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Colorado law to force insurance to cover infertility treatment, still thousands without coverage

A new federal ruling is to blame
Colo. infertility law leaves thousands without coverage
Posted at 9:25 PM, May 24, 2021
and last updated 2021-05-25 01:04:59-04

DENVER — When state lawmakers passed the Colorado Building Families Act, it was supposed to force all insurance companies to cover costly infertility treatment starting next year, but a new federal ruling will leave thousands of Colorado families without the coverage they were promised.

“I, even as an attorney, had to save up for so many years to have access to fertility treatments. I don't have the ability to pay for it again, so I don't know what we'll do,” said Megan Moodie, who is currently going through intro vitro fertilization or IVF.

Moodie was counting on insurance to cover the cost of treatment, if her first round of IVF doesn’t work but recently learned she won’t have coverage due to the federal ruling.

“It doesn't make a lot of sense to me,” she said.

The federal government became involved in Colorado’s legislation because of the Affordable Care Act. Shortly after the bill became law, the Colorado Division of Insurance said the Trump Administration ruled that expanded coverage for infertility treatment would increase the federal tax credit for certain health plans, therefore impacting the federal budget.

All that means smaller business on the small group market and those who are self-employed through the individual market will not have coverage for infertility treatment next year. Large employers with more than 100 employees who have plans regulated by the state will have to cover infertility treatment in 2022.

Moodie is a partner at a local family law firm in Cherry Creek and works for one of the small businesses who will not have coverage.

“There are a whole group of people who don't have $50,000 who just don't even have a chance,” she said.

Last year, Denver7 Investigates first exposed how costly infertility treatments were forcing couples onto the black market. A thriving online marketplace where people are buying and selling cheaper, leftover IVF drugs.

Shortly after our story, lawmakers got involved and passed the law to mandate insurance companies to cover infertility treatments.

Lawmaker behind the bill weighs in

State Rep. Kerry Tipper, D-Jefferson, spearheaded the legislation.

“Honestly, it’s one of the most important bills that I’ve run,” she said. “I’m kind of heartbroken because I know what it’s like to wait.”

Tipper recently had her first child, a 6-month-old baby girl, who she said they were able to have because of IVF treatment.

“It’s exclusively an equity issue,” Tipper said. “I'm sorry that we couldn't get this across the finish line for you right now, but we are fighting to do everything we can to make sure that you're covered.”

Colorado’s Insurance commissioner says they plan to keep fighting

Michael Conway said he’s hoping the Biden Administration will reverse the federal decision and require companies to cover IVF for all.

“I hear you and I know that this is a painful thing for us to have to come to you and tell you, but it is something that we’re going to continue to fight for. It’s something that we think should be in place,” he said.

As for why 18 other states have been able to mandate infertility coverage, “this new regulatory requirement went into place last year just as our legislation was working through,” Conway said.

Colorado doctor calls ruling disappointing

Dr. Alex Polotsky is in the business of making babies.

“It’s really embarrassing,” said Dr. Polotsky, director for University of Colorado Advanced Reproductive Medicine. “It is considered to be a medical condition, but unfortunately, as far as insurance, it is treated like cosmetic surgery.”

Polotsky said he has many patients who have been waiting until next year to start infertility treatment with the assumption it would be covered by insurance.

“There is a lot of people who are really putting it off, and so I would really, really hate to see them crushing their dreams,” he said.

For Moodie, she’s just trying to stay hopeful this time will be her time.

“I’m obviously hopeful that it won’t fail. But if it does fail, I don’t know what we’ll do,” she said.

Conway said 2023 is the earliest Colorado could see coverage for small businesses and the self-employed.