Financing infertility treatment is an expanding business. There are shared risk and financial aide programs at infertility clinics, individuals are crowd-sourcing their medical bills, medical finance groups are making IVF specific loans, and a new internet company  claims they can advocate for discounts at clinics for you – although it is not clear what that means. For better and for worse, for profit or not, Assisted Reproductive Technologies (ART) are expensive and many are looking to play the financial game.

Considering this variety of financial options available, infertility treatment can feel like a gamble. In her recent NYTimes Blog, Amy Klein asks one of the big questions about the IVF gamble, “How much would we be willing to spend?”  For many experiencing infertility and seeking treatment, finances are yet another area where a delicate balance must be struck.  Either extreme – nothing or anything – is not usually the answer but is possibly an extreme exit strategy.  One IVF averages $12,400. Based on the statistics, what if it take 3? What if a donor is needed which adds another $20,000 for each attempt? What if your cash savings is only$10,000?  In other words on top of the ups and downs of the infertility roller coaster, you can add figuring out how much financial risk can be tolerated.

That risk and its emotional toll were major reasons why Hasidah was founded.

Assuming the costs involved for the treatment are legitimate and the statistics reliable, the question of how much we are willing to pay is a difficult one. Beyond the individual decision, there are also larger contextual questions. How can the Jewish community ignore the low birthrate? At a time when the length of young adulthood is expanding and affiliation is contracting, can we risk not addressing those who want to build the Jewish community through children? If we can ease the pain of people experiencing infertility, is this a good use of our resources?

Anybody choosing to start a family is taking a risk. Parenthood is a gamble. But ignoring infertility is too high of risk to take for the Jewish community. It is not only alienating those currently in need, it is severing hope for future generations. We can assume some of the risk by providing financial and emotional support to those who are committed to building Jewish families. Financial assistance for ART could lead to successful outcomes for having children. It could also support better emotional health and financial security for those families. That is not a gamble. That is a good investment.

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Like other types of insurance coverage, many people are unaware if they have insurance  for infertility treatment until they find themselves in need of using it. Some may have coverage but are unaware of the limitations or restrictions. The reality is that insurance coverage varies greatly depending on the state, the medical situation, the treatment, and the individual. And the exceptions can make holes big enough to drive trucks through.

According to American Society for Reproductive Medicine, there are 15 states that have some form of insurance coverage requirements for treatment. Most of them cover treatments (Arkansas, Connecticut, Hawaii, Illinois, Louisiana, Maryland, Massachusetts, Montana, New Jersey, New York, Ohio, Rhode Island, and West Virginia) while others “offer coverage” (Texas and California).  The coverage mandate in some states includes in vitro fertilization (IVF), in other states it excludes IVF, and in others it includes only IVF. Moreover being in a state with a mandate that includes IVF (or anything else) does not mean that your employer will provide coverage. Many employers are exempt from the law for a variety of reasons.

In addition to exemptions that can entirely eliminate any infertility coverage, insurance may not cover certain treatments or fertility drugs in all cases. The coverage may have specific medical requirements, limitations on methods, age requirements, caps on number of cycles or lifetime spending limits.

IVF procedures are usually performed after prepayment which means a large out-of-pocket expense since the average cost is $12,400.  In a state without a mandate or if the employer doesn’t provide the coverage for whatever reason, that is a potentially roadblocking cash payment standing in the way of a possible solution to infertility. Someone with insurance coverage of 50% for infertility treatment still has to pay $6,200 cash or equivalent for treatment. That is not small change.

Insurance coverage can be helpful and some coverage is better than no coverage. However there are many exclusions, exceptions, hurdles and holes which often make it less effective. The result is that for many people experiencing infertility, insurance is no solution to the expense of infertility.

