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New state law will require more coverage for IVF, fertility treatments

On Oct. 15 and Oct. 18, successful IVF recipients talked about the process, its challenges and the new New York State law that will expand insurance coverage for fertility treatments. (Credit: Newsday / Shelby Knowles, Steve Pfost)

Most people get pregnant for free.

For people who can’t conceive a child in the usual way, getting that bundle of joy can cost a bundle of money. But help is coming.

Beginning Jan. 1, the state will require many New York companies with at least 100 employees to offer health insurance coverage for in vitro fertilization, as well as certain other fertility treatments. In addition, many companies, regardless of size, must cover egg retrieval and freezing or sperm freezing when it’s medically necessary to preserve fertility for patients facing chemotherapy or other treatments that affect fertility. Patients still will have to meet their customary deductibles and copays for medical treatments, but then insurance coverage will take over.

“It’s a great start,” said Risa Levine of Manhattan, a member of the board of directors of the Virginia-based national nonprofit Resolve: The National Fertility Association, which advocates for access to fertility support for everyone. “There will be thousands of babies who will be able to be born from this. This is a great step forward for millions of people across New York State.”

Doctors on board

Possibly the biggest benefit is for patients needing in vitro fertilization. A cycle of IVF using fresh embryos typically costs $15,000 to $20,000, doctors said. A so-called fresh cycle typically includes a 10-day process during which the woman repeatedly injects hormone medication to stimulate her ovaries to mature more than the single monthly egg. That is followed by surgical withdrawal of the eggs from her body, fertilization with sperm in a petri dish to form viable embryos, and embryo implantation into the woman’s uterus. Extra embryos can be frozen and then thawed if another attempt, referred to as a frozen cycle, is needed. Frozen cycles are less expensive because they don’t involve another egg retrieval and fertilization.

“It’s really encouraging,” Dr. Christine Mullin, an infertility specialist and director of Northwell Health Fertility in Mineola, said of the new law, passed this spring as part of the state's budget. “As physicians, it’s hard for us not to be able to offer treatment for economic causes. It’s nice that we’ll be able to offer care to patients who we weren’t able to before.”

Dr. James Stelling, co-founder and director of Stony Brook Community Medical-Island Fertility, did his medical training in the 1990s in Massachusetts, which already requires that fertility issues be treated like any other medical condition in all health insurance policies. “There I could do what the patient deserved. I just did what was the appropriate medical care. Here I have to modify because of economics,” Stelling said. “I discuss economics with every patient. There are people who should do IVF but don’t do it because of the economics.”

Some 'left behind'

Some New Yorkers already have fertility coverage through their companies' health insurance plans. This new law will cover more families and may strengthen some people’s current coverage, doctors said. “Tons of patients are waiting to see what happens to their benefits,” said Dr. Linda Sung, a reproductive endocrinologist and fertility specialist at NYU Langone Reproductive Specialists of New York in Mineola. “The law is behind where the technology is. We really need to focus on giving patients the best technology we have.”

Still, there are plenty of people who will remain without IVF coverage because the law doesn’t include their employers. “I always think about the people left behind,” Resolve’s Levine said. Resolve participated in lobbying lawmakers to endorse the new rules. “We weren’t able to get coverage for small group or individual plans," Levine said. Sung said she is hoping there will be future amendments to the law to extend help to more people.

Said Stelling: “It’s great for the ones it affects. My fear is now the politicians are happy and they won’t advance.”

Here are three of the types of families the current law is designed to help:

Cancer + egg freezing + IVF = baby

If Millicent Ramos, who is due to give birth to a boy on Dec. 27, had benefited from a law such as the one about to go into effect, she wouldn’t have had to pay the $6,800 she  paid six years ago to freeze her eggs, or the $11,600 she  paid this year for IVF to get pregnant.

Ramos was diagnosed with Hodgkins lymphoma in her early 20s, a cancer of the lymph nodes that requires chemotherapy, radiation therapy or stem-cell transplant, depending on the severity of the disease. Such treatments can cause infertility.

Ramos’ oncologist referred her to Mullin of Northwell Health Fertility to talk about preserving her eggs. Ramos had had one child before her cancer diagnosis.

“To think of never giving him a sibling was devastating,” she said. At the time, Ramos didn’t have savings, she said; fortunately, her family stepped in to help pay and Mullin was able to extract and freeze 23 of her eggs. “The egg freezing to me was the best decision I’ve ever made. I said to myself, ‘I’m going to beat this, and I’m going to be a mother again.’”

Fast forward through chemotherapy, return of the cancer, stem cell transplant, and ultimately news that she was cancer free. Ramos, 31, works in customer service for Delta Air Lines at Kennedy Airport and lives in Copiague. Her son, Edgar, is now 11. In February, Ramos, who is single, decided to go through IVF. She returned to Northwell Health Fertility, where her eggs were fertilized with donated sperm and an embryo was then successfully implanted in her uterus. “For some reason, this year it felt right,” she said. Her mother, Juanda Agosto, is moving in to help with the new baby, whom Ramos plans to name Greyson.

Ramos’ mother also helped her bear the cost. “It was pretty steep,” Ramos said. “When I found out that I had no coverage from my health insurance company for IVF I was upset.” Health insurance coverage for fertility “could have helped me tremendously,” she said.

