When the Alabama Supreme Court issued a surprise ruling this month that led doctors to restrict IVF treatments in the state, it raised a series of questions that the court did little to answer.
In the wake of the ruling, doctors and patients worry that they could be vulnerable to prosecution in any number of once-routine medical scenarios. Some facilities in Alabama have stopped or limited treatment, and patients elsewhere worry that similar rulings or laws may soon come to their states.
And because so many people pay so much for health care, the fallout from the Alabama case also raises big economic questions. What would it cost to transfer the embryos to a state less likely to make a similar decision? Will insurance cover this or transferring care to new health providers?
Here are the questions and answers stemming from the case.
For people who are considering transferring their embryos
Who moves the fetuses for me?
Cryoport Systems, IVF Cryo and ReproTech are three shipping companies that specialize in embryo transfer, although there are others. Your doctor or insurance company may have preferred providers.
Aren’t some shippers stopping embryo shipments from Alabama?
Yes, on Friday Cryoport stopped shipping embryos to or from the state. IVF Cryo and ReproTech, however, have both announced they will continue to serve the state.
Companies may change their policies depending on developments.
How quickly can I transfer my embryos from one state to another?
It could be as little as a week, but probably closer to a few weeks.
“There are so many checks and balances for this to happen safely,” said Emily Jungheim, professor and chief of reproductive endocrinology and infertility at Northwestern University Feinberg School of Medicine, who is also a practicing physician. “It’s not something you can just say, ‘I want to send them,’ and it will happen tomorrow.”
Is there a way to insure the financial risk in case the embryo is destroyed, to recover the money you spent to create it?
It may exist. One company, ReproTech offers a $65 policy that can cover up to $35,000 in replacement costs for certain types of damage.
The cost
What might it cost to transfer my embryos?
If you don’t have specific insurance coverage, transferring the embryos to another clinic or long-term storage typically costs about $500 to $1,000 or more, fertility providers said. Some shipping services post a fee schedule online, while others require you to request a quote.
“There’s a lot that goes into moving them safely and correctly,” said Angeline Beltsos, chief executive officer at Kindbody, which has 35 clinics across the country and provides fertility benefits coverage to employers including Walmart.
Will my health insurance cover the cost of moving my embryos if I can no longer do IVF in my home country?
It can. Some coverage could be broad enough to pay for embryo transfer.
“It’s possible that employees who work for large employers have some kind of coverage,” said Elizabeth Mitchell, chief executive of the Purchaser Business Group on Health, which represents large employers that provide benefits to their employees.
Would fertility cover allow my treatment elsewhere?
Maybe, and it’s more likely to happen if you work for a large company. Some employers with workers in Alabama are considering covering the cost of treatment in locations where it is still possible, along with travel expenses for patients.
Progyny, which provides specialty fertility coverage (including in Alabama) through a network of providers, said it would cover the transfer of embryos and tissue to another in-network clinic if IVF could no longer be performed at a particular location. And it can cover travel expenses, depending on the options available through an employer. (Certain costs, such as coinsurance, may apply.)
“This means patients can continue their treatment out of state if they wish,” said Dr. Janet Choi, chief medical officer at Progyny. It may also cover the transfer of embryos to another long-term storage facility within the network.
WIN, another provider of fertility benefits, said it is working with its employer clients who are considering updating their plans to include some of these benefits.
How much does embryo storage cost?
Without any insurance coverage, embryo storage typically costs about $400 to $1,500 a year, reproductive experts said.
Is embryo storage usually covered by any health insurance or fertility benefits?
Long-term storage is usually not covered, although employer plans may pay for the first year, Dr. Kindbody’s Belchose.
But some large employers will pay for up to five years.
If I don’t have fertility coverage, can I use money from a health savings account (or flexible spending account through my employer) to pay for my embryo transfer?
Yes, according to Nicky Brown, vice president of public policy and government affairs at HealthEquity, which manages accounts. (Shipping for other types of medical care is also usually eligible.)
With a flexible spending account, employers have some leeway in designing their plans, so it’s always best to ask about the details.
Are embryo storage costs also an eligible expense for HSA or FSA reimbursement?
Publication 502 is the Internal Revenue Service document that governs eligible expenses, and IVF-related “temporary storage” is listed. Its definition of “temporary” is unclear, and there may be limits to any workplace-based account.
What do fertility benefits — including those for IVF — tend to cover?
It depends. Coverage is complicated and varies wildly depending on where you live, whether you’re covered by a workplace plan, and if so, the size of your employer. But many people are often stuck paying thousands of dollars out of pocket for IVF, even if they have some employee benefits. And many people have no coverage.
What can happen next
Who should I talk to first to find out what I need to do medically?
Start with reproductive specialists, who are likely to address 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.
If I am in the middle of treatment in Alabama, what should my next steps be?
Start by discussing your options with your doctor. “We are working with members to determine when, where and how they will access alternative care if IVF treatment has been canceled or is in jeopardy,” said Dr. Roger Shedlin, CEO and president of WIN, which provides benefits to employers. health plans and individual patients.
Do other states have pending lawsuits or legislation that could lead to similar results to Alabama’s?
Alabama already has an abortion ban, and lawmakers there are considering legislation that would clarify the state’s IVF rules.
Given their position that every fetus in the womb is a person, Alabama lawmakers will likely determine how they want citizens to treat fetuses outside the womb. Louisiana has already banned the destruction of embryos.
The anti-abortion movement has long sought to extend “personhood” to embryos and fetuses, giving them the same legal rights and protections as humans. This creates a lot of legal liability for IVF providers, and the situation in Alabama has thrown the industry there into chaos.
Courts in other states could issue rulings with similar consequences, while state legislatures could create laws that have similarly chilling effects. For now, reproductive health policy experts said they didn’t know anything was about to break down in court. However, laws on the books in many states could potentially jeopardize access to IVF, and more personhood-related legislation is being introduced.
“The reality is that 11 states have broad fetal personhood laws that are similar to what Alabama has that were used to justify this decision,” said Dana Sussman, deputy executive director at Pregnancy Justice, an advocacy group.
Karla Torres, senior human rights counsel at the Center for Reproductive Rights, said four states — Georgia, Alabama, Missouri and Arizona — already have personhood laws related to abortion. (The group is challenging the law in Arizona.) They generally use language that is vague enough — defining life at any stage of development, for example — that it could potentially extend to embryos and complicate IVF.
And about 13 states have personhood-related bills moving through their legislatures. “They are broad enough to be interpreted to include embryos, but they don’t specifically mention cryopreserved IVF embryos,” Ms Torres said. “This is all very worrying.”
