Abstract
Over the last several decades, cancer survival rates have tremendously increased, largely due to enhanced early detection and improved therapeutics. What was once considered a “death sentence,” now allows survivors to imagine a life after cancer with expectations beyond survival [1]. These medical achievements should be tempered by the resultant gonadotoxic effects. As such, survivorship issues are of increasing importance. Fertility loss is of particular concern for the approximately 135,000 pediatric, adolescent, and young adults (AYA) diagnosed each year [2]. Infertility caused by cancer treatment is iatrogenic, meaning any adverse condition induced by medical interventions including reactions from prescribed drugs or from medical and surgical procedures. Iatrogenic infertility is typically caused by cancer treatments such as chemotherapy, radiation, or surgical removal of reproductive organs. While the focus of this chapter will be specific to cancer patients, fertility may be compromised by treatments for other conditions such as autoimmune disorders.
Keywords
- Preimplantation Genetic Diagnosis
- Fertility Preservation
- Medical Necessity
- Internal Appeal
- Iatrogenic Condition
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.
This is a preview of subscription content, log in via an institution.
Buying options
Tax calculation will be finalised at checkout
Purchases are for personal use only
Learn about institutional subscriptionsReferences
ACS. American Cancer Society Cancer Facts and Figures 2012. Atlanta: American Cancer Society; 2012.
SEER. Surveillance, Epidemiology, and End Results (SEER) Program Populations (1969–2009) (http://www.seer.cancer.gov/popdata), National Cancer Institute, DCCPS, Surveillance Research Program, Cancer Statistics Branch, released January 2011; 2011.
Bath LE, et al. Depletion of ovarian reserve in young women after treatment for cancer in childhood: detection by anti-Mullerian hormone, inhibin B an d ovarian ultrasound. Hum Reprod. 2003;18(11):2368–74.
Chemaitilly W, et al. Acute ovarian failure in the childhood cancer survivor study. J Clin Endocrinol Metab. 2006;91(5):1723–8.
Letourneau JM, et al. Acute ovarian failure underestimates age-specific reproductive impairment for young women undergoing chemotherapy for cancer. Cancer. 2012;118(7):1933–9.
Campo-Engelstein L. Consistency in insurance coverage for iatrogenic conditions resulting from cancer treatment including fertility preservation. J Clin Oncol. 2010;28(8):1284–6.
Prevention, C.f.D.C.a. International Classification of Diseases, Tenth Revision (ICD-10). 2011 [cited 2013 01/18/2013]; Available from: http://www.cdc.gov/nchs/icd/icd10.htm.
Cigna. Medical Necessity Definitions. 2013 [cited 2013 01/18/2013]; Available from: http://www.cigna.com/healthcareprofessionals/resources-for-health-care-professionals/clinical-payment-and-reimbursement-policies/medical-necessity-definitions.html.
Livestrong. Position Statement: Insurance Coverage for Iatrogenic Infertility. 2011 [01/18/2013]; Available from: http://www.livestrong.org/What-We-Do/Our-Approach/Platforms-Priorities/Health-Insurance-Coverage-for-Iatrogenic-Infertility.
Policy NM. Fertility preservation in cancer patients. 2012 [cited 2013 01/18/2013]; Available from: https://http://www.healthnet.com/.
NCSL. Mandated Health Insurance Benefits and State Laws. 2012 [01/15/2013]; Available from: http://www.ncsl.org/issues-research/health/mandated-health-insurance-benefits-and-state-laws.aspx.
HEALTH, A.C.O. Assembly Bill 428. 2011 [01/15/2011]; Available from: http://www.leginfo.ca.gov/pub/11-12/bill/asm/ab_0401-0450/ 428_cfa_20110501_122908_asm_comm.html.
(CHBRP), C.H.B.R.P. Analysis of Assembly Bill 428: Fertility Preservation, in Report to California State Legislature 2011, Oakland, CA.
Auditor O.o.t. Mandatory health insurance coverage for fertility preservation procedures for people of reproductive age diagnosed with cancer. A report to the Governor and the Legislature of the State of Hawai’i, 2012;12(09).
CLRC, L.F.H. Position Statement: Health Insurance Coverage for Iatrogenci Infertility; 2011
Acknowledgement
This work was supported by the Oncofertility Consortium NIH 5UL1DE019587 and NIH K12-HD001271-13 (LAK).
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Appendices
Appendix 1
Appendix 2
[Center Letterhead]
[Date]
[Insurance Name] Review Unit
By fax: (999) 999-9999
Attn: Appeals
RE: Doe, Jane
D.O.B: 9-30-1984
Blue Cross Blue Shield ID #: 9999999999
Group #: 99999
To Whom It May Concern:
Ms. Jane Doe is a 35-year-old with Stage 4 colon cancer diagnosed in January 2009. The patient’s plan of care for this diagnosis includes chemotherapy and likely subsequent radiation. Many of these therapies that so effectively help increase survival have side effects that may cause the loss of fertility. The patient is not currently infertile but may be rendered sterile by the cancer treatment (a covered benefit under her plan).
