California is taking great strides with Senate Bill 600, written by state Senator Anthony Portantino (D-La Cañada Flintridge). This exciting bill, signed in Sacramento, guarantees private health insurance carriers will cover fertility preservation procedures for women or men whose fertility futures are threatened by cancer and/or their cancer treatments – or else they face legal consequences.
Northern California Fertility Medical Center is thrilled about this new bill. In addition to making fertility treatments achievable for a very tender and vulnerable population, it is another step in the right direction when it comes to making fertility diagnosis and treatment more affordable for all.
SB 600 Legally Enforces Private Insurance Carriers’ Fertility Preservation Obligations
One of the most interesting things about SB 600 is that fertility preservation coverage was already part of the verbiage in health insurance policies because fertility preservation as the result of a cancer diagnosis – or the treatment/medications required to eradicate cancer – fall into the “basic health care services” category.
Unfortunately, many insurance carriers have simply refused to pay out, putting their customers in an incredibly difficult position – at a time when they don’t have the financial or energetic resources left to go to battle for themselves.
One of the downfalls of the bill is that, according to Mary Ellen Grant, a spokeswoman for the California Assn. of Health Plans, SB 600, “…mandates that privately insured patients will gain a broad set of benefits that will increase healthcare costs, but its exemption of Medi-Cal is evidence that this mandate is costly and too broadly defined.” That leaves about 30% of Californians without equal coverage.
The CA Association of Health Plans is additionally concerned that language in the bill means insurance carriers will have to pay retroactively to cover fertility preservation claims, which will cost taxpayers a significant sum.
The New Bill Only Covers Initial Fertility Preservation Procedures
It’s important to highlight what SB 600 does cover – as well as what it does not.
Sperm preservation and egg freezing
The bill will cover the costs associated with sperm preservation as well as egg freezing procedures. SB 600 also covers the initial consultations and office visits related to those procedures.
It will not cover successive fertility treatments
However, once the sperm or eggs are frozen and preserved, patients are on their own when it comes to covering storage costs as well as treatment costs. So, for example, while your partner’s sperm retrieval will be covered, you will still need to pay out-of-pocket when you are ready to use the sperm via IUI or IVF.
Similarly, private health insurers must cover costs associated with egg retrieval, including the fertility medications and visits, but individuals or couples are responsible for IVF and other fertility treatment costs when they’re ready to start their family.
The exceptions are those fortunate enough to work for a company who provides fertility treatment benefit plans.
Time is of the Essence When Pursuing Fertility Preservation
While oncologists mean well, their primary focus is (understandably) your overall physical health and treating your cancer diagnosis as soon as possible. If physicians aren’t asking about your plans for a future family, you can wind up pursuing cancer treatments that are detrimental to your fertility future – before you have a chance to learn otherwise and create a modified treatment/fertility plan.
If you are facing cancer diagnosis, and your future fertility is a concern, schedule a consultation with a fertility specialist ASAP.
We will work with your oncologist to sync treatment timing so we have the best chances at retrieving eggs or sperm before any irreversible damage is done. We can also help you navigate the insurance claims process, as well as work with you to make successive fertility treatments as affordable as possible when the timing is right for you.
Contact us here at Northern California Fertility Medical Center to learn more about how you can benefit from SB 600 or to explore your fertility preservation options.
