State laws and regulations addressing third-party reimbursement for infertility treatment: Implications for cancer survivors

Objective: To examine codified state policies related to infertility and assess their implications for cancer patients. Lack of insurance is often identified as a barrier to use of fertility preservation (FP) services. Design: None. Setting: A keyword search was developed to identify statutes and administrative regulations of insurance coverage for FP in the United States. Patient(s): N/A Intervention(s): N/A Main Outcome Measure(s): Laws addressing the general population but pertaining to FP were compiled using Lexis-Nexis. Data were analyzed by reviewing the "plain meaning" of the text, legislative/administrative history, and annotated case law. Legal reasoning and common rules of statutory construction and legislative interpretation were used. Result(s): Fifteen states (29.4%) had laws relating to insurance coverage for infertility or in vitro fertilization (IVF) procedures and two states (CA and IL) specifically excluded IVF from a mandatory offer of coverage. No state laws or regulations addressed insurance coverage for FP methods specific to cancer patients. Conclusion(s): There is an argument for policies that require coverage for FP for cancer survivors before treatment.