IVF Insurance Coverage for Recurrent Pregnancy Loss
So, let’s start with, “yes”. Yes, we are luckier than most. Seeking fertility care in a mandated state like New Jersey is much easier than in states with little, to no coverage. And yes, we live in a state that respects a woman’s right to healthcare. Where elsewhere in the country, more and more states are rolling back reproductive rights all together. And yes, as an industry, New Jersey has some of the very best Reproductive Endocrinologists and fertility clinics not only in the country, but frankly, in the world.
That doesn’t mean getting IVF coverage is easy.
Case in point, let’s examine the fertility journey of Jessica Rella. Jessica tragically experienced pregnancy loss on multiple occasions within a year – four to be exact. Devastated, she did what she was supposed to do. She consulted with a reputable and experienced REI, did the requisite tests for diagnosis and then armed with loads of factual data and medical recommendations, she informed her insurance provider that she needed IVF with pre-implantation genetic testing.
She was denied coverage.
New Jersey’s Mandate dictates that to be covered for IVF “the patient has used all reasonable, less expensive & medical appropriate treatments and is still unable to get pregnant or carry a pregnancy”.
Many insurance companies interpret that coverage loosely. Allowing for no explanation on what is “reasonable and medically appropriate” but happy to look at what’s less expensive.
Translation: Jessica needs to first try IUI.
Jessica was not, however, having any trouble getting pregnant – due to chromosomal abnormalities within the embryos, she was not able to carry to term. So IUI’s would only cause more heartache. What Jessica needed was pre-implementation genetic testing (PGT) to make sure that only a healthy embryo was implanted.
Here’s when paying it forward & advocating for access to care for all truly manifests itself. Through her heartache, Jessica was undeterred. One night, as she was researching avenues to help her cause, Jessica came upon an article on IRMS’ patients Deanna & John Harkel. The Harkel’s fertility journey was similar to Jessica’s. They too had experienced repeated miscarriages, were denied coverage for IVF, and told to try an IUI by their insurers, even though they were paying for a policy that did cover IVF and genetic testing of embryos. IRMS’ Medical Director and REI rockstar Dr. Debbra Keegan, the Harkel’s physician, joined their fight and together they appealed to the New Jersey State Department of Banking & Insurance and finally won the right to coverage. This case now set a precedent for Jessica Rella and her husband to overturn their denial.
“It is so unbelievably unfair how the insurance companies work and so unnecessary the level of stress they put on the patients. I attached my speech for you to read in hopes that maybe one day it will help someone else in the future. If there is anything I can do to pay this forward, please let me know. I will forever be grateful to you all for not giving up and fighting so hard.”—Jessica Rella
So, this is how it works. If we stand in the light, keep being loud and demand what is right – the pendulum shifts. The Harkel’s bravely shared their story, and Jessica heard it and now will welcome her first born this year.
Jessica, in turn, is fearlessly sharing her story in hopes that you hear it and it empowers you to your forever family.
Below is the speech she delivered for her appeal and the IG Live she did with Dr. Keegan about her journey.
I am 1% of the population that has had 4 recurrent consecutive miscarriages. I want you to keep that in mind when you make your decision that I am not your average case. By definition, infertility is the failure to achieve a pregnancy after 12 months or more of unprotected sexual intercourse.
I am not infertile.
My husband and I have gotten pregnant naturally 4 times over the last 12 months. All 4 of these pregnancies ended in devastating miscarriages. After the third miscarriage we had a D&C and tested the fetus. We found out our baby boy did not survive due to abnormal chromosomes, trisomy 6 to be specific.
According to the American Society for Reproductive Medicine, preimplantation genetic testing may be recommended for someone with recurrent miscarriage.
My doctor, with me here today, Dr. Cho, recommended we pursue IVF as it is our best chance at obtaining a healthy pregnancy. This is the only treatment option that offers us the opportunity to perform genetic testing before implantation to ensure we are implanting a healthy embryo. This will drastically reduce my chance of having another miscarriage. There is no other treatment available that gives us that option.
I understand that in many, or most cases, IUI is suggested as the first form of treatment for many infertility issues. But I am not infertile. In my case, I do NOT need assistance getting pregnant. Not only is it inhumane to force me to pursue IUI to obtain coverage for IVF, there is no medical indication for it. The purpose of IUI is to improve your chance of fertilization and I clearly have not had any issues getting pregnant. In my case, IUI will more than likely result in another devastating miscarriage- something that would be traumatizing for me to endure for a fifth time. Not only will it most likely result in another miscarriage, but that would also mean a D&C and another hysteroscopy.
From Horizon’s perspective, these unnecessary procedures also have costs associated with them. In my case, there is a high likelihood that IUI would fail so it doesn’t seem to benefit you to force this upon me either.
I’d like to point out that Horizon has had to address this before. In 2018, there was another couple, Deanna and Jon Harkel, who had nearly the same exact fertility issues as my husband and me. They also had four consecutive miscarriages related to abnormal chromosomes. They appealed their Horizon’s denial with the state and a third party agreed with them that the service should be covered. The outside doctor who reviewed the case said preimplantation genetic testing was considered medically necessary given the couple’s history of miscarriage.
Horizon‘s decision was overturned. They received their coverage for IVF and currently have two children as a result. Please do not delay us starting a family any longer.
I feel there is strong evidence here as to why IVF and preimplantation genetic testing is necessary, and that IUI will not benefit us in this case. I am pleading with you to reconsider your denial of my coverage for IVF. IVF is medically necessary for me to achieve a healthy pregnancy and there is no other cost- effective alternative that can achieve the same outcome. Our fertility journey has been so physically and emotionally painful for us. We are truly hoping after understanding our unique situation, you will reconsider this decision and help us make our dream of becoming parents come true.
If you are struggling with recurrent pregnancy loss, please contact us. You do have options. You can reach us via our website, give us a ring at 973.548.9900 or DM us on our social handles and book a consult.