The following article appeared in th Saturday, January 10th edition of the New York Times.
January 10, 1998

Aetna Halting Health Coverage for Costly Fertility Treatments


Aetna Inc., one of the nation's biggest health insurers, said Friday that its U.S. Healthcare health plans would eliminate coverage for advanced fertility treatments, including in vitro fertilization, on April 1.

The company said that women who had fertility problems had been joining the U.S. Healthcare plans because they knew the advanced treatments were available. Aetna has been under pressure recently from Wall Street investors to reduce costs and increase profits.

The decision was sharply criticized by doctors and advocates for infertility patients, who said that many couples were already struggling to cover the costs of such treatments out of their own pockets.

"We don't question what it costs to fix a tennis elbow or a football player's knee," said Pamela Madsen, a spokeswoman in New York for Resolve, a national patient advocacy and support group for people with fertility problems. "Where are our priorities?"

U.S. Healthcare, which began offering this coverage in 1995, was one of the first managed care companies to do so and set an example that other health plans followed. Fertility is a problem for 6.1 million Americans, but fewer than half of those who are infertile obtain the expensive medical services, according to a 1995 survey by the federal Centers for Disease Control and Prevention; cost is considered to be a major factor.

A growing number of states require health plans to offer a variety of fertility treatments, although these laws do not apply to most workers, because they are covered by self-insured health plans that are exempt from state jurisdiction. States that require coverage for some form of infertility treatment include New York, Connecticut, California, Texas, Illinois, Massachusetts, Ohio, Maryland, Arkansas, Montana, Rhode Island, West Virginia and Hawaii.

A bill will be introduced in Congress this year to require all health plans to provide for fertility treatments, said Sean Tipton, a Washington lobbyist for the American Society for Reproductive Medicine, a doctors' group.

The Aetna decision, which evoked emotionally charged concerns about working mothers and childbearing, added fuel to the debate over whether health plans and the employers who pay for them should be required to cover specific expensive treatments and procedures.

Tipton assailed the Aetna move as an example of "a health system that is driven by the interest of shareholder dividends rather than the interest of patients."

Sari Madden, 30, a second grade teacher in a Public School 152 in Queens, N.Y., said U.S. Healthcare had paid for procedures at a Manhattan fertility center that enabled her to become pregnant five months ago. She and her husband had been trying to have a baby for two years.

"I'm surprised that they are doing this," Ms. Madden said. "If it wasn't for that program, I wouldn't have gotten pregnant at all. I couldn't have afforded it."

Employers can arrange for advanced fertility treatments through a number of health plans, including Empire Blue Cross and Blue Shield. About 40 percent of large employers offer some form of advanced fertility treatment, including in vitro, artificial insemination and drug therapy, according to a 1996 survey of employers with 500 or more workers by William M. Mercer, a benefits consulting firm.

Nineteen percent of health maintenance organizations offer in vitro fertilization, the Mercer survey said.

In vitro fertilization, in which eggs from a woman typically are combined with her husband's sperm in a laboratory dish and reimplanted in the woman, can cost $8,000 to $12,000 for each procedure. Ms. Madden said U.S. Healthcare paid for her first unsuccessful attempt and arranged a special price of $5,000 for the second, successful attempt at in vitro, which she paid for herself.

But the cost of adding the in vitro benefit to a standard package of health benefits is only about 26 cents per month for each member of a health plan, said Diana Dean, a consultant with Mercer.

A spokeswoman for Aetna would not comment on the economic basis for the change in U.S. Healthcare policy, which patient advocacy groups had announced on the Internet several weeks ago. The Philadelphia Inquirer reported the action Friday.

Aetna said the change applied to 750,000 female members of U.S. Healthcare from age 20-45. It said about 1.5 percent, or 11,250, had fertility problems, of which fewer than 2,500 had the in vitro procedure. The fertility treatments were not offered as a basic benefit by other Aetna health plans.

Dr. Zev Rosenwaks, director of the Center for Reproductive Medicine and Infertility of New York Hospital/Cornell Medical Center, said that it was "unfortunate that the insurance companies don't see the treatment of infertility as an important medical condition to be covered," and that "the inability to conceive is a disorder like any other medical condition."

Dr. John Nelson, an obstetrician in Salt Lake City who is a trustee of the American Medical Association, said he had "concerns about insurance measures that specifically single out women." He said in vitro fertilization "is not an experimental procedure," and that "it works very well but it is expensive."

He added, "Are they going to discriminate against any kind of procedure that is expensive?"

Ms. Madsen, of Resolve, said she had had to pay for the in vitro assisted births of her sons, who are now 5 and 8.

"Even though I had health insurance and my husband worked, we were told then that the desire to have a baby was something optional that was not covered, like plastic surgery or a private room at the hospital."

Resolve, which has 13,000 members, and the American Society for Reproductive Medicine have written to Richard Huber, chief executive of Aetna, to protest the change in policy, which also eliminates coverage for fertility technology called gamete intrafallopian transfer, zygote intrafallopian transfer and embryo cryopreservation.

Jill Griffiths, a spokeswoman for Aetna U.S. Healthcare, said the insurer would continue to offer a fertility benefit for diagnosis, surgery, drugs taken orally (but not injected), and intrauterine insemination.

Rosenwaks, whose center performs more than 1,100 egg removals for in vitro fertilization each year, said it "could be cheaper to do the in vitro procedure in a good clinic than to do a protracted standard treatment that most insurers pay for, which may not work."

Copyright 1998 The New York Times Company

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