Health Advice

/

Health

Even when IVF is covered by insurance, high bills and hassles abound

Phil Galewitz, Kaiser Health News on

Published in Health & Fitness

“It’s finally making logical sense,” Pritt said after learning that their billing dispute was resolved. “It’s good to know we won’t be getting any more bills.”

After Blue Cross decided to cover the IVF in Winter Park, the couple received $1,600 back from Orlando Avenue Surgery Center.

John Simley, a spokesperson for Blue Cross and Blue Shield of Illinois, said: “With non-routine waivers, mistakes can happen. The good news is they generally get fixed quickly.”

In this case, though, it took nearly a year.

Experts say Kaminski’s case shows that even when people have coverage for IVF, they can be left with huge bills. Also, insurers’ lists of in-network providers are not always accurate. “It feels like a bait-and-switch,” said Sabrina Corlette, a research professor and co-director of the Center on Health Insurance Reforms at Georgetown University.

A new federal insurance law, the No Surprises Act, went into effect in January 2022. It says patients don’t have to pay more than the in-network cost-sharing amount if the insurer’s provider directory gave inaccurate information.

Whether the law would apply in cases such as Kaminski and Pritt’s is unclear. Even if it did, the law took effect too late for them.

 

Betsy Campbell, chief engagement officer at Resolve: The National Infertility Association, a patient advocacy organization, said Kaminski’s case shows that insurance coverage isn’t always designed around the patient. “Infertility treatment is a series of very complex procedures involving lab work, surgery, anesthesia, and it needs to be provided in a way that the insurance system has not always respected,” she said.

Too often, insurance makes a couple jump through hoops to get the care they need, Campbell said. “Everyone should have the right to build a family, and it should not matter what employer you work for, or what state you live in, or how big a check you can write,” Campbell said.

Kaminski and Pritt aren’t giving up on having children. For now, they’re pursuing other fertility treatments that aren’t IVF.

____

Bill of the Month is a crowdsourced investigation by KHN and NPR that dissects and explains medical bills. Do you have an interesting medical bill you want to share with us? Tell us about it!

©2022 Kaiser Health News. Distributed by Tribune Content Agency, LLC.
 

Comments

blog comments powered by Disqus