Advocacy
At Fertility Specialists of Houston, we are honored to be a partner in helping you achieve your dreams of building a family.
And as your partner, we know that financial issues can be a frustrating component of the process when fertility treatment is needed. We encourage you to become educated about your health insurance policy and Texas laws so that we can together understand what options are available as we work toward our shared goal.
Are there laws regulating how infertility treatment services are covered?
How is infertility treatment covered in Texas?
Where do I go for more information?
What else can I do?
Are there laws regulating how infertility treatment services are covered?
Every state has its own laws regulating how insurance companies handle infertility diagnosis and treatment claims.
- Some do not require its insurance plans to cover infertility treatment.
- Some states have a "Mandate to Cover"-that is a law that requires insurance carriers to provide infertility treatment benefits in every policy.
- And some states, like Texas, have a "Mandate to Offer"-that is a law that requires some insurers to offer plans that provide infertility treatment coverage, but does not require employers to purchase these plans.
How is infertility treatment covered in Texas?
In Texas, insurers that cover pregnancy services must also offer coverage for IVF. Therefore, insurers must notify employers that this coverage is available. They are not required, however, to provide the coverage; nor are employers forced to include it in their health plans.
Patients who are offered the IVF benefit must meet the following criteria:
- The patient must be the policyholder or the spouse of the policyholder and be covered by the policy;
- The patient's eggs must be fertilized with her spouse's sperm;
- Other infertility treatments that are covered by insurance have been unable to achieve a successful pregnancy;
- The IVF is performed at medical facilities that conform to standards set by the American Society for Reproductive Medicine or the American College of Obstetricians and Gynecologists; and
- The patient and her spouse must have a continuous history of unexplained infertility that extends at least five years or the infertility is associated with one of these conditions:
- Endometriosis;
- Fetal exposure to diethylstilbestrol (DES);
- Blocked or surgical removal of one or both fallopian tubes; or
- Oligospermia
Carriers affiliated with bona fide religious organizations are exempt from this law if their beliefs conflict with the treatment.
(Texas Insurance Code, Article 3.51-6).
Where do I go for more information?
For additional information regarding insurance coverage and advocacy, please visit:
- American Society for Reproductive Medicine - a non-profit organization devoted to advancing knowledge and expertise in reproductive medicine. http://www.asrm.org/Patients/topics/insurance.html
- The InterNational Council on Infertility Information Dissemination, Inc. - a nonprofit organization that helps individuals and couples explore their family-building options.
- RESOLVE: The National Infertility Association - a non-profit organization dedicated to promoting reproductive health and to ensuring equal access to all family-building options for men and women experiencing infertility or other reproductive disorders.
What else can I do?
There is still much progress to be made in ensuring adequate coverage for infertility treatments. Please consider contacting Texas Senators John Cornyn or Kay Bailey Hutchinson and ask them to introduce and support legislation requiring infertility treatment coverage.
For additional ideas on how to advocate for infertility treatment coverage, visit RESOLVE at http://www.resolve.org/site/PageServer?pagename=ta_home
The doctors and staff at Fertility Specialists of Houston cannot give legal advice about any property or custody rights issues or questions that an interested party may have and anyone considering these programs is strongly encouraged to obtain legal advice from a competent attorney of their choosing.
