title: Infertility services in a managed care environment.
abstract: Managed care schemes are replacing traditional fee-for-service reimbursement to physicians and hospitals in the United States. Managed care schemes take the form of discounted fee-for-service, utilization review, global fee reimbursement, and capitated reimbursement schemes with funds to be distributed among providers. Reimbursement for infertility services has been excluded from many managed care plans as infertility is viewed as a social condition, not a medical condition, and coverage for infertility diagnosis and treatment is viewed as unnecessary in the bundle of services offered by insurers and other managed care organizations. However, some states mandate infertility coverage and some managed care organizations realize that provision of care for infertile couples makes their product more attractive. Large managed care organizations such as Blue Cross/Blue Shield of illinois and some entrepreneurial organizations are developing managed care plans that incorporate infertility services. Comprehensive services--including in-vitro fertilization--can be offered at a lower cost than traditional fee-for-service care. Newer technologies such as in-vitro fertilization are replacing fallopian tube surgery and surgical treatment for male infertility. These can be implemented at a lower cost and with better outcome for infertile couples than traditional services.
authors.affiliation: Bates Consulting Company, Greenvile, SC 29607, USA.
authors.forename: G W
authors.initials: GW
authors.lastname: Bates
authors.forename: S R
authors.initials: SR
authors.lastname: Bates
mesh_terms: D003191:Comprehensive Health Care / Q000458:organization & administration*; D003363:Cost Control; D005260:Female; D006801:Humans; D007246:Infertility / Q000175:diagnosis* / Q000628:therapy*; D019458:Insurance Coverage; D008297:Male; D008329:Managed Care Programs / Q000145:classification / Q000458:organization & administration*; D012051:Reimbursement Mechanisms; D012099:Reproductive Techniques; D016896:Treatment Outcome; D014481:United States