Easing such financial burdens will offer more people hope, Ramos said. “Bringing a child into the world, it’s a beautiful thing. You don’t want to feel that financial strain. You just want to worry about whether you’ll get pregnant. You have to be at peace and happy and positive when you go through the journey. When you worry too much, you affect the process that’s going on with your body. I will be extremely happy for everyone else who will be able to benefit from 2020 moving onward.”

A twinge of envy

When Ian Savage hears about the new law that will require many New York companies to offer insurance coverage that includes three cycles of in vitro fertilization, he said it’s hard for him to suppress a twinge of envy.

Savage’s wife, Danielle, has endometriosis, a medical condition that caused scarring of her fallopian tubes. The Savages, who live in Bayport, need IVF to conceive. But because they get their benefits through a Vermont-based company that offers insurance through Blue Cross Blue Shield of that state, the Savages expect they won’t qualify for coverage under the new law and will have to come up with $20,000 for a fresh IVF cycle themselves.

“The process of infertility is ... very emotionally draining, especially for the woman. It’s a very physically draining process, especially for the woman,” said Ian Savage, 37, a financial adviser. “Having to focus as much as we do on the finances of it adds another level of stress and anxiety to a process that is already filled with stress and anxiety. It’s kind of like salt in the wound for us.”

Danielle, 38, a new-business manager, said, “It’s an illness that’s inside my body that I have no control over. Just like if you walked into a doctor’s office and they took a blood test and saw you have cancer. This has to do with my reproductive organs, but it’s not covered.”

The Savages used IVF to conceive their first child, who is 2½, and have returned to Stelling to try to give their daughter a sibling. They had one embryo that they had frozen during the first IVF cycle and had hoped that they would get lucky with it — using a frozen and thawed embryo eliminates the need for the hormone injections and egg retrieval, and therefore cost them closer to $3,000. “We just found out that it didn’t work,” Danielle said. “Now we’re trying to get $20,000 together so we can start a whole new cycle.”

“The fact that we have our daughter and each other and the health that we have, we’re lucky," Ian said. "We feel tremendously blessed.” Still, he said it seems unfair that New York State will now require some people be offered fertility coverage through their health insurance while other state residents won’t benefit. “Why not us?” he said.

Try, try again

 It took Andrea and Maryann Sherie of Bay Shore four IVF attempts before Andrea got pregnant with their daughter, Chase, now 7 months old. They had first tried multiple rounds of traditional artificial insemination and doctor-assisted insemination before moving on to IVF. 

They never could have afforded four IVF tries if Maryann, 37, wasn’t a New York City physical education teacher with fertility coverage offered as part of her health care benefit. “They cover 75 percent of the IVF cost,” Maryann said.

The women, who are married, said they have friends who had to pay out of pocket for their IVF attempts and had to stop because they ran out of money. “They pretty much used up their savings,” Maryann said. Andrea, 35, who is a stay-at-home mom, said, “If we had to pay for everything out of pocket, I don’t know if we would have made it this far. We might have been in the same boat as our friends.” The new state law “will make more couples be able to have a family,” Maryann said.

Insurance coverage doesn’t eliminate all the expenses, the Sheries said. The couple’s portion of the first IVF cycle still was $4,500. Andrea went through the IVF process with Sung of Reproductive Specialists of New York; Andrea produced enough eggs to fertilize six viable embryos using donor sperm that the Sheries purchased (the more than $20,000 it cost them to buy all the units of sperm they needed — as well as the frozen storage of some that they plan to use for a second child — wasn’t covered, they said). The Sheries were able to use frozen embryos for the last three IVF attempts, which cut their portion of the cost to about $400 each for those transfers, they said.

Their outlay was much less than they would have paid out of pocket, and that allowed them to try, try again. “When it came to our last attempt, we were like, ‘This better work because our bank account is getting smaller,” Maryann said. “We didn’t want to have to shell out another $4,500,” Andrea said.

Even with health insurance coverage, economics still influenced the Sheries’ choices the longer it took to get pregnant, they said. They only chose to implant one embryo each of the first two tries because they preferred not to have twins. But on the third try they wanted to boost their chances to avoid having to pay for yet a fourth attempt, so they opted to have two embryos implanted. They did the same on their fourth try — and Andrea held onto a ladybug charm for good luck — and they were overjoyed when one embryo took.

Andrea found out first. “Maryann was in the backyard. I had a little mug that said, ‘Be nice to me, my wife is pregnant.’ I said, ‘You’re going to have to bring this to work with you.’”

“I immediately hugged her and started crying,” Maryann said. In 2020, the women plan to try for a second child. This time it will be Maryann’s turn. For now, they are relishing Chase. “She’s the light of our life. She was well worth it,” Andrea said.

“We both always knew we wanted to be moms one day,” Maryann said. “I’m a teacher. I just love kids. I wanted to have my own kids to teach. It’s so hard to describe the feeling when you become a mom. Your heart becomes full and life becomes better. All those couples who want to do this, I want them to be able to experience it.”

Will you be covered for IVF?

The new rules apply to companies with so-called fully insured plans — those where a company pays a New York State-regulated insurance carrier to cover employee health claims.

  • Ask your employer if the company is self-insured. If so, it is not required to provide the coverage.
  • Does your employer employ more than 100 people in New York? If so, the employer typically would be required to provide the coverage. However, if it is based in another state, it may be exempt.

Source: Resolve: The National Fertility Association

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