Incorporating Insurance Education into the Fertility Preservation Process

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.

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.