An employer that will cover fertility treatments? They’re out there and slowly increasing

Pigeon605 Staff

March 28, 2022

By John Hult, for Pigeon605

Katie Bjorklund has wanted a child for half her life. Her husband, Matt, has wanted one since he met Katie.

Three years ago, the couple started trying to make that dream a reality. 

They don’t have a baby today, but they’re both on a first-name basis with the medical professionals and support staff at the Sanford Fertility Clinic. 

The Bjorklunds don’t have comprehensive fertility coverage through their employers’ insurance. The consultations, the months of largely fruitless testing for easily fixable fertility problems, the three failed rounds of intrauterine insemination?

Katie’s insurance covered $2,000 of IUI. The rest was out of pocket.

“That $2,000, that’s lifetime,” Katie said. “Once it’s used up, it’s gone.”

Staring down an $18,000 to $20,000 bill for in vitro fertilization, 32-year-old Katie and 36-year-old Matt turned to the crowdfunding site GoFundMe to tell their story and ask for help. They’re selling puzzle pieces and planning a Mario Kart tournament.

“If it were covered, we would have already been like ‘let’s do this,’” Matt said in early February. 

The Sioux Falls couple, who began IVF earlier this month, are among the one in eight in the U.S. who struggle with fertility. They aren’t, however, among the growing number of Americans, including Sioux Falls residents, whose employers offer insurance coverage to treat it.

Employers opting in

Starbucks announced that it would begin to offer coverage in 2019, the same year hardware retailer Lowe’s added similar coverage to its benefits package.

We are always listening to our associates and looking for ways to enhance our benefits package, and we received feedback that associates were looking for additional support in this area,” said Lowe’s spokesman Steve Salazar, who noted that the company has about 70 employees in Sioux Falls. “The feedback has been very positive from both the group of associates who use the benefits and those who are aware of colleagues who use them.

Wells Fargo began to offer infertility coverage in 2017 and added fertility coverage, which means no infertility diagnosis needed to secure coverage, this year for its employees nationwide. That amounts to 2,500 South Dakota employees with the benefit option, most of whom work in Sioux Falls, according to Wells Fargo spokesperson Staci Schiller.

Online retailer Amazon, which is building a massive fulfillment center on the northwest edge of the city, offers infertility coverage as well.

“Fertility coverage has expanded significantly in the past 20 years and especially in recent years, with both small and large employers adding this coverage, which is not only highly valued by their employees but also affordable and beneficial to employers,” said Betsy Campbell, chief engagement officer for Resolve, the National Fertility Association.

Tech companies, consultant firms and the finance industry have led the way, she said, as well as cities such as Portland and Seattle in the Northwest and Pittsburgh, which offer coverage for municipal employees.

Campbell offered a variety of reasons for the shift, including more people waiting until later in life to start a family and a recognition of the needs of single parents and same-gender couples seeking to start families.

Employers tend to worry about spikes in health care costs with an addition of fertility coverage, but a 2021 survey commissioned by Resolve found that 97 percent of employers offering fertility coverage did not see such a spike.

Cost is the No. 1 barrier to care for individuals, however. Just one in four of those who need fertility treatment in the U.S. actually get it, Campbell said.

“No one expects that they will need help building their family – whether through medical treatment, adoption or surrogacy – but everyone deserves access to the family-building option they need,” Campbell said.

Growing demand 

Dr. Keith Hansen, a reproductive endocrinologist with Sanford Fertility and Reproductive Medicine, has seen an uptick in patients over the past few years, and more of them have insurance coverage for it.

“Some places are slowly starting to cover more of these treatments,” Hansen said.

It’s still a fairly rare offering. The extensive list of tests, procedures and possible interventions might help explain why. Before landing on something as involved as IVF, a couple having trouble conceiving will run through a battery of tests and evaluations to find out if the trouble is linked to a known or unknown medical issue. 

If the woman has endometriosis, for example, treating that could be enough. If the man has cystic fibrosis, assistive technology can typically unite sperm and egg to help a couple conceive.

“Our goal is to help them get pregnant with the least amount of interventions because that’s what will give them the best chance for a healthy mom and a healthy baby,” Hansen said. 

It’s not uncommon for Hansen or his fellow specialists in Sioux Falls to move couples through the full screening process and even to address some of the more obvious potential problems, yet still have no clear explanation for their difficulty getting pregnant.

Wherever the search for answers goes, questions of dollars and cents aren’t far behind. Sanford Fertility has a financial counselor who’s available at each appointment to meet with couples and run through the options, insurance coverage and potential out-of-pocket costs. 

Cost of care drives tough decisions 

Katie and Matt Bjorklund have a love-hate relationship with those upfront information sessions. They appreciate the openness and thorough approach, but it also can be overwhelming and a bit depressing.

“The costs, the numbers, all the extra things you could do … every few minutes, it feels further and further away,” Matt said. 

More frustrating still, Katie said, are the false starts. On their second go-round with IUI, she “was having symptoms of being pregnant” and felt confident enough about it that she bought Matt a congratulatory new dad T-shirt. 

“But then I got my period,” she said. “I bawled all day.”

She still has the shirt, and the couple still has hope. Their GoFundMe page has pulled in a few hundred dollars in less than a month from the puzzle piece sale, and the couple has yet to plan out the details of the Mario Kart tournament. Katie took the crowdfunding idea from one of the women she has met on the three Facebook fertility support groups she has joined. She started her own group in February for women who have never been pregnant before. It’s not at all rare for her to visit one of those pages and learn about someone else who found a way to pay for treatment or finally got pregnant. 

As with the financial counseling, such news inspires hope and desperation in equal measure. 

“I’ll see friends talking about getting pregnant or see these success stories and just think when is it my turn? When will we get our miracle?” she said. 

The Bjorklunds are looking into the feasibility of private insurance with fertility coverage, though the hefty price has been off-putting. They’ve applied for grants and loans as well but haven’t been awarded one. They’ve even begun to ponder their careers. Matt works at LifeScape and Katie at Midco. Neither want to leave, but the lack of fertility coverage has them each wondering if a move to a job that offers it might be the right choice.

So far at least, the answer has been no.

“I could do what I do now for Comcast, and this would all be covered, but I love my job,” Katie said.

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