As a former infertility patient, I know what it’s like to live with the disease of infertility. The feeling of helplessness and lack of control is extremely emotional. For me, not having insurance benefits through an employer, in addition to being infertile, was like pouring salt on an open wound.
Fertility Within Reach was developed as an educational resource for those seeking infertility treatment or fertility preservation insurance benefits. We provide information, tools, and coaching to empower infertile individuals to advocate their case in order to build their family.
The Fertility Within Reach website is intended to support the communication process with physicians, insurance companies, employers, and legislators in our efforts to access fertility treatment for the prospective mother and for the infertility community as a whole. We do this by offering step-by-step instructions and resources. An extensive list of state information is provided to help individuals understand their options. The information needed to optimize their chance of success is available online, 24 hours a day and is FREE! Plus, everyone can receive a 20-minute consultation at no cost. Simply email us to set up a time to connect at firstname.lastname@example.org.
We understand not everyone has the time or energy to manage their advocacy efforts. That is why we also provide Infertility Insurance Consulting, for the patients who decide they would like additional assistance in their efforts to gain insurance coverage. Through this service, we help patients strategize the best options to gain coverage and we supply them with specific research to support their individual circumstance. We also review and provide feedback on the letters they create.
Many patients don’t believe they can win an insurance appeal or they are not encouraged to request benefits. We can tell you, advocating for insurance coverage works and people are successful all of the time.
Listed below are a few examples of success we have witnessed:
One of our favorite examples was helping a woman who did not have infertility, but she had a genetic condition which gave her a 50% chance of miscarrying or having a still birth with each pregnancy. We worked together, and then this patient took the information we provided and ran with it. While her insurer still said no to coverage, she went back to her employer and they agreed to cover the cost of an IVF cycle using a donor egg.
Another couple we helped had been denied coverage citing the patient was naturally infertile due to perimenopause. This patient was able to collect letters from her doctors and she also used supportive research to back her medical history. The insurer upheld their denial, but it was overturned when the patient requested an External Appeal (when an outside insurer reviews the case). She received coverage for two additional IVF cycles.
We also helped a lesbian couple be reimbursed for most of their IVF cycle. The law where they lived happened to have a mandate, but they were denied coverage based on their sexual orientation. The patient was prompted by our organization to remind the insurer that she met the state law requirement stating coverage should be provided to anyone with an underlying medical condition that could cause infertility (such as severe endometriosis) and was having recurrent sex that did not result in conception. Most of their IVF expenses were reimbursed by their insurer.
The overall message we want to share with patients is that there is an opportunity for them to be in control and to do everything they can to see their family building become a reality. Once a patient is empowered with information and support, a life-long sense of strength and confidence develops.
Why do we encourage patients to try to advocate for themselves? It not only brings on a sense of empowerment, there is also a monetary value to their investment of energy and time. Let’s say it takes six hours to collect documents, write your letters, etc. If the patient receives coverage for an IVF cycle, averaging $12,000, they essentially earned $2,000 an hour. Every time someone makes a request, they are also increasing the opportunity of success for others with similar needs in the future.
For those who choose not to advocate, there is supportive information available as well. The Fertility Within Reach website provides a list of grant opportunities and tips for filling out applications. Other supportive information includes a list of patient resources, helpful blogs, and a direct link to the Fertile Thoughts Forum.
Whatever path a patient chooses, there is hope and we are excited to help!
Davina Fankhauser, a trained educator and counselor, is a long-time family and children’s advocate with a Bachelor’s Degree in Psychology and Communications and a Master’s Degree in Education. After experiencing infertility for more than a decade and successfully advocating for infertility at the state and national levels, she co-founded the nonprofit Fertility Within Reach, along with Sandra O’Keefe. Davina currently lives in MA with her husband and two children; she continues to advocate for the infertility community and is dedicated to helping youth preserve their reproductive health.