizes and virtually eliminates the risk of a multiple pregnancy, making it a safer treatment option.

Sometimes, a heterosexual couple needs help from a third party to build their family. They may need a sperm donor or an egg donor if the couple’s own sperm or eggs are not sufficient or of good quality. Or they may need a woman to act as a gestational carrier to carry their embryo(s) and resulting pregnancy if the uterus of the woman of the couple is either absent or not otherwise suitable.

Now let’s look at how LGBT family-building is different.

Well, for starters, virtually all LGBT couples need some kind of help from a third—or even a fourth—party in order to build their family. In fact, in virtually all cases, sex alone will never result in a pregnancy for the LGBT couple without outside intervention. So, while it does happen that a LGBT patient could have a medical factor making them infertile, in the vast majority of cases, LGBT couples seek out an infertility specialist to obtain the “missing contribution” that is required to make a baby. The exception is the transitioning individual who has not begun hormonal treatment to transition from male to female or from female to male.

Here are the general treatment options and the ways “missing contributions” for LGBT couples can be obtained. They are slightly more straightforward in the cases of lesbians and gay men than in transgender cases.

Lesbian couples:

Two women will need a sperm donor. Depending on their age and the health of their eggs and uterus, they can do IVF and may even be able to do an IUI. If doing IVF, some couples decide to use one woman’s egg and have the other woman carry the pregnancy in her uterus.

Gay couples:

Two men will need an egg donor. They will also need a gestational carrier who will carry the pregnancy in her uterus for them. Gay couples may decide to divide the number of eggs retrieved from the egg donor in half and then each partner may contribute a semen specimen to fertilize half of the eggs—thereby each being a biological father to the embryos that resulted from their contribution.

Transgender couples:

Transgender family-building is relatively new in comparison to lesbian and gay family-building which the LGBT community has been able to access for decades. There are varied options for transgender family-building, but they all require knowledge and proactive steps on the part of the transgender person.

The single most important takeaway from this article for transgender folks who do (or may in the future) want to have a biological child is this: See a reproductive endocrinologist BEFORE taking any medical or surgical steps on the transgender transition or sexual reassignment journey.

In “Woman to Man” reassignment, before the woman hormonally, medically, or surgically becomes a man, she should consider having her eggs retrieved and frozen for future use. Or if she has a male partner now, her eggs can be fertilized with his sperm and the embryos either implanted in her uterus now so she can carry the baby before she transitions, or if the woman does not want to carry the pregnancy and prefers to move ahead with the transition, then the embryos can be frozen and transferred into the uterus of a gestational carrier at any time.

However, if the woman who transitions prefers a female partner, then the couple has most of the same options as any lesbian couple. They could use either woman’s eggs with donor sperm and the resulting embryos could be implanted into the partner with the uterus or into the uterus of a gestational carrier if needed. Some couples choose his eggs and her uterus so both can be involved.

Now the opposite case.

In “Man to Woman” reassignment, before the man hormonally, medically, or surgically becomes a woman, he should consider having his sperm frozen for future use. Sperm freezing is so much cheaper and easier than egg freezing. If he has a female partner now and they want to become pregnant now, his sperm can be used to impregnate her through IUI or, if she undergoes IVF, then her retrieved eggs can be fertilized with his sperm and the resulting embryos either implanted in her uterus now or frozen for later use. Some couples choose his sperm and her eggs and/or uterus so both can be involved. If his female partner’s eggs or uterus are not optimal, they will need an egg donor and/or gestational carrier.

However, if the man who transitions prefers a male partner, then the couple has the same options as a gay couple. They could use either of their sperm with the egg donor’s eggs and transfer the resulting embryos into a (gestational carrier) woman’s uterus.

If you identify as queer or gender-fluid, you can utilize donor egg, donor sperm, a gestational carrier or any combination of the above options as they fit you and your partner.

Sadly, not all physicians realize or advise transgender individuals of their fertility-preservation and family-building options before the transition process has begun, so it is up to you to initiate the discussion or take action. It is absolutely critical that egg and sperm freezing be done before the hormonal, medical or surgical transition or reassignment begins. Or it will be too late.

Despite the current and uncertain political climate, there has never been a better time for LGBT members to pursue family-building. As a result of rapidly advancing ART, today’s LGBT community has choices beyond the noble but limited options of foster parenting and adoption—choices that allow for biological children. The lesbian and gay parents of recent decades have blazed a path of slow but ever-increasing acceptance that has not only benefitted today’s lesbian and gay parents, but has helped open the door for the transgender population to come out and claim their own fertility and parenting rights.

