I wrote about the options available for young cancer patients to preserve their fertility here recently. Sadly, getting information to cancer patients regarding their options is only half the battle. A few weeks ago, my patient with breast cancer was denied coverage for her IVF cycle even though she had IVF coverage with her insurance. Her employer had paid extra for this coverage. The reason for her denial was that she did not have the diagnosis of infertility according to the insurance rules, which mandated that patients needed at least 2 years of unprotected sex before they could be considered infertile and able to use their infertility benefits. They seem to have no exceptions to this, meaning that patients with blocked fallopian tubes, lack of sperm in their partner, or cancer cannot be considered infertile for 2 years. This is ludicrous on so many levels. For one thing, the commonly accepted definition of infertility is 1 year of unprotected sex in a person without known fertility factors. Someone with blocked tubes is infertile from the get go, and is not going to get pregnant by “waiting, relaxing, and vacationing.” For another thing, cancer patients need to do their IVF right now, before they have chemo and radiation. Delaying cancer treatments for two years so that fertility preservation can be done is ridiculous. Waiting until after all their cancer treatments are completed defeats the purpose. When I called the insurance company and spoke with the medical director, an MD, our conversation went like this:
Me: “I’m asking you to cover Ms. X for IVF. She has IVF coverage, and she has breast cancer. She is starting her chemotherapy in 2 weeks.”
Dr. Useless: “I understand what you’re saying and completely agree, but she hasn’t had infertility for 2 years, so no.”
Me: “She will have infertility for the rest of her life after chemo. 80-90% of women who have this type of chemotherapy suffer from infertility afterwards. Many of the remaining women require 5-10 years of tamoxifen, during which time they cannot get pregnant. This means they are also much older by the time they can start, and what window they had has closed.”
Dr. Useless: “I understand what you’re saying and completely agree, but our rules are that she can’t get IVF unless she has been trying to conceive for 2 years. If we changed the rules for her, we would have to change them for everybody.” (Slight gasp, as if this were unthinkable).
Me: “Yes! Exactly! I am asking you to change the rule for everybody that has infertility coverage and cancer.”
Dr. Useless: “I understand what you’re saying and completely agree, but our underwriters say we can’t do this.”
Me: “I’m not asking you to cover IVF for everybody in your plan. Just the ones who already purchased coverage for IVF. Who have cancer. Who also desire fertility preservation. In North Dakota. That’s what, 3 patients a year?”
Dr. Useless: “I understand what you’re saying and completely agree, but then we’d also have to cover sperm freezing in men with cancer.”
Me: “Yes! That’s what I want!”
Dr. Useless: “No.”
Preserving fertility in young cancer patients gives them something to look forward to once cancer treatments are ended. The ability to have a normal life and a family if they wish allows cancer patients to plan for the future when they are free of disease. It’s not only a plan for survival, but may also help increase survival, because it focuses their attention on the future.
My point is not that insurance companies should suddenly start covering IVF if they haven’t in the past. I’d love it if they did, and so would my patients, but that battle is not one worth fighting until we have a better idea how the Affordable Care Act is going to affect healthcare costs nationally. Historically, infertility coverage has only been offered by companies wishing to purchase the additional insurance to entice workers. When unemployment rates rise, benefits drop, because companies don’t need to work as hard to keep employees happy. But if a patient already has the coverage, she should be able to use it if she needs IVF. She shouldn’t have to wait two years to access her coverage because of a rule that has no basis in medicine.