THE VIRGINIAN-PILOT
Copyright (c) 1994, Landmark Communications, Inc.
DATE: Friday, November 4, 1994 TAG: 9411040730
SECTION: LOCAL PAGE: B3 EDITION: FINAL
SOURCE: BY DIANE TENNANT AND DEBRA GORDON, STAFF WRITERS
DATELINE: NORFOLK LENGTH: Medium: 93 lines
Baby-desperate couples will find shelter under The Travelers Insurance umbrella at the Jones Institute for Reproductive Medicine, thanks to the first health insurance policy that selects ``centers of excellence'' for infertility treatment.
The contract with The Travelers Insurance Companies, signed last month, named Jones as the first of five clinics nationwide where couples will be referred for assisted reproduction. But only persons whose employers buy a rider covering infertility treatments are eligible.
``By channeling patients into this specialty care network, which have much higher pregnancy rates than other centers and fewer multiple births, we can provide quality and cost savings,'' said Sandra Scoggins, national director of specialty care institutes for Travelers.
A similar program for transplants instituted four years ago has resulted in significant cost savings for the company, Scoggins said, and a 15 to 20 percent increase in survival rates.
With the contract, Travelers becomes one of the few insurance companies in the country to provide unlimited coverage for infertility, and the only company to pre-select ``centers of excellence'' for its patients.
The Jones Institute, part of Eastern Virginia Medical School, was approached by the insurance company last May, said Jerry Otten, administrator for the institute.
Travelers covers 6 million people around the country, and estimates about 20 percent, or 1.2 million, are covered under existing infertility riders that do not pre-select clinics.
The program was developed after employers requested a more cost-effective method of providing that coverage, Scoggins said.
Jones does not know how many patients it can expect under its contract with Travelers, Otten said, although it is the only East Coast center in the network so far.
Travelers has contracted with two other centers - the University of California in San Francisco and the University of Washington in Seattle - and expects to contract with two more. There are about 350 in-vitro fertilization clinics nationwide.
The riders offer 100 percent coverage and do not exclude pre-existing infertility.
They enable patients to undergo any treatment, including in-vitro fertilization, as long as the physician agrees it is medically necessary. The insurance company will pay for the couple's round-trip airfare to Norfolk and their hotel.
Most insurance companies, including Trigon (formerly Blue Cross/Blue Shield of Virginia) do not cover IVF.
Jones Institute doctors hailed Travelers' decision to include IVF coverage as a way to provide more cost-effective infertility treatment in the long run.
``Sometimes here we're forced to undertake treatments that are covered by insurance companies (like surgery for blocked tubes) even though we know that the best treatment might not be (surgery),'' Dr. James Toner said.
His comments, and Travelers' announcement, came during a forum on the costs of infertility treatment held Wednesday night by the Hampton Roads Fertility Society.
During the forum, Del. Jerrauld Jones, D-Norfolk, said he will introduce into the General Assembly for the sixth time a bill mandating coverage of infertility treatments, including IVF. Previous bills have been killed in committee.
Ten other states require some form of insurance coverage for infertility treatment.
``It's the most heartbreaking legislative policy issue I've ever been involved with during my career,'' Jones said. ``You're up against the perception of, `Well, they can always adopt,' and `It's kind of a yuppie thing, isn't it?' ''
But the legislator didn't hold out much hope for the bill's passage in the 1995 session. ``You're up against the fact that 1 million Virginians have no health insurance,'' he said. ``And the emphasis now is toward providing basic health benefits.'' ILLUSTRATION: Graphic
STEVE STONE/Staff
TREATMENT COSTS
Intrauterine insemination (IUI) $150
IUI after ovary-stimulating drugs $2,000
In-vitro fertilization $8,000
TYPICAL COVERAGE
Provider Tests Therapies Exclusions
Sentara/Optima 50% 50% (includes IUI) Drugs, IVF
Trigon Blue Cross/Blue Shield)
80% 80% (unless IUI or IVF) Drugs, IUI and IVF
Tricare (CHAMPUS) 85% 85% IUI and IVF
SOURCE: Jones Institute for Reproductive Medicine
by CNB