Coverage for infertility treatent has made family a reality for some
Kristen Magnacca looked at the price and panicked. The cash register at the pharmacy said she owed $978.97. And that was just for the first round of fertility drugs she would need in what she knew could be a long quest to conceive a baby.
She ran to her car, sobbing, her mind racing. “How do we pay our mortgage and get the medicine we need to have a baby?” she thought.
She called her husband, who persuaded her to go back into the drug store and see if she could pay for just two days’ worth of the prescription to get the medication started.
The pharmacist took one look at her face, made a few phone calls and found that there had been a mistake. Magnacca’s health insurance actually did cover the fertility medication.
“I went back to the car shaking and thinking how blessed we were that it was covered,” she said.
This year marks 20 years since Massachusetts approved a legislative mandate requiring health insurance companies to cover fertility treatments. It was the first state to pass such a mandate, and since then 14 other states have followed suit.
About 10 percent of couples in the United States struggle with fertility problems. Since the Massachusetts mandate took effect, about 50,000
babies have been born statewide with the help of insurance-covered fertility treatments, including costly procedures like intrauterine artificial inseminations and in vitro fertilizations, according to Resolve of the Bay State, an organization that educates and supports couples dealing with infertility.
Without the mandate, many couples wouldn’t be able to afford procedures like in vitro, which can cost $10,000 to $15,000, said Rebecca Lubens, executive director of Resolve of the Bay State.
“I can’t even imagine how many fewer babies would have been born without the mandate because people would have had to financially bankrupt themselves in order to afford treatment,” she said.
There are some exemptions to the Massachusetts mandate: Companies that have their own private health insurance policies, for instance, are not required to cover fertility treatments.
But the law does not limit the number of treatment cycles, nor does it impose a dollar lifetime cap.
That has allowed many couples, like the Magnaccas, to move forward with several procedures in an attempt to conceive a child. For three years Kristen Magnacca tried everything she could; she and her husband both went through surgery, and Kristen had repeated in vitro and intrauterine inseminations. All those treatments would have cost them tens of thousands out of pocket if insurance hadn’t covered the expense.
“We could not have done it ourselves,” Magnacca said. “We would have made it happen, but we would have been in major debt.”
Magnacca is glad she never had to let concern over money limit her decision to try the procedures. And now Magnacca, 43, has an 8-year-old son and a 3-year-old daughter.
When a baby doesn’t come easily, it is taxing enough emotionally, said Magnacca, who fell into a deep depression while trying to conceive. If a couple is faced with paying for their own fertility treatments, the financial burden adds a whole new level of stress, she said.
“I coach women and couples going through infertility (in other states), and they have to make the decision between buying a house or having a child,” said Magnacca, who lives in Upton and is vice president of Resolve. “I don’t know how people outside Massachusetts manage the stress of it.”
Many couples in other states where fertility treatments are not covered decide to pursue adoption instead, she said. If they are going to spend a lot of money, they figure they should spend it on the more sure bet of adopting a child rather than the gamble of attempting a costly fertility treatment that may fail.
Sarah Summers of Norwell ended up adopting her son Lucas, who is now 6, from Korea – but only after going through several fertility procedures for two years.
If Summers had not attempted the fertility treatments first, she believes she never would have been able to emotionally give up on the possibility of conceiving a child and therefore would probably never have pursued an adoption.
“Going through fertility treatments helps you accept the fact that you might have to adopt if you want to be a parent,” she said.
Summers, 50, likens the need for insurance companies to cover fertility treatments to the need for insurance to cover knee surgery.
“You can live with torn cartilage; it’s just that your life isn’t as full. A lot of procedures that are covered by insurance are not a necessity or a matter of life and death,” she said. “And it’s not a necessity to be pregnant, but from the time you’re a small boy or girl, you’re told you’ll have children, a home with a white picket fence and a cat or dog. If there’s one thing you’re supposed to be guaranteed in life, it’s having children. When it came down to the fact that we couldn’t have children, that hit a nerve we never knew existed.”
Now Summers and her husband, Jim, regularly get together with other couples they met during their struggle with infertility. And as the couples watch all their children play, they realize that whatever it took to bring their children home, it was worth it.
“Many of my really good friends have had babies through adoption, IVF or donor eggs,” she said. “We get together, and you look at all the kids and you totally forget how they got there.”
Patriot Ledger reporter Dina Gerdeman may be reached at email@example.com.