Decoding Insurance With Fertility Advocate Davina Fankhauser

If you met Davina Fankhauser and saw her 2 adorable kids, you may assume that she never had any fertility issues. But Davina struggled with recurrent miscarriages and female- and male-factor infertility with her partner for more than a decade. Her 2 kids were the result of 6 rounds of in vitro fertilization (IVF) treatments, 10 pregnancies, and a commitment to get better educational, emotional, and financial support during the process of building her family.

When Davina started trying to conceive, she didn’t work for an employer that offered insurance coverage for fertility treatment, and she and her partner weren’t in a position to pay for unlimited treatments. Davina wanted to make a difference and help others avoid this situation. She did the research and found a way to provide assistance through Fertility Within Reach, a national nonprofit, to educate and support others who are navigating the confusing process of insurance coverage for fertility treatment.

Davina is passionate about advocating for others navigating fertility challenges and access to treatment and was successful in lobbying for better insurance benefits in her home state of Massachusetts in 2010. In her words, “I decided to help others advocate so they had a chance to get those benefits and feel empowered versus helpless.”

Here’s more on how to decode insurance benefits and advocate for yourself so you can get more support as you build your family.

How many companies offer insurance coverage for fertility treatments?

There is an organization known as INCIID, The International Council on Infertility Information Dissemination, which has the most extensive list available. They cite 116 companies that may offer insurance coverage for fertility treatments. This site collected its information through surveys, so it’s not complete, but it is certainly helpful as a start.

It should also be noted that patients and advocacy groups regularly meet with their employers to discuss the positive impact of providing insurance coverage for fertility treatments. Companies such as Progyny and WINFertility reach out to employers, offering fertility treatment benefits packages that employers can add to their regular health plans.

The good news is, the number of companies offering these benefits is increasing each year. Many people may not realize that their company provides benefits for fertility treatment. It’s always worth asking if yours does!

Many people may not realize that their company provides benefits for fertility treatment. It’s always worth asking if yours does!

Whom, specifically, should someone ask for more information on fertility benefits?

Women and couples can contact their insurance company or their company’s human resources department to request detailed information about their benefits. Most will share a summary of covered services, which is not always helpful. Women will need to access the details to learn what is covered and what the medical guidelines are to qualify for coverage, and to find out what’s excluded. Anyone who is covered through an insurance provider has a right to access this information. Individuals can usually do a Google search to find the PDF version detailing their insurance policy on infertility and fertility preservation.

How can one effectively speak to an insurance company about coverage if fertility treatments aren’t covered?

People can have a more productive conversation when speaking to their insurance provider by understanding the process. For example, the person you first connect with can read you your policy and answer basic questions. If you still have questions, you can ask for a supervisor. The key to being effective is to take nothing personally and work to address your needs.

When speaking with an insurance representative, it’s also helpful to share your personal story and to illustrate why you’re a good candidate.

You’ve written about “non-group” insurance as a way to access treatments. What does this mean and how is it potentially helpful?

“Group” insurance is a policy offered through an employer. A “non-group” health plan is an insurance policy people can purchase that is not affiliated with an employer. These plans vary in terms of coverage, and you have to shop around to determine if any of them have benefits for diagnosing fertility challenges, fertility treatment, or fertility preservation. Due to the competitive market, you may find some plans more generous than others.

What are some other ways to gain access and coverage if your current employer or insurance company doesn’t cover fertility treatments?

• If you’re attending a college or university, you may be able to get coverage. Universities and colleges will usually offer a health plan that can be purchased by students. When visiting the school health center, you can ask the receptionist, a nurse, or a physician about the school plan and request materials to learn more about this option.
• Inquire if fertility clinics in your area are conducting a study or offering discounted IVF cycles to qualifying participants. Or, consider pharmaceutical companies that may have programs to help patients who cannot afford their treatment and medication.
• During the annual open enrollment period, people can change their insurance plans to one that potentially includes fertility benefits. You can also drop your spouse from your plan so they can apply for coverage through a school or a different employer.

For people about to start fertility treatments, what would you want them to know about accessing insurance?

Financially:

• When you have a reproductive health concern such as pain, discomfort, detecting an abnormality with your body, etc, it is usually treated by a doctor who is not a reproductive endocrinologist and is covered by your insurance. Some of the resulting diagnoses could be endometriosis, varicocele, abnormal hormone levels, thyroid disorder, etc. While all of these conditions could lead to fertility challenges, they should be covered by your health benefits. It is always important to bring up your concerns to an appropriate physician for all initial diagnostic testing.
• Employers offer benefits for a couple of reasons. One is to stay competitive by enticing applicants with their robust benefits package. The second is because an employee asked. If you ask and provide supportive information, there is a real chance the employer will say “yes.” 

Emotionally:

• Head into this with an idea of what your goals are. Is your goal to become pregnant and give birth? Is your goal to become a parent through any family-building option? What is your timeline to achieve your goals? The answers to these types of questions can help determine which treatment path you want to pursue, especially if finances are an issue.

Navigating insurance coverage for fertility treatment doesn’t have to be overwhelming. If you advocate for yourself and understand your coverage, you will be more empowered during the process of building your family. In fact, by doing the proper research, you may discover that you’re covered for more than you even realized.

If you advocate for yourself and understand your coverage, you will be more empowered during the process of building your family.