Zornio: Coloradans seeking IVF need help getting health care coverage
The American health care system has long been broken, a sentiment I was reminded of when a dear friend shared her struggles securing health insurance coverage for in vitro fertilization in
In vitro fertilization is a laboratory technique that combines a female's eggs and a man's sperm to create embryos. These embryos can later be transferred into the body in hopes of achieving a viable pregnancy. This process is the last resort for couples to overcome infertility or to pursue parenthood on one's own.
Those who rely on IVF face a challenging path to childbearing. The process includes long periods of waiting, invasive procedures and heavy financial burdens. On average, one cycle of IVF can cost
State Rep.
The act would have mandated insurance to cover three rounds of IVF for all state-regulated insurance plans, amounting to roughly one-third of insurance holders. Tipper would later refer to the legislation as "one of the most important bills that I've run."
And it was, until the Trump administration interfered.
Despite Tipper's best efforts and the bill passing with bipartisan support, a subsequent ruling by the Trump administration's
According to
However, Trump's DHHS disagreed with
The 2022 bill requiring IVF coverage also passed and will take effect in
This is where things get more complicated.
Additionally, many companies that otherwise fall into the large group plans are trending toward self-funded health care models. This removes them from the mandated pool to cover IVF, leaving even fewer policyholders to qualify — unless DHHS reverses its decision.
There is reason to believe a DHHS decision reversal is possible.
For now, this leaves Coloradans seeking IVF in mixed categories of coverage depending on their health insurance plan — and it's not always easy to determine if one's plan qualifies.
First, policyholders can look for "CO-DOI" on their insurance cards. This tells you if your plan is state-regulated. The new law will not apply to you if it does not appear on your card.
Next, policyholders must determine if their plan is designated as a large group plan. This is determined by contacting your employer's human resource department or the insurance company directly. This law will not apply if your policy is not a large group plan based in
This brings me back to my friend in
One day, I know she will be an amazing mom. How do I know this? Because she, like others in her position, have the strength and fortitude to not only figure out how all of this absurdly complicated health care coverage works, but she is determined to find a way to make it possible despite learning she doesn't qualify for full IVF coverage on either of her two insurance plans.
Not qualifying for full IVF coverage is forcing many tough decisions: Does she leave her current job to find a new one with a large group plan? How does she determine if a new company covers IVF without asking? If she can't find coverage, how do she and her husband take on the hefty medical bills not covered by insurance?
My friend is not alone. These are decisions facing many Coloradans since there are no current federal protections for IVF coverage, and Biden's DHHS hasn't yet issued a reversal.
There are many takeaways:
First, large
Second, employees of large companies with self-funded health plans should lobby their employers to include full coverage of IVF, whether or not they need IVF. This reduces the burden for their colleagues who need IVF.
Third, federally elected
Fourth,
Fifth, state policymakers should consider if there is a way to permit Coloradans who were denied coverage for IVF after the CBFA was intended to take effect to seek reimbursement for incurred costs by their insurance plan, should a reversal of the
Sixth, state officials must work to ensure that anyone interacting with the public regarding IVF laws is aware of the status of the CBFA.
Starting a family is one of the most important and intimate decisions we can ever make. Not covering IVF in full further perpetuates systemic issues, leaving only those who can afford to cover tens of thousands of dollars able to have children.
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