Alabama I.V.F. Ruling: What to Know About the Costs of Moving Embryos

When the Alabama Supreme Court issued a surprising decision last month that led doctors to restrict in vitro fertilization treatments in the state, it raised a host of questions that the court did little to answer.

In the wake of the decision, doctors and patients have worried that they could be vulnerable to prosecution in any number of medical scenarios that were once routine. Some Alabama facilities have halted or restricted treatment, and patients elsewhere worry that similar rulings or laws may soon come to their states.

And because so many people pay so much for health care, the fallout from the Alabama case raises big financial questions, too. What would it cost to move embryos to a state less likely to issue a similar ruling? Will insurance cover that or the transfer of care to new health providers?

Here are the questions and answers that spring from the case.

For People Considering Moving Their Embryos

Who moves the embryos for me?

Cryoport Systems, IVF Cryo and ReproTech are three shipping companies that specialize in transporting embryos, though there are others. Your doctor or insurance company may have preferred providers.

Aren’t some shippers halting shipments of embryos from Alabama?

Yes, on Friday Cryoport paused its shipping of embryos to or from the state. IVF Cryo and ReproTech, however, have both announced that they would continue to service the state.

Companies might change their policies depending on developments.

How quickly can I get my embryos from one state to another?

It could take as little as a week, but probably closer to a few weeks.

“There are so many checks and balances in order for it to happen safely,” said Emily Jungheim, a professor and chief of reproductive endocrinology and infertility at Northwestern University’s Feinberg School of Medicine who is also a practicing physician. “It’s not something where you can just say, ‘I want to ship them out,’ and it’s going to happen tomorrow.”

Is there a way to insure the financial risk in case the embryo is damaged, to recover the money you spent creating it?

There may be. One company, ReproTech offers a $65 policy that can cover up to $35,000 in replacement costs for certain kinds of damage.

The Cost

What might it cost to move my embryos?

If you don’t have specific insurance coverage, ferrying embryos to another clinic or long-term storage facility usually costs anywhere from roughly $500 to $1,000 or more, fertility providers said. Some shipping services post a fee schedule online, while others ask you to request a quote.

“There’s a lot that goes into moving these safely and properly,” said Angeline Beltsos, chief executive physician at Kindbody, which has 35 clinics across the country and provides fertility benefit coverage for employers, including Walmart.

Will my health insurance cover the cost to move my embryos if I can no longer get I.V.F. in my home state?

Maybe. Some coverage could be broad enough to pay for the transport of embryos.

“It is likely that employees working for large employers have some kind of coverage,” said Elizabeth Mitchell, the chief executive officer of Purchaser Business Group on Health, which represents large employers that provide benefits for their workers.

Would fertility coverage pick up my treatment elsewhere?

Maybe, and it’s more likely to happen if you work for a large company. Some employers with workers in Alabama are considering covering the costs of treatment in locations where it’s still possible, along with travel expenses for patients.

Progyny, which provides specialized fertility coverage (including in Alabama) through a network of providers, said it would cover embryo and tissue transport to another in-network clinic if it was no longer possible to conduct I.V.F. at a certain location. And it may cover travel expenses, depending on the options available through an employer. (Some out-of-pocket costs, like coinsurance, may apply.)

“This means patients can continue their treatment out of state should they wish,” said Dr. Janet Choi, chief medical officer at Progyny. It may also cover the transport of embryos to another in-network long-term storage facility.

WIN, another fertility benefit provider, said it was working with its employer clients who were considering updating their plans to include some of these benefits as well.

How much does storing embryos cost?

Without any insurance coverage, embryo storage typically costs anywhere from roughly $400 to $1,500 per year, reproductive experts said.

Is embryo storage typically covered by any health insurance or fertility benefits?

Long-term storage is typically not covered, though employer plans may pay for the first year, said Dr. Beltsos of Kindbody.

But some large employers will pay for up to five years.

If I don’t have fertility coverage, can I use money from a health savings account (or a flexible spending account through my employer) to pay to move my embryos?

Yes, according to Nicky Brown, vice president of public policy and government affairs at HealthEquity, which administers accounts. (Shipping for other kinds of medical care is also typically eligible.)

With a flexible spending account, employers have some leeway in designing their plans, so it’s always best to ask about the specifics.

Is the cost of storing embryos also an eligible expense for H.S.A. or F.S.A. reimbursement?

Publication 502 is the Internal Revenue Service document that governs eligible expenses, and “temporary storage” associated with in vitro fertilization is on the list. Its definition of “temporary” is not clear, and there may be limits in any workplace-based account.

What do fertility benefits — including those for I.V.F. — tend to cover?

It depends. Coverage is complicated, and it varies tremendously depending on where you live, whether you’re covered by a workplace plan, and, if so, the size of your employer. But many people are often stuck paying thousands of dollars out of pocket for I.V.F., even if they do have some employee benefits. And many people don’t have any coverage.

What May Happen Next

Whom should I talk to first to figure out what to do medically?

Start with reproductive specialists, who are probably sympathetic to your concerns about changes in the law and the courts. If you have specialized fertility coverage, your benefit providers may have their own logistical teams in place to help you get your treatment elsewhere.

If I’m in the middle of treatment in Alabama, what should my next steps be?

Begin by reviewing your options with your medical provider. “We are working with members to determine when, where and how to access alternative care if their I.V.F. treatment has been canceled or is in jeopardy,” said Dr. Roger Shedlin, chief executive officer and president of WIN, which provides benefits to employers, health plans and individual patients.

Do other states have pending lawsuits or legislation that could lead to similar outcomes as the one in Alabama?

Alabama already has an abortion ban, and lawmakers there are considering legislation that would clarify the state’s rules for in vitro fertilization.

Given their stance that any embryo inside the womb is a person, Alabama legislators will presumably specify how they want citizens to treat embryos outside the womb. Louisiana has already banned the destruction of embryos.

The anti-abortion movement has long tried to extend “personhood” to fetuses and embryos, granting them the same legal rights and protections as people. That creates great legal liability for I.V.F. providers, and the situation in Alabama has thrown the industry there into chaos.

Other states’ courts could issue decisions with similar consequences, while state legislatures could create laws that have similar chilling effects. For the moment, reproductive health policy experts said they weren’t aware of anything imminently coming down the pike in the courts. But laws on the books in several states could potentially jeopardize I.V.F. access, and more personhood-related legislation is being introduced.

“The reality is that 11 states have broad fetal personhood laws that are similar to what Alabama has and which were used to justify this decision,” said Dana Sussman, deputy executive director at Pregnancy Justice, an advocacy group.

Karla Torres, senior human rights counsel at the Center for Reproductive Rights, said four states — Georgia, Alabama, Missouri and Arizona — already have personhood laws related to abortion. (The group is challenging the law in Arizona.) They generally use language that is vague enough — defining life at any stage of development, for example — which could potentially extend to embryos and complicate I.V.F.

And about 13 states have personhood-related bills moving through their legislatures. “They are broad enough to be interpreted to include embryos, but they are not explicitly calling out I.V.F. cryopreserved embryos,” Ms. Torres said. “All of these are very concerning.”