News4 Investigates exposes “Miscarriage Loophole”

NASHVILLE, TN (WSMV) – As if going through a miscarriage isn’t hard enough, wait until you hear what News4 Investigates has uncovered about what else mothers are enduring after their loss.

There are tests that could help determine why pregnancies fail, but mothers are being required to have two and sometimes three miscarriages before insurance will cover them.

For Stefanie Murphy, her miscarriage in 2014 was just the first of several heartbreaks to come.

“The pain of what could have been, the what was, the reminders of the dates, the physical toll, the emotional toll,” said Murphy.

It took Murphy and her husband Ryan Murphy three miscarriages before insurance would finally cover a specialist to help them figure out what was happening.

“It’s not fair,” said Murphy.

“It’s cruel. It’s discriminatory and it is unnecessary,” said Barbara Collura, the president and CEO of the national infertility association RESOLVE.

Collura calls this insurance rule, requiring multiple miscarriages before a specialist is covered, the “miscarriage loophole.”

“For insurers to say, ‘Hey you gotta suffer through these three devastating things before we’re going to allow you to see a specialist’ again, there is nothing medically sound about that,” said Collura.

Collura said the reason why insurance requires this is simple: money.

“This is not doctors saying that this is how it should be. This is what we call ‘the payer,’ the insurance company saying, ‘we’re going to make you suffer, and go through all of this, and because of why? Because we want to lower our costs,'” said Collura.

News4 Investigates contacted multiple big insurance companies, one telling us, “For testing, the requirements for approval depend on the specific type of testing requested. We carefully review genetic testing requests, following evidence-based criteria for approval.”

The Director of Health Studies at Belmont, Deborah Farringer, said the painful truth for mothers is that insurance companies aren’t required to cover post-miscarriage tests or treatments at all.

“So the fact that they have something that kicks in at a certain point is something, that’s actually, an insurance company would probably argue, above and beyond what the minimum obligations are,” said Farringer.

“Why not allow people to not have to go through this emotional and physical pain multiple times,” asked Murphy.

It took Murphy seven years, five miscarriages, several hospital procedures and thousands of dollars, but eventually she got her miracle babies.

“It’s surreal. It makes me, both of my babies, sorry um, it’s special, a lot of hard work, a lot of tears for Ryan and I both,” said Murphy through tears.

She just wonders why the loss of one baby simply isn’t enough to get answers.

“It’s about money. It’s about money. It’s about having the least amount of coverage so they are not having to pay out,” said Collura.

If this is happening to you or someone you know, experts at RESOLVE said you should fight it.

If your insurance company says a referral isn’t covered, they said you should appeal.

If your employer is self-insured, you can go to your HR department.

<a href=”https://resolve.org/what-are-my-options/insurance-coverage/coverage-at-work/employee-seeking-fertility-insurance-coverage/” target=”_blank”>To access a tool kit that will help you have that conversation click here.</a>

To learn more about how to fight an insurance claim denial watch the excerpt from our News4 interview below.