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The costs for IVF patients after the Alabama ruling

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When the Alabama Supreme Court issued a surprise ruling this month that led doctors to restrict in vitro fertilization treatments in the state, it raised a host of questions that the court did little to answer.

In the wake of the decision, doctors and patients are concerned that they could be vulnerable to prosecution in a number of once routine medical scenarios. Some facilities in Alabama have halted or limited treatment, and patients elsewhere fear similar rulings or laws could soon apply in their states.

And because so many people pay so much for health care, the fallout from the Alabama case also raises major financial questions. What would it cost to move embryos to a state where a similar ruling is less likely? Will insurance cover that or the transfer of care to new healthcare providers?

Here are the questions and answers arising from the case.

Cryoport systems, IVF Cryo And ReproTech There are three shipping companies that specialize in the transport of embryos, but there are others. Your doctor or insurance company may have preferred providers.

Yes, on Friday, Cryoport stopped shipping embryos into or out of the state. However, IVF Cryo and ReproTech have both announced they will continue to serve the state.

Depending on developments, companies can adjust their policies.

It could take a week, but probably more like a few weeks.

“There are so many checks and balances to make this happen safely,” he says Emily Jungheim, a professor and chief of reproductive endocrinology and infertility at Northwestern University’s Feinberg School of Medicine, who is also a practicing physician. “It’s not something where you can just say, ‘I want to ship them,’ and it’s going to happen tomorrow.”

There can be. One company, ReproTech, offers one $65 policy which can cover up to $35,000 in replacement costs for certain types of damage.

If you don’t have specific insurance coverage, transferring embryos to another clinic or long-term storage facility usually costs anywhere from $500 to $1,000 or more, according to fertility providers. Some shipping services post a fee schedule online, while others ask you to Request a quote.

“There’s a lot that goes into moving this safely and properly,” said Angeline Beltsos, chief executive of Kindbody, which has 35 clinics across the country and provides fertility services. benefit coverage for employers, including Walmart.

Maybe. Some coverage could be broad enough to pay for embryo transport.

“It is likely that employees who work for large employers have some form of coverage,” said Elizabeth Mitchell, the CEO of Purchaser Business Group on Health, which represents large employers that offer benefits to their employees.

Maybe, and it’s more likely to happen if you work for a large company. Some employers with employees in Alabama are considering covering the cost of treatment at locations where it is still possible, along with patient travel costs.

Progyny, which offers specialty fertility coverage (including in Alabama) through a network of providers, said it would cover embryo and tissue transfers to another clinic in the network if it were no longer possible to perform IVF at a particular location. And it can cover travel costs, depending on the options an employer offers. (Some out-of-pocket costs, such as coinsurance, may apply.)

“This means patients can continue their treatment out of state if they wish,” says Dr. Janet Choi, chief physician at Progyny. It may also include the transport of embryos to another long-term storage facility within the network.

TO WIN, Another fertility benefits provider said it was working with its employers who were considering updating their plans to include some of these benefits.

Without any insurance coverage, embryo storage typically costs between $400 and $1,500 a year, reproductive experts say.

Long-term storage is typically not covered, although employer plans may pay for the first year, says Kindbody’s Dr. Beltsos.

But some large employers pay for up to five years.

Yes, according to Nicky Brown, vice president of public policy and government affairs at HealthEquity, which manages the accounts. (Shipping for other types of medical care usually also qualifies.)

With a flexible spending account, employers have some leeway in designing their plans, so it’s always best to ask about the details.

Publication 502 is the Internal Revenue Service document that governs eligible expenses, and “temporary storage” related to in vitro fertilization is on the list. The definition of “temporary” is not clear, and there may be limits to each workplace account.

It depends. Coverage is complicated and varies greatly depending on coverage where you live, whether you are covered by a workplace plan and, if so, the size of your employer. But many people often have to pay thousands of dollars out of pocket for IVF, even though they have some benefits. And many people don’t have coverage.

Start with reproductive specialists, who are likely to be sympathetic to your concerns about changes in the law and the courts. If you have specialist fertility cover, your benefit providers may have their own logistics teams to help you get your treatment elsewhere.

Start by reviewing your options with your medical provider. “We are working with members to determine when, where and how they can access alternative care if their IVF treatment has been canceled or is at risk,” said Dr. Roger Shedlin, CEO and President of TO WINthat offers benefits for employers, health insurance companies and individual patients.

Alabama already has an abortion ban, and lawmakers there are considering legislation that would clarify the state’s rules for in vitro fertilization.

Given their position that every embryo in the womb is a person, Alabama lawmakers will likely specify how they want citizens to treat embryos outside the womb. Louisiana has already banned the destruction of embryos.

The anti-abortion movement has long sought to extend “personhood” to fetuses and embryos, granting them the same legal rights and protections as humans. That creates major legal liability for IVF providers, and the situation in Alabama has thrown the industry there into chaos.

Courts of other states could issue decisions with similar consequences, while state legislatures could create laws that have similar chilling effects. At this point, reproductive health policy experts said they were unaware anything threatening would come before the courts. But laws on the books in several states could potentially jeopardize access to IVF, and more person-related legislation is being introduced.

“The reality is that 11 states have broad fetal personality laws similar to Alabama’s that were used to justify this decision,” said Dana Sussman. Deputy Executive Director at Pregnancy Justice, an advocacy group.

Karla Torres, senior human rights adviser at the Center for Reproductive Rights, said four states — Georgia, Alabama, Missouri and Arizona — already have personhood laws regarding abortion. (The group is challenging the Arizona law.) They generally use language that is vague enough — for example, defining life at each stage of development — which could potentially extend to embryos and complicate IVF.

And about thirteen states have personality bills moving through their legislatures. “They are broad enough to be interpreted and include embryos, but they do not explicitly refer to IVF cryopreserved embryos,” Ms Torres said. “All this is very worrying.”

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