Kathleen's Story

My husband Mike and I married late, I was 36. We knew we wanted 2 or 3 children and we knew that our time was limited so we started trying to have our family fairly quickly, never dreaming we'd be infertile. We are not wealthy. We are limited to the medical treatments allowed within my insurance contract. We took that information and made decisions on the treatments we would attempt based on our coverage. We started trying for a family within a year. I had 3 surgeries to clear blocked tubes, remove scar tissue and uterine fibroids. We then began treatment with oral infertility medications in January of 2004. We had no success so we began injectable medications in March of 2004. Either Mike or I would give me a shot in my abdomen every day of strong hormones to help facility follicle development and ovulation. My insurance covers monitoring and diagnosis of infertility and 6 cycles of injectable medications (per lifetime or per pregnancy, meaning if we achieved a pregnancy I could renew and get 6 more cycles. The medications are very expensive and can cost up to $4000 a month). I had two more surgeries for scar tissue and severe endometriosis. I was told I would probably not conceive on my own and I should call an IVF clinic. While we were waiting for an appointment, we decided to continue trying with the cycles my insurance offered and pay for an IUI (intrauterine or artificial insemination) out of our own pocket (our insurance does not cover the procedure of IUI) Our insurance does not cover any services or medications leading to ART (Assisted Reproductive Technology) which is IVF (In Vitro Fertilization) and all it's treatments. We were blessed with a very rare success with this IUI and our daughter was born on May 9, 2005.

We began trying with the same treatment protocol 6 months after our daughter's birth. I had 2 more surgeries and finally had my left ovary removed. The scar tissue and cysts produced on that side were causing too many problems. The endometriosis was still everywhere, but had cleared itself from my right, and good ovary. We started injecting medications again, this time twice a day. After 3 failed cycles, with cysts developing in between cycles we tried another IUI, which we paid for out of our own pocket. That treatment was unsuccessful, so we tried again. And again. And again. By this point, our insurance decided that they were not going to cover any services relating to infertility, although my contract clearly states that I have coverage for the treatments we were attempting. Anything not covered, we paid for. The first claim was denied in September of 2006. That's almost a year ago. I turned 43 in April. Statistically, the chances for success with any fertility treatment have declined 80% in that year. We stopped treatments in December of 2006 when the stress of the insurance fight became too much and was dooming any further attempts to failure.

We have not had any treatments since then. My childbearing years are coming to an end and the insurance company has taken away almost a year of that precious time. We have had appeals, promises, denials, delays, obstructions and more appeals. They have not followed their own policies as written in my contract. We have hired an attorney who specializes in insurance and contract law. Our case is solid; we have coverage for the services we tried. We had another formal appeal before the heads of departments within the insurance company and we were promised a decision in 5 days. That was over 3 weeks ago. Just yesterday, on September 14, we received the letter stating that they will cover all past denied claims and will cover all future claims for the stated services covered under my contract, which they should have done from the very beginning. Now we have to fight to have our attorneys fee's covered. They've admitted we have coverage and those claims should have been paid. If they'd honored our contract from the beginning we wouldn't have needed to hire an attorney to protect our rights.

If we had infertility coverage that included IVF and related procedures, we would not have had a total of 10 surgeries. Those surgeries, with the exception of 2 would have been unnecessary. We would have moved onto IVF immediately. I had yet another surgery 2 weeks ago. While we know there is no guarantee that we would have been successful with IVF, our chances of success are much much greater than with the treatments I was doing. The costs would have been much less, both for the insurance company and for us (and all policy holders in general). The stress would have been greatly reduced, helping facilitate success. Mike and I have been trying to build our family for 6 years. We have a total of 63 disappointments and failures. Every month that goes by is yet another reminder of how painful this journey is.

We know that we are truly blessed with our daughter. While our dream was to have a family with 3 children, we love her dearly and will be thrilled with her whether we are successful in providing her a sibling or not.

My story is not uncommon. In fact, my story is less painful than many couples that have faced repeated miscarriages, infant loss and other devastating results. Our stories are all different. Our pain is the same. There are 15 states that have mandated insurance coverage for infertility. Studies among those states show that mandated coverage actually reduces health care premiums. Insurance costs are reduced. The number of high order multiple pregnancies is reduced and there are healthier pregnancies and babies as a result. Couples can get the health care they need and not go through unnecessary procedures with lower success rates.