What If Employers Covered Infertility Like An Essential Health Benefit? 

Infertility

A call to action for employers  

By: Amanda Lesesne, Progyny VP of Sales 

From personal experience, I know infertility is lonely, isolating, and can feel shameful. I also know compounding those emotions with the stress and worry of how to pay for treatment can only make you feel further stigmatized.   

With October being National Pregnancy and Infant Loss Awareness Month, there’s an important conversation to be had on the mental and physical toll people trying to conceive go through and how employers can better support them on their journey.  

In my role, I educate employers and consultants every day about the value of fertility and family building benefits and how to adopt them while being mindful of quality and cost. It’s easy to assume any coverage is good coverage, but not all fertility benefits are the same, and not every benefit meets the needs of your employees. We always discuss: Are you further stigmatizing someone experiencing infertility by covering their treatment differently than everything else on your medical plan? 

Why is infertility any different? 

The American Medical Association defines infertility as a disease, a disorder of structure of the reproductive system somehow, someway. When you are diagnosed with a disease, you likely turn to your health insurance policy to help with treatment costs. Yet, traditional employer-sponsored health insurance plans have nuance upon nuance about what constitutes infertility and limitations of what coverage is worth through a dollar cap maximum. Meaning, people who already feel horrible that they can’t get pregnant then face an insurance policy defining how they can be treated and how much that is worth. Imagine asking yourself that. 

How much is this disease worth? 

To put it in perspective, here’s what a dollar cap reimbursement model would look like for another complex medical condition. Say your appendix bursts and your employer says they can give you $15,000 for care, but you must figure out how to spend it. Additionally, you would need to pay up front and, therefore, meet with billing coordinators ahead of time to understand the cost of each service before proceeding to see what you can afford. Would you skip using an ambulance or anesthesia to save a few thousand? Go to a cheaper doctor even if they’re further away? Discharge yourself early to escape a hospital room bill? You could try to calculate every penny and likely still pay thousands of dollars, as an appendectomy on average costs Americans $33,000, AND receive low-quality treatment. 

So, when employers say they are already “covering” infertility through their general health insurance policy or with a dollar cap reimbursement model, I ask them:  

Are you furthering the stigma of infertility? 

By not providing value-based care, employees are often left wondering why their employer isn’t addressing this complex medical condition, why they are left with the bulk of the cost, and why they have limited options. It also leaves them to question their value as an employee and drives the societal shame they feel. This is a group of people who have already experienced a significant amount of heartache and isolation. Employers need to step up and show them they care.  

Offer comprehensive and equitable fertility and family building coverage. 

Take the first step today. Speak with your team of decision-makers and really look at your plan design to see if infertility is even covered. If it isn’t, start the discussion and research for onboarding a comprehensive one that covers an entire course of care. If it is covered, see if you are treating it comprehensively, just as you do other disease states, or if you’re attaching a dollar limit. It might be time to re-evaluate how to enhance the current benefit to better support your workforce. 

To learn more about how you can destigmatize infertility in your workforce, reach out to sales@progyny.com or schedule a demo.