The battle for a baby, the battle for coverage

By Chen May Yee, Star Tribune

Last update: October 21, 2007 - 8:24 PM

For women who are trying to get pregnant, time is marked not in days or seasons, but in ovulation cycles. Kathy Jackson speaks of the year of fighting her health insurer as a year of lost cycles.

On the face of it, her case is about a simple dispute over what her health plan covered and what it didn't. But it also shows how insurance policies have lagged behind advances in fertility medicine, locking some women into less effective treatments simply because they are covered, instead of sending them to more effective treatments that aren't covered. For some women, by the time they've exhausted all covered options, it might be too late.

Kathy and Mike Jackson, who live in Golden Valley, were married in 2000. After trying for a year to get pregnant, they sought medical help.

Since then, she's had 10 surgeries related to reproduction. Medical bills soared to more than $100,000, she says, and were paid by Blue Cross and Blue Shield of Minnesota.

Insurance also paid for several rounds of fertility drugs. At one point, a nurse suggested artificial insemination, a procedure that cost a few hundred dollars and wasn't covered. Jackson got pregnant and on May 9, 2005, she gave birth to a girl, Ellie, five weeks early. Difficult as the pregnancy was, she says, it "was worth every single minute."

The Jacksons began trying for a second baby. Doctors removed a diseased ovary. After another failed round of hormones and artificial insemination, she says, her health plan abruptly stopped paying for anything related to infertility. For a year, they were locked in a dispute with Blue Cross over some $7,000 in medical bills.

In August, Jackson, now 43, appeared at a Blue Cross hearing to appeal the denial of her claims. At one point, she broke down crying. "It feels like you have, in effect, taken away our family," she told the roomful of insurance executives. "While I know there was no guarantee that we would have conceived another child, it was my right to try and you took that away from me."

In September, Blue Cross agreed to pay for past and future claims within her contract. "This mistake should have been recognized earlier, and we regret any concern that our delay may have caused," said Blue Cross spokesperson Jan Hennings.

Chen May Yee • mychen@startribune.com

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