from
the book How to Have a Baby: Overcoming Infertility
by Dr. Aniruddha Malpani, MD and Dr. Anjali Malpani,
MD.
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The Ethical Issues - Right or Wrong?
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Do
insurance companies cover infertility treatment ?
Being infertile can be very expensive! Tests and treatment
cost considerable money, and since there is no definite
endpoint, budgeting for medical expenses can be very
difficult.
The availability of modern assisted
reproductive techniques, such as IVF, have made treatment
even more expensive - since so much expertise and technology
is needed for these procedures. This means that there
really is no upper limit to how much you can spend in
your pursuit of a baby!
You need to control your finances -
and it is unfortunately only too common to find patients
who are so desperate to have a baby, that they have
begged and borrowed, and even sold their lands, possessions
and belongings, so that they could continue trying to
have a baby.
Of course, for infertile couples, a
baby is priceless, but you cannot afford to waste money.
You may need to shop around to get a realistic estimate
of how much treatment costs. Charges vary widely - and
don't automatically assume that the more expensive a
clinic, the better it is.
You need to consider the cost-effectiveness
of each treatment option. While it is true that an IVF
cycle is four times as expensive as an IUI cycle, the
chance of a pregnancy is also four times as great! A
common mistake patients who are not very well off often
make is that they repeat the treatment of IUI repeatedly,
because they feel that they cannot afford IVF. However,
in the long run, they often end up spending even more!
You need to have a plan of action, and to stick to it,
rather than to keep on trying the same treatment over
and over again, just because it is less expensive!
When considering expenses, you need
to consider not only the money you will be spending,
but the time and energy you need to invest as well!
All of us have finite resources – and you need to invest
them carefully!
Ironically, infertile patients who are
rich are subject to the risk of overtreatment. Just
because they can afford it, doctors advise them to go
in for an IVF cycle, while simpler treatments such as
IUI could also have helped them to get pregnant.
It is important to get a breakdown of
the expenses for all procedures - preferably in writing.
For example, for surgery, find out what is included
in the quoted figure - does this include just the surgeon's
fees ? the assistant's ? anesthesia? theatre charges
? hospitalisation ? followup visits ? Often what is
excluded can add up to a pretty penny! This is especially
true for IVF treatment, where "hidden expenses" can
lead to your spending much more than you had bargained
for.
Patients are often reluctant to talk
about money and expenses with doctors - but remember,
it's your hard-earned money you are spending. You can't
afford to shy away from this topic. Doctors are also
sometimes vague about money matters - and this makes
getting specific figures so much more important.
You need to calculate what your total
expenses will be, not just the medical costs. Remember
to include travelling costs; lodging and boarding if
you are from out-of-town; and the cost of time taken
off work.
Do insurance
companies cover infertility treatment ?
Unfortunately, most insurance companies
in India will not reimburse you for the medical expenses
for treating infertility - they still take the old-fashioned
view that infertility is not a medical problem! A number
of couples are also reluctant to claim for medical expenses
for treatment, since they do not wish to disclose to
anyone else that they are infertile. Also, Government
medical facilities rarely provide quality care for infertility,
since this is not a primary concern for them. Until
these attitudes change, a number of patients will be
deprived of infertility care, because of financial constraints
- and this is a shame!
Infertile couples in USA have used the
courts to get their medical bills paid. In 1998, the
city of Chicago agreed to cover infertility treatments
for its employees after a female police officer sued
the city for violating the Americans with Disabilities
Act. The officer said her infertility was a disability
because it impaired a "major life activity." In 13 states
in the USA, insurers are required by law to offer some
form of infertility coverage. Hopefully, infertile couples
and their advocates will be able to successfully lobby
for similar changes in India as well.
However, patients have devised ingenious
methods to overcome these financial hurdles. For example,
young women who can grow lots of eggs and who need IVF
but cannot afford to pay for this, have agreed to "
share " their eggs. Older women, who need donor eggs
and are well-off, can then pay for the entire IVF cycle,
and the two can share the eggs, giving both of them
a chance to get pregnant. Egg sharing allows the doctor
to match financial and reproductive resources, and is
beneficial for both donor and recipient.
You can also get coverage for some of
your medical treatments (such as laparoscopy) by requesting
your doctor to say that the surgery was done for treating
pelvic pain (which means your expense will be reimbursed
by the insurance company ) rather than for treating
infertility.
Approximate costs for procedures, tests
and treatments is summarized in this chart. These figures
are for the year 2000 in the city of Bombay, and are
only meant to be representative - do remember there
can be considerable variation! These are "all-inclusive"
medical expenses.
Note:
1 US dollar = Rs 40.00
1 UK pound = Rs 80.00
Compared to the UK and USA, IVF treatment
is much less expensive in India, and the quality is
as good. This is because doctors charge much less -
so that by international standards, IVF in India is
very cost-effective, and quite a few patients do fly
down to India for treatment (and have money left over,
even after paying for air-fare!)
In fact, reproductive tourism has
become very popular; and about half the patients we see
in our clinic come to us from the US and UK.
Medical tourists can be demanding
patients ! They have often lost faith in their own
medical system; and many of them are doctors and nurses
who make their own medical decisions. They are
challenging to treat and I enjoy doing so, because they
are well-informed and capable of thinking out of the box
– it does take guts to travel to
India
for medical treatment !
I just did an interview for BBC, and
one of the first questions I was asked is - "Why do
patients come to your clinic from all over the world ?"
In the beginning, I think the major reason was the fact
that our prices were much more competitive than what
clinics in the USA and UK charge. However, our major USP
is no longer our labour arbitrage . I think what sets us
apart is the fact that we are a
"focussed factory" ( a concept described by Michael
Porter and Regina Herzlinger). We run a lean and mean
unit , which does IVF and only IVF ! Because we do so
many cycles, we are very good at it; and because we do
nothing else, we have to be very good at it !
--------------------------------------------------------------------------------
Initial consultation Rs 500 to 1000
(US $ 20 )
Semen Analysis Rs 200 to 500 (US $ 10)
Hysterosalpingogram Rs 500 to 2000 (US
$ 40)
Hormonal blood assays (FSH, LH, prolactin,
estrogen, progesterone) - Rs 200-400 for each test
Testicular biopsy Rs 2000 to 10000 (US
$ 200)
Endometrial biopsy Rs 500 to 2000
Diagnostic Laparoscopy Rs 10000 to 40000
(US $ 1000)
Operative Laparoscopy Rs 25000 to 50000
(US $ 1200)
Major surgery (microsurgery for tubal
repair) Rs 40000 to 65000 (US $ 1000)
IUI (insemination) Rs 3000 to 15000
TID (Therapeutic insemination by donor),
per cycle Rs 8000 to 20000
HMG treatment cycle (for superovulation)
Rs 8000 to 20000 (US $ 400)
GIFT Rs 50000 to 120000 (US $ 3500)
IVF Rs 50000 to 120000 (US $ 3000)
Embryo freezing Rs 20000-40000
Microinjection (ICSI) Rs 80000 – Rs
150000 (US $ 3500)
Preimplantation genetic diagnosis Rs
150000 - 200000 (US $ 5000)
Next page: Pregnant
- At Last!
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The Ethical Issues - Right or Wrong?
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