Lesbian Parents and Insurance for Fertility Treatments

by Katharine Swan

Infertility is often defined as the inability to get pregnant within a year of having unprotected intercourse. Lesbian would-be parents often face a harsher reality, however. The success rate for conceiving with frozen sperm hovers between 8 and 15 percent, compared with a 20 to 30 percent chance of conceiving during intercourse. These odds lead many lesbian bio-moms to use fertility drugs and other treatments to supplement artificial insemination, in vitro fertilization (IVF), and other methods of getting pregnant without intercourse.

Unfortunately, fertility treatments are expensive. Fertility drugs can cost up to $1,000 every month, artificial insemination costs as much as $500 per attempt, and IVF runs patients an average of $12,400 each time. For most women dealing with infertility, insurance is the answer – but for a lesbian, infertility insurance can be difficult to obtain.

State-Mandated Health Insurance, Fertility Treatments, and Lesbian Parents

Overall, only about a quarter of employer-sponsored health plans cover fertility treatments. State law requires employers to offer or provide this coverage in 15 states:

1. Arkansas
2. California
3. Connecticut
4. Hawaii
5. Illinois
6. Louisiana
7. Maryland
8. Massachusetts
9. Montana
10. New Jersey
11. New York
12. Ohio
13. Rhode Island
14. Texas
15. West Virginia

Unfortunately, in 14 of these 15 states your health insurance only needs to cover fertility treatments if they are deemed “medically necessary” – in other words, if you have been diagnosed as infertile. And in most of these cases, you can only be diagnosed as infertile if you have been having unprotected intercourse for a specified period of time, usually a year. Of course, this definition of fertility automatically excludes lesbians, rendering the required fertility insurance in these states virtually worthless for a lesbian mother.

Another problem for lesbians is that five of these states only require employer-sponsored plans to cover treatments for married women – again, automatically excluding lesbians from coverage:

• Arkansas
• Hawaii
• Maryland
• Rhode Island
• Texas

Of these five states, all but one – Rhode Island – even stipulate that they will only cover IVF if the husband’s sperm is used.

Determining if Your Health Insurance Covers Fertility Treatments

Although the odds are certainly against your health insurance covering fertility treatments for a lesbian, you should still check with the company directly. Your best bet is to call them up and ask. Be thorough with your questions, however – just because your coverage includes infertility insurance doesn’t mean that all procedures will be covered.

Questions to ask your health insurance company include:

• What specific fertility treatments and/or medications do you cover?
• How does the policy define infertility?
• How does policyholder infertility need to be documented, and if so, how?
• Do you cover fertility treatments for unmarried women and/or lesbians, and if so, which procedures?

Make sure you also read your policy handbook from cover to cover. If the policy does not specifically say they won’t cover fertility treatments, then technically they have to!

Finding Infertility Insurance for Lesbians

If your health insurance policy does not cover fertility treatments, you will need to obtain separate infertility insurance. In order to qualify for infertility insurance, you will need to have current health coverage, usually under a plan you’ve had for at least a year, and you will need to fall within the provider’s definition of infertility.

Not all infertility insurance providers will cover a lesbian’s fertility treatments, so you will need to ask providers similar questions as the ones you asked your own health insurance provider. For instance, you should ask:

• How does the policy define infertility?
• Do you cover treatments for unmarried women and/or lesbians?
• Does infertility need to be documented before treatment will be covered, and if so, how?
• What procedures and/or medications are covered by the policy?

Other Funding Options for Fertility Treatments

If you are unable to obtain infertility insurance, there are other options that can help ease the expense, such as refund programs and loans. However, these programs usually offer the most generous financial assistance if the fertility treatments don’t work – that is, if you don’t have a baby.

• Refund Programs – Refund programs require you to pay for your fertility treatments up front. However, if the treatments are unsuccessful, the program typically reimburses between 70 and 100 percent of the cost.
• Financing – Another option is to take out a loan. If the treatments work, you will repay the loan as you normally would. However, if you don’t have a baby as a result of the treatments, you may not be required to pay back the entire balance.

Hope for Better Access to Infertility Insurance

Obtaining infertility insurance can be difficult, if not nearly impossible, for many lesbian women and their partners. States and health insurance companies both discriminate against lesbians by using language that automatically excludes lesbians from coverage.

Fortunately, in some cases this is beginning to change: Some insurance companies are beginning to redefine infertility as an inability to get pregnant via unprotected intercourse or artificial insemination. Hopefully, these changes in perception will continue to take place, allowing more lesbian women to take advantage of the medical miracles that are now possible via fertility treatments.

References:

Website for Infertility Insurance

Website for Infertility Treatment Not Covered by Many Employer Health Insurance Plans, USA

Website for Lesbian, Single-Mother Families Still Face Hurdles

Website for Baby Steps: How Lesbian Alternative Insemination is Changing the World

Website for Dear Ari: Butch Parenting

Website for Will Fertility Services Be Covered by My Insurance?

Website for Future Choices: Assisted Reproductive Technologies and the Law Section 1: Insurance Coverage of Infertility Treatments

Website for State-Mandated Benefits

Website for The Concepts of Conception

Website for Increasing the Odds of Getting Pregnant

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