Saturday, April 28, 2012

Insurance Coverage Post-Class Reflections

I think that our group had a pretty stable (mock) health insurance company! Other than denying payment for all ART, we generally chose to cover doctor approved treatments up to a set amount of money or a percentage of the treatment cost.
This decision was disputed by another group who questioned why our insurance company had the right to deny payment for ART but still allow coverage for PGD (pre embryo diagnosis). Our decision was made in a more economical sense rather than an emotional one: if the couple could not afford a full reproductive treatment, there is much less chance that they will be able to take on all the expenses that will come with those treatments in the future. However, if you can pay for your full treatment initially, then our insurance company would pay for you to have your embryos diagnosed to see which one would be the most viable, producing the healthiest baby, lowering the cost to our insurance company in the long run. Is it okay for us to assume that if you cannot pay for the initial treatments then we don't think you should have them? This is correct. Some other groups had our same stipulations and views on insuring for ART, but they also provided insurance over less expensive infertility drugs, meeting patients half-way. I can see how this could be a valid option, but where do you draw the line on where the infertility drugs will get as expensive as ART, basically nullifying the reasons that we discarded the idea of insuring ART in the first place?
Our idea behind setting up a sort of financial 'barrier' to the assisted reproductive treatments is that in the long run this will ensure that our clients who decide to enter onto this long road of the new technologies is well prepared, (financially, and thereby emotionally) to endure the trials that may come with using these technologies. If someone has prioritized getting pregnant to the extent of paying for IVF, then they are well prepared to face dealing with the decisions that come later in the journey of testing and cycles.
But does this frame of mind discriminate against the people who cannot pay for ART? Is it fair to deny them the chance to have a child because they cannot pay for the treatment? The people who would get the treatment would be the people who could pay, inevitably prioritizing the upper class, and insurance companies have never been able to regulate who becomes pregnant or is financially equipped to become pregnant in the past. However, this is exactly how everything else in life works. If I wanted a BMW but was making the wages of a cashier, I would have to REALLY want that BMW and therefore have to save for many years to afford it. Just because it may be painful and seem unfair not to have the amount of money for these reproductive treatments, it is always possible to save. And it may help you in the long run that these treatments are so expensive -- you realize how much money a baby can be, and may decide that you are not ready yet. Studies have shown that a baby costs around 11-14 K in their first year, so realizing the costs early is actually a good thing!
I guess talking about it in class brought up the more 'is this a humane way of thinking' more than actually thinking of insurance companies like they are- companies. For profit companies. They want money to pay off their stockholders and in general are comprised of businessmen and women who are primarily thinking about the financial aspect of the business when describing the rules rather than focusing on if they are offering equality across social classes in their coverage. So in this respect, our mock insurance company did a good job at focusing on the profit side of the insurance business, and some other groups did a good job of focusing on how patients would respond.

1 comment:

  1. I agree that focusing on the business side did give groups a very different perspective. Thanks also for you comments about the technology.

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