So, let’s start with, “yes.” Yes, as New Jersey residents, we are lucky. Seeking fertility care in a mandated state like New Jersey is much easier than in states with little to no coverage. And yes, we live in a state that respects a woman’s right to healthcare. Where elsewhere in the country, more and more states are rolling back reproductive rights all together. And yes, as an industry, New Jersey has some of the very best Reproductive Endocrinologists and fertility clinics not only in the country, but frankly, in the world.
That doesn’t mean getting IVF coverage is easy.
Case in point, let’s examine the fertility journey of one our patients. Jessica Rella tragically experienced pregnancy loss on multiple occasions within a year – four to be exact. Devastated, she did what she was supposed to do. She consulted with a reputable and experienced REI, did the requisite tests for diagnosis and then armed with loads of factual data and medical recommendations, she informed her insurance provider that she needed IVF with pre-implantation genetic testing.
She was denied coverage.
New Jersey’s Mandate dictates that to be covered for IVF “the patient has used all reasonable, less expensive & medical appropriate treatments and is still unable to get pregnant or carry a pregnancy.”
Many insurance companies interpret that coverage loosely. Allowing for no explanation on what is “reasonable and medically appropriate” but happy to look at what’s less expensive.
Translation: Jessica needs to first try IUI.
Jessica was not, however, having any trouble getting pregnant – due to chromosomal abnormalities within the embryos, she was not able to carry to term. So IUI’s would only cause more heartache. What Jessica needed was pre-implementation genetic testing (PGT) to make sure that only a healthy embryo was implanted.
Here’s when paying it forward & advocating for access to care for all truly manifests itself. Through her heartache, Jessica was undeterred.
One night, as she was researching avenues to help her cause, Jessica came upon an article on CCRM Fertility patients Deanna & John Harkel. The Harkel’s fertility journey was similar to Jessica’s. They too had experienced repeated miscarriages, were denied coverage for IVF, and told to try an IUI by their insurers, even though they were paying for a policy that did cover IVF and genetic testing of embryos.
CCRM Fertility Medical Director and REI rockstar Dr. Debbra Keegan, the Harkel’s physician, joined their fight and together they appealed to the New Jersey State Department of Banking & Insurance and finally won the right to coverage.
This case now set a precedent for Jessica Rella and her husband to overturn their denial.
