The Family Act of 2011 Needs Your Support!

Dear Readers and Followers in the U.S.A.,

I am taking the time this morning to blog about an important piece of legislation for Infertility patients that needs a co-sponsor in the Senate. This legislation was introduced by Senator Gillibrand of New York and proposes a tax credit for those who undergo assisted reproductive treatments. Here is the gist of the legislation and what you can do to help pasted from the Facebook page "The Family Act of 2011" (please visit & like, FB members!):

On May 12, 2011, legislation was introduced into Congress that, if passed, will establish a tax credit to improve access to medical treatment for infertility, which affects millions of people in the United States i. This important legislation could help those who might not otherwise be able to have children, build families of their own through in vitro fertilization (IVF) if indicated as a course of action.

The Family Act of 2011 is the first tax credit introduced in Congress to support those seeking to build a family through medical treatment for infertility. It was introduced to the Senate by Senator Kirsten Gillibrand (D-NY) in an effort to reduce the considerable cost barriers that infertile couples face.

The American Society of Reproductive Medicine (ASRM) lists the average price of one in vitro fertilization (IVF) cycle in the U.S. to be $12,400.i For the majority of patients seeking treatment for infertility, costs for assisted reproductive technology, such as IVF, are paid for-out-of-pocket and not a covered benefit under group or individual health insurance policies. Only 15 states have passed laws requiring that insurance policies cover or offer to cover some level of infertility treatment.

With new U.S. healthcare costs continually rising and new coverage mandates in place as a result of the new healthcare reform law, it is more important than ever to establish tax and economic policies that are supportive of families.

If you would like to contact your Congressman to voice your support of the Family Act, go to http://bit.ly/lsFfKx.

About the Family Act:

Tax payers who have been diagnosed as infertile by a licensed physician and for whom the indicated course of treatment is to undergo IVF treatment would be able to claim a tax credit
Eligible treatments include medical procedures, laboratory procedures, professional charges and other necessary costs when a patient undergoes IVF treatments

The maximum credit amount available to eligible tax payers would be $13,360

The credit would be available to taxpayers that have an adjusted gross income of less than $182,500 and phases out for those whose incomes reach $222,520

There is a 50/50 cost share inherent in the credit so eligible tax payers may claim the credit for up to one half of their expenses

**To quote the Association's website bulletin: "ASRM has endorsed this measure and encourages its members to call their two Senators in Washington to urge that they co-sponsor this legislation. You can locate contact information for your Senators at http://www.senate.gov/ or connect via the US Capitol switchboard at 202-225-3121."

Thank you very much and let's keep our fingers crossed that this will go through!!!

Edward Ramirez, MD
Monterey Bay IVF
http://www.montereybayivf.com/

THE INFERTILITY PATIENT AND THE INSURANCE COMPANY...THE ODD COUPLE.

Here is some advice regarding getting coverage for infertility testing. Consumers need to keep in mind that medical insurance companies are not your advocates. They make their money by keeping the premiums that you have paid, if you don't use them. Therefore, their goal is to keep as much of your money as they can (profit); and they have been doing a good job of it. Evaluation of their stock and company perfomance show that they are one of the best businesses to invest in because, despite a recession, they continue to make lots of money. That being said, here is one way that insurance companies shortchange infertility patients.

As many infertility patients know, once they determine that they have been unable to become pregnant, they need to undergo an evaluation. Also, patients undergoing higher level treatments, such as in vitro fertilization, are required to undergo testing as mandated by the FDA and CDC. In most cases, these tests are general health screening tests and not specifically infertility tests. They are tests such as infectious disease testing, hepatitis, AIDS, hormone testing, pelvic ultrasounds, etc. These are tests that are done for many reasons and for many diagnoses, not specifically or only for infertility. Coding requirements mandate that the most specific diagnosis is used when billing. Infertility, is not a very specific diagnosis. In most instances, there is a diagnosis that is a more specific illness, which as a consequence of their effect, can lead to or cause infertility. These are illnesses such as:

• irregular menstrual cycles


• polycystic ovarian syndrome


• sexually transmitted disease screening


• abnormal bleeding, endometriosis


• uterine fibroids, etc.

Make sure that your doctor or clinic is using the most specific diagnosis that they can.

In terms of insurance coverage, if you do not have infertility coverage, then insurance companies will not pay for infertility services. As mentioned above, many of the tests, if coded with the specific illness, are not infertility codes. Therefore, these tests should be covered. However, many, if not most, insurance companies will automatically flag your account if there is ANY reference to infertility. They then will deny all claims that can be related to infertility testing or treatment thereafter, including general health tests. Remember, their goal is to not pay for as much as possible and this is one way that they get away from paying for tests. Keep an eye on your EOB's, the statements you receive from your insurer that tells what they covered and did not cover. Also, check your test requisitions too and ask what diagnostic code they used. If they used an infertility code, ask if there is a more specific diagnosis code pertaining to your condition that they can use. Then if the lab test is denied, YOU need to contact your insurance company and file an appeal. It should be done in writing and keep all records of your attempts. Do not rely on the doctor's office to do this for you. Remember, you are the insurance company's client, NOT the doctor. You have more leverage than they do. Ultimately, if the insurance company denies a justified claim, that you have repeatedly appealed, you can go to the next level of appeal, which is the Commissioner of Insurance for your State and file a complaint.

Word of Caution! I am NOT advocating that you commit fraud. If there is no other diagnosis or illness that applies to your test, and infertility is the only diagnosis that can be used, then that is the correct diagnosis. In that case, the insurance company has the right to deny the claim. Do Not ask your doctor to lie about your condition by using another diagnosis code. Both you and your doctor can be criminally liable if you commit fraud. Remember, honesty is your greatest weapon when dealing with the insurance companies. They are required to be honest with you as well. If you are not honest, you have nothing to stand on to refute their denial. If you are, and your claim is legitimate, then the insurance company has to accept your claim. You are paying them for the services they have promised to provide. Be a wise and diligent consumer and make sure they are providing you with all the services you are entitled to.