[For the chart of insurance coverage by state, see American Society for Reproductive Medicine Insurance: http://www.asrm.org/detail.aspx?id=2850]

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The costs of Assisted Reproductive Technologies (ART) like in vitro fertilization (IVF) can be a serious roadblock for many who might benefit from their use. Helping defray those costs is our goal. Below are a couple recent articles in the news about the costs of IVF:

http://www.healthline.com/health-news/women-the-high-cost-of-in-vitro-fertilization-101613

http://www.resolve.org/family-building-options/insurance_coverage/the-costs-of-infertility-treatment.html

 

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Rosh Hashanah 5774
Hannah: A Modern Interpretation

וַיְהִי֩ אִ֨ישׁ אֶחָ֜ד מִן־הָרָֽמָתַ֛יִם צוֹפִ֖ים מֵהַ֣ר אֶפְרָ֑יִם וּשְׁמ֡וֹ אֶ֠לְקָנָ֠ה בֶּן־יְרֹחָ֧ם בֶּן־אֱלִיה֛וּא בֶּן־תֹּ֥חוּ בֶן־צ֖וּף אֶפְרָתִֽי:  וְלוֹ֙ שְׁתֵּ֣י נָשִׁ֔ים שֵׁ֤ם אַחַת֙ חַנָּ֔ה וְשֵׁ֥ם הַשֵּׁנִ֖ית פְּנִנָּ֑ה וַיְהִ֤י לִפְנִנָּה֙ יְלָדִ֔ים וּלְחַנָּ֖ה אֵ֥ין יְלָדִֽים
(1Samuel 1:1-2) Now there was a certain man of Ramathaim-zophim, of the hill-country of Ephraim, and his name was Elkanah, the son of Jeroham, the son of Elihu, the son of Tohu, the son of Zuph, an Ephraimite. And he had two wives: the name of one was Hannah, and the name of the second Peninnah; and Peninnah had children, but Hannah had no children.

They were on many accounts successful. They had careers and a house and family and friends that loved them. But they had no children.


וּלְחַנָּ֕ה יִתֵּ֛ן מָנָ֥ה אַחַ֖ת אַפָּ֑יִם כִּ֤י אֶת־חַנָּה֙ אָהֵ֔ב וַֽיהֹוָ֖ה סָגַ֥ר רַחְמָֽהּ
(1:5) But to Hannah he would give a special portion, for it was Hannah he loved, but the Eternal One had shut her womb.

They saw doctors and specialists who could find nothing to repair. They ascended the ladder of interventions steadily and were lifted into the realm of Assisted Reproductive Technologies.

   וְכֵ֨ן יַֽעֲשֶׂ֜ה שָׁנָ֣ה בְשָׁנָ֗ה מִדֵּ֤י עֲלֹתָהּ֙ בְּבֵ֣ית יְהֹוָ֔ה כֵּ֖ן תַּכְעִסֶ֑נָּה וַתִּבְכֶּ֖ה
(1:7) And as he did so year by year, when she went up to the house of the God, so [Peninnah] vexed her; therefore [Hannah] wept,

And so this happened year by year. She continued to prayer for strength and health and asked God for compassion. And he began to work extra to pay for the medical bills. And life vexed them as the rest of the world seemed fecund and others with good intentions would comment. They went to more specialists, had more procedures, and had more losses. And as they slowly moved through life, pregnancies ended.

    וְהִ֖יא מָ֣רַת נָ֑פֶשׁ וַתִּתְפַּלֵּ֥ל עַל־יְהֹוָ֖ה וּבָכֹ֥ה תִבְכֶּֽה
(1:10) And she was in bitterness of soul–and prayed to the Eternal, and she wept deeply.

And her soul was in pain and she prayed to the Eternal One. And she wept bitterly.

  וְחַנָּ֗ה הִ֚יא מְדַבֶּ֣רֶת עַל־לִבָּ֔הּ רַ֚ק שְׂפָתֶ֣יהָ נָּע֔וֹת וְקוֹלָ֖הּ לֹ֣א יִשָּׁמֵ֑עַ
(1:13) Now Hannah, she spoke in her heart; only her lips moved, but her voice could not be heard;

Just before one of the IVF procedures, when she and he, the doctor and nurse, the lab technician and the assistant were present, she tried to pray for strength and health and ask God for compassion.  But only her lips moved and no words came out. So he read the words for her. And they all wept with hope.

Yet that too ended in loss.

So they began to ask God and themselves different questions.  They began to count their blessings differently. They made a commitment to help others who wanted children too but did not have such blessings.