All people of reproductive age who are considering becoming parents at some point would benefit from a fertility screening by a reproductive endocrinologist—ideally sooner rather than later. At that exam, screening tests would be conducted to identify any actual or threatened obstacles to fertility, such as diminished ovarian function or premature ovarian failure or other factors in women, or sperm issues in men. Depending on what is found, proactive steps could be taken to preserve your fertility, including egg freezing for women who just want to preserve their young and healthy eggs for use at a future date.

Also file this important bit of information away and hope you will never need to remember it: If you or a loved one are ever faced with a cancer diagnosis and time allows for it, egg-freezing and sperm freezing done prior to starting certain chemotherapy or radiation protocols for certain cancers are options to preserve your fertility. That way, your healthy eggs and sperm are waiting for you when you’re ready to build your family after your cancer battle has been won. Be sure to call a reproductive endocrinologist to discuss fertility preservation before cancer treatment.

If you would like more information on LGBT parenting options  or would like to schedule an initial consultation with a reproductive endocrinologist, the doctors and staff at Long Island IVF have been helping build LGBT families for decades and would be happy to help you. With several offices throughout Long Island and one in Brooklyn, we’re conveniently located near you.

As a partner of the LGBT Network on Long Island, Long Island IVF is committed to continuing to build families for the LGBT community through cutting-edge medical technology and sensitivity to all patients’ individual needs.

Long Island IVF, along with the LGBT Network, offers free LGBT family building seminars every June and periodically throughout the year. Click here for information and to preregister for the June 29th event.

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Long Island IVF and LGBT Network Alliance

By Tracey Minella

April 7th, 2016 at 4:25 am

 

image courtesy of LGBT Network


Long Island IVF is proud to partner with the Long Island LGBT Network as the exclusive family planning service for the LGBT Network community.

On April 7, 2016, Long Island IVF physicians, Dr. David Kreiner, Dr. Steven Brenner, and Dr. Satu Kuokkanen presented a check in the sum of $17,000 to LGBT Network’s Jonathan Chenkin, Development Officer for Corporate and Business Relations and Robert Vitelli, COO – Director of Development. This donation will fund and support our mutual educational and outreach efforts here on Long Island.

Long Island IVF has been building families in the LGBT community for decades and has long practiced its belief that every person is entitle to become a parent. Not only are some staff members also members of the LGBT community, but our entire staff has been trained to be sensitive to our LGBT patients. Your needs and treatment are unique and your comfort is important to us.

Long Island IVF will again sponsor the Family Services Pavilion at the Long Island Pridefest on June 11, 2016. Be sure to come by and meet our team. Some of our patients and their little miracles often drop in, and they love to share their LIIVF family-building experience with others just starting their journeys.

If you’d like to schedule an initial consultation with one of our physicians, please call 877-838-BABY today. With six offices across Long Island and Brooklyn, there is sure to be one convenient to you.

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Will we see you at Pridefest?

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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.

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Long Island IVF Sponsors LI Pridefest 2015

By Tracey Minella

June 10th, 2015 at 6:49 pm

 

Long Island IVF is proud to be a major sponsor of this year’s LI Pridefest on June 13, 2015 in Suffolk County’s beautiful Heckscher Park in Huntington, NY. http://lgbtnetwork.org/pride

LIIVF has been actively building families for the region’s LGBT community for decades due to its long-standing belief that every person has a right to be a parent. We pride our practice… which includes members of both the non-LGBT and LGBT communities… on acceptance and inclusion. And we address the unique aspects of LGBT family-building from both a personal and medical perspective. In many ways, your needs are the same as the non-LGBT community, but in some ways they are different. We get that.

Just stop by our booth at LI Pridefest and meet some of the team. Our prior successful LGBT parents will stop by for impromptu reunions throughout the event, too, and are often eager to share their experiences as well. The Long Island IVF booth will be in the Health & Wellness area of the Family Services Pavilion the entire event, from 1:00 until 6:00pm.

Not in the mood to chat long with all the festivities to see? Swing past and grab some of our fun giveaways, including bracelets, balloons, and informational brochures to read later. We’ve even got water bottles if it’s a hot one!

You can also get to know us later this month as we host a very special event at the LGBT Network Community Center in Woodbury, NY on June 25, 2015 from 6:00- 9:00 pm. Long Island IVF’s “Family-Building the LGBT Way”. Two of our doctors, Steven Brenner, MD and Satu Kuokkanen, join other key LIIVF team members to bring you a seminar on everything you ever wanted to know about today’s LGBT Family-Building options. Please pre-register for this free event by emailing lmontello@liivf.com. Light refreshments will be served.

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So who is coming to Pridefest?!

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