In preparation for these treatments, the patient saw me in consultation to review fertility preservation options as per American Society of Clinical Oncology (ASCO) and American Society for Reproductive Medicine Guidelines (Attached). After discussing the probable impact of the proposed cancer treatment on her fertility, we reviewed the range of options available.
(Select the appropriate paragraph and delete the others.)
After discussing the spectrum of options, based on cancer treatment, age, diagnosis and the window of time available to the start of cancer treatment the decision was made to bank [oocytes / embryos / ovarian tissue cryopreservation] [Oocyte / embryo] banking is the standard of care for fertility preservation for someone in her circumstances.
After discussing the spectrum of options, based on the cancer treatment, age, diagnosis and window of time available to the start of cancer treatment the decision was made to perform a fertility sparing unilateral salpingo-oophorectomy and ovarian cryopreservation prior to beginning her treatment. Surgical intervention is the standard of care for obtaining ovarian tissue for cryopreservation.
Note on Male Patients: This can be customized to include a description of the male diagnosis if the male is the patient. Use of sperm banking, donor sperm and/or assisted reproductive technologies to treat couples where the man has been rendered infertile by cancer treatment is NOT the same as infertility from other causes and often covered.
Therefore, we request that this treatment as well as related procedures and testing, which have been previously denied, be reconsidered for coverage for this patient. As noted, the patient did not present with infertility but this fertility preservation treatment is essential to preserving fertility prior to beginning cancer treatment.
If you have any questions or need further information, please do not hesitate to contact me.
Sincerely,
John Smith, MD
Lead Physician
Center for Advanced Reproductive Services
Attachments:
1. American Society of Clinical Oncology Recommendations on Fertility Preservation in Cancer Patients. Journal of Clinical Oncology 24: 917–2931, 2006.
2. Fertility preservation and reproduction in cancer patients. Fertility and Sterility, Vol. 83, No. 6, June 2005.
Appendix 3
Jane Doe
22 Fair Avenue
Chicago, IL
[date]
[Insurance Company Name] Review Unit
By fax: (999) 999-9999
Attn: Appeals
RE: Doe, Jane
D.O.B: 9-30-1984
Blue Cross Blue Shield ID #: 9999999999
Group #: 99999
To Whom It May Concern:
I am a 35-year-old with stage 4 colon cancer diagnosed in January 2009. My plan of care for this diagnosis includes chemotherapy and likely subsequent radiation. Many of the therapies that so effectively help increase survival have side effects that may cause the loss of fertility. I am not currently infertile but may be rendered sterile by the cancer treatment (a covered benefit under their plan). In preparation for these treatments, I met with Dr. John Smith in consultation to review the possible impact of my cancer treatment on my fertility and my options for fertility preservation options as per American Society of Clinical Oncology (ASCO) and American Society for Reproductive Medicine Guidelines (see below).
(Select the appropriate paragraph and delete the others.)
After discussing the range of options available, based on my cancer treatment, age, diagnosis and time available to the start of my cancer treatment the decision was made to bank embryos. Embryo banking is the standard of care for fertility preservation for someone in my circumstance.
After discussing the range of options available, based on my cancer treatment, age, diagnosis and time available to the start of my cancer treatment the decision was made to bank eggs. Egg banking is the standard of care for fertility preservation for someone in my circumstance.
After discussing the range of options available, based on my cancer treatment, age, diagnosis and time available to the start of my cancer treatment the decision was made to perform a fertility sparing unilateral salpingo-oophorectomy and ovarian cryopreservation prior to beginning her treatment. Surgical intervention is the standard of care for obtaining ovarian tissue for cryopreservation.
Note on Male Patients: This can be customized to include a description of the male diagnosis if the male is the patient. Use of sperm banking, donor sperm, and/or assisted reproductive technologies to treat couples where the man has been rendered infertile by cancer treatment is NOT the same as infertility from other causes and often covered.
Therefore, we request that this procedure as well as related procedures and testing previously denied for coverage be reconsidered. As noted, I do not have infertility but this treatment was essential to preserving my fertility before my cancer treatment could begin.
If you have any questions or need further information, please do not hesitate to contact Dr. Smith at [Practice Name] or me.
Sincerely,
Jane Doe
References:
1. American Society of Clinical Oncology Recommendations on Fertility Preservation in Cancer Patients. Journal of Clinical Oncology 24: 917–2931, 2006.
2. Fertility preservation and reproduction in cancer patients. Fertility and Sterility, Vol. 83, No. 6, June 2005.
Rights and permissions
Copyright information
© 2014 Springer Science+Business Media New York
About this chapter
Cite this chapter
Kondapalli, L.A., Crisci, A. (2014). Incorporating Insurance Education into the Fertility Preservation Process. In: Woodruff, T., Clayman, M., Waimey, K. (eds) Oncofertility Communication. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-8235-2_14
Download citation
DOI: https://doi.org/10.1007/978-1-4614-8235-2_14
Published:
Publisher Name: Springer, New York, NY
Print ISBN: 978-1-4614-8234-5
Online ISBN: 978-1-4614-8235-2
eBook Packages: MedicineMedicine (R0)