    וַֽיִּזְכְּרֶ֖הָ יְהֹוָֽה:  וַֽיְהִי֙ לִתְקֻפ֣וֹת הַיָּמִ֔ים וַתַּ֥הַר חַנָּ֖ה וַתֵּ֣לֶד בֵּ֑ן
(1:19-20) And the Eternal remembered her. And it came to pass, when the time was come about, that Hannah conceived, and bore a son

And the Eternal One remembered her.  At the turn of the third year, blessed with the resources to secure the doctors and a clinic, a donor and nurses, and the strength to try again, they conceived. The following summer their twin daughters were born.

 וַתֹּ֨אמֶר֙ בִּ֣י אֲדֹנִ֔י חֵ֥י נַפְשְׁךָ֖ אֲדֹנִ֑י אֲנִ֣י הָֽאִשָּׁ֗ה הַנִּצֶּ֤בֶת עִמְּכָה֙ בָּזֶ֔ה לְהִתְפַּלֵּ֖ל אֶל־יְהֹוָֽה:  אֶל־הַנַּ֥עַר הַזֶּ֖ה הִתְפַּלָּ֑לְתִּי וַיִּתֵּ֨ן יְהֹוָ֥ה לִי֙ אֶת־שְׁאֵ֣לָתִ֔י אֲשֶׁ֥ר שָׁאַ֖לְתִּי מֵֽעִמּֽוֹ
(1:26-27) And she said, O my God, as you live my God, I am the woman that stood with you here to pray to the Eternal One. For this child I prayed; and the the Eternal One has granted me my petition which I asked of Him;

And when she planned to wean them, they went to the House of the Eternal One. They remembered their petitions to God and knew it was the time to fulfill the commitment of helping others. And the Hasidah Foundation was brought into life.

Hasidah comes from the root Hesed – lovingkindness. Hasidah means stork. The Hasidah Foundation’s purpose is to build Jewish families by providing financial support for Assisted Reproductive Technologies, which is the term that includes in vitro fertilization (IVF) and the many related treatments and procedures.

The reading above is the story of Hannah and Elkanah. There are many Hannahs and Elkanahs today whose prayers for children are not answered as expected. Feeling denied of the fundamental human ability of bearing children, being unable to fulfill the commandment to be fruitful and multiply, cuts deeply. Nobody is raised to think they may not be able to bear children in the traditional way. Quite the opposite – we are repeatedly cautioned of its ease.  The world of infertility then becomes dark and lonely. It is – it was – deeply personal and painful.

So there is silence, sadness, sometimes anger, and a loss of control. Balancing the hopes and the fears can become a Herculean effort.  And for some, during the difficult time of dealing with infertility, there is also an insurmountable financial barrier between them and Assisted Reproductive Technologies, which can be a potential solution.

Assisted Reproductive Technologies have been able to address many of the variables that cause infertility. Medical issues, cancer, genetic factors, male factors, female factors – there are many situations where Assisted Reproductive Technologies can provide real possibilities for having children. There is access to the procedures here in Columbus and around the country. The statistics for success are in our favor. However, the financial barrier is a real one for many. It can cost from $10K to over $40K all inclusively for one IVF cycle depending on what all is involved.

Hasidah’s goals are to build awareness about infertility in the Jewish community, to help ease the financial burden that for some is a complete barrier, and ultimately to build Jewish families.

To you who are reading this, thank you for recognizing this issue. We hope you will continue to spread awareness to those those in need and those who can help.

To the Hannahs and Elkanahs today in our community, my prayer for you is for strength, patience and hope and to know which one you need at which time.  May God and all of us hear your silent prayers and take notice of this affliction.

:וַיִּשְׁתַּ֥חוּ שָׁ֖ם לַיהֹוָֽה
(1Samuel 1:28) And they worshiped the eternal one there.

הָרַחֲמָן, הַמְרַחֵם, רַחֵם עָלֵֽינוּ
May the merciful One, Who acts mercifully, have mercy upon all of us.
Now and always.

שנה טובה
Good wishes for the New Year

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We are thrilled to be launching our website and beginning the work needed to establish the Hasidah Foundation. There are many support groups and resources for people experiencing infertility, but we are starting with a simple focus – financial support for Assisted Reproductive Technologies (ART).  The Jewish tradition values family building highly and for many people the financial roadblock to benefit from ART can be insurmountable.  We want to help.

This blog will provide updates about our progress as we establish Hasidah and share insights into the world of infertility and treatment.

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