A lawsuit charging Blue Cross of California with failing to offer infertility benefits required by California law was certified as a class action in October 2007. This will allow the class representative and her attorneys to seek an injunction directing Blue Cross to offer much broader infertility coverage to group health plans covering employees of governmental entities and many religious institutions. Blue Cross currently offers only a limited benefit of $2,500 a year, and requires plan members to pay 50% co-pays.
According to attorney Mark F. Didak of Los Angeles, who represents the class, California Health & Safety Code and Insurance Code require health plans to offer infertility coverage on the same terms as they cover other health conditions, without lower coverage limits or higher co-pays. “The benefit should cover all infertility diagnosis and treatment services ‘consistent with established medical practices,’” Didak said, “except that health plan providers are not required to offer coverage for the actual laboratory procedures involved in in vitro fertilization.” The last part is important, says Didak, because health insurers typically refuse to pay for anything associated with in vitro fertilization, which can cost anywhere from $10,000 to $25,000 per cycle. “The law only allows them to not offer coverage for the lab procedures, which usually cost between a few hundred dollars and $1,500.” Didak hopes to persuade the court to issue an injunction that might serve as an example to the health insurance industry by clarifying what infertility benefits must be offered and which ones they can choose not to offer. (Read more on this class action here)
Why is infertility separated from the rest of the disease processes? Who ever heard of insurance paying for diagnosis and then deciding not to pay for treatment? Infertility is an umbrella term including many different syndromes and diseases. Endometriosis, Polycystic Ovarian Syndrome, Low Sperm Counts, Premature Ovarian Failure and more.
Infertility is no one's national emergency. . . that is until it affects you or someone you love. Then the tables turn and you get a front row seat to the heartbreak, urgency and necessity of treatment.
For more information about Infertility contact INCIID. Get more information about companies that cover their employees infertility treatment here.
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