Amanda Wilde (Host): Welcome to Fertile Edge, a podcast presented
by the Reproductive Science Center of the San Francisco Bay Area.
I'm your host, Amanda Wilde.
Today everything you need to know about the new California
Insurance Mandate with Dr.
Deborah Wa, Dr.
W's IVF.
Practice director and managing partner at Reproductive Science Center.
Thank you so much for being here today.
Dr.
Ws.
Dr Deborah Wachs: Thank you so much for having me.
Amanda Wilde (Host): What is SB 7 29?
Dr Deborah Wachs: So SB 7 29 is a new Senate bill that has passed in California.
It's a law that expands insurance coverage for infertility and fertility treatment,
Amanda Wilde (Host): And in what ways does it do that?
Dr Deborah Wachs: so prior to this law going into effect.
Large group insurance health plans did not necessarily have to cover fertility.
And the biggest change that we are excited to see for our patient's is
that now an infertility diagnosis that comes from a physician now
leads to insurance coverage for the fertility treatment that will follow.
Amanda Wilde (Host): When does the new law take effect?
Dr Deborah Wachs: That's a little tricky to answer.
So officially, the mandate starts January 1st of this year.
But what will really happen is that as plans are renewed.
Or as open enrollment, is completed, that's when the plan
will need to go into effect.
So for employers, any renewal or open enrollment that occurs in 2026 then
has to go into effect for the new plan.
And many of the employers.
Do open enrollment towards the end of the year.
So for many of our patient's, it may be that the open enrollment that they
have in October or November of 2026 is what's gonna allow the mandate to go into
effect for them for the following year.
Amanda Wilde (Host): You just mentioned employers.
What about clients or patient's?
What should we do to prepare for the new mandate coverage?
Dr Deborah Wachs: So we're encouraging all of our patient's to talk to
their employers to understand how their employers are going
to be rolling out this mandate.
It is also important to understand that there are some employers who
are putting it into effect earlier.
So.
It's a combination of patient's speaking directly to their human
resources department, plus our office and our financial counselors
helping patient's navigate.
Amanda Wilde (Host): Can you expand on what services are
covered under this new law?
Dr Deborah Wachs: Yes.
So what.
SB 7 29 covers is the diagnostic procedures and tests that are
being ordered to arrive at the diagnosis of infertility.
Then the treatment recommendations that follow.
That can include IVF services and specifically up to three egg retrievals.
Then following egg retrievals, the next step is commonly embryo transfer.
And the plan does cover unlimited embryo transfers following clinical guidelines.
And we also expect that there will be the tests that patient's have
often had to pay out of POCAT.
Thus far, tests for their fallopian tubes, semen analysis, hormone
levels, so that will all fall under the diagnostic portion.
Amanda Wilde (Host): So this will make a big difference for your patient's who is
eligible under the new California mandate.
Dr Deborah Wachs: This is potentially gonna make a huge difference
for a lot of our patient's.
up until now we had approximately 50 to 60 of our patient's who already had.
Fertility as a covered benefit, and that's been great for them.
But it was always really challenging for the large subset of patient's
who didn't fall under an insurance plan that was covering it.
the definition is broad, and that's another aspect That is.
Really exciting for patient's and far more inclusive for patient's.
So when the law, is defining who falls under this, it is no longer excluding.
Patient's based on their marital status or their sexual
orientation or gender identity.
We now have clear guidelines that lgbtq plus individuals will have coverage,
same sex couples will have coverage, single people will have coverage.
So it's far more inclusive and expansive.
Amanda Wilde (Host): so many more folks are covered.
who is not covered?
Dr Deborah Wachs: So there's a couple areas that seem to be carved out.
One is fertility preservation That is falling under an elective diagnosis.
So we have a lot of patient's who come to us who aren't quite ready to start
their families, or they're single and they wanna freeze their eggs that.
Is excluded from this plan.
So what they're calling elective egg freezing or elective embryo
freezing for a non-medical reason is generally gonna be excluded.
just to follow-up on that, if, if.
Fertility preservation is deemed medically necessary.
So for example, if somebody is gonna start chemotherapy treatment for a new cancer
diagnosis, that's considered a medical indication for fertility preservation
And that will likely fall under the bill.
but uh, not all plans are going to.
Have to follow this mandate.
Small employers, less than a hundred employees are not, being held
accountable to the same mandate.
Amanda Wilde (Host): So what should clients or patient's look at in terms of.
If they are not covered under this new law, can you address
what happens for those folks?
Dr Deborah Wachs: Yes, they fall under a category that we're very used to
helping because up until this point, we really have had a lot of patient's
who came to us already having the diagnosis of infertility and already
knowing they needed treatment, but not necessarily having coverage for that.
What we try to offer at RSC is every patient has their own financial counselor.
We have programs that can help patient's apply for financial aid.
We have payment programs, we have multi-cycle, discounted programs.
So we are well set up for helping the subset of patient's where this bill is not
necessarily gonna change their coverage.
Amanda Wilde (Host): So that's a real benefit that you have.
Those resources to provide.
Dr Deborah Wachs: Absolutely.
Another thing that we're excited about is even without this, bill, RSC has
already had longstanding relationships with all of the major insurance carriers.
Since 2008, we have had strong, referrals and relationships with the insurance
companies and have been able to provide patient's who came in with that coverage.
We've had contracts that were already in place, so we're hoping for this whole new
subset of patient's who now have benefits.
It'll be a very smooth transition because we're already contracted
with their carriers most likely.
Amanda Wilde (Host): That is excellent.
Well, thank you Dr.
Wa, for this important information about the California insurance mandate
and how we go forward in the future.
Dr Deborah Wachs: Thank you so much.
One thing I'd also just love to add for patient's is it's never too
early to schedule the appointment and start the workup and get that
diagnosis of infertility and ideally.
The patient's will already have been seen by us.
We'll know what plan we wanna put into effect, And then we're just waiting for
the insurance to kick in, And that will be really beneficial for patient's to be.
Uh, ahead of the game rather than waiting for the coverage to kick in
And then scheduling the appointment.
So we are really excited to open doors to patient's for initial consultations
to help them find out what their issues are, do they have this diagnosis, what
treatment is gonna be recommended, so that once the plan goes into effect,
they're ready to go and they can just smoothly transition into treatment.
Amanda Wilde (Host): That's great.
Thank you so much for being a resource and as I said earlier, getting us
pointed in the right direction for those who will be exploring the new
possibilities under this new mandate.
Dr Deborah Wachs: Thank you so much.
Amanda Wilde (Host): Dr.
Deborah Wa is IVF practice director and managing partner
at Reproductive Science Center.
To learn more about SB 7 29 or to schedule an appointment with an RSC fertility
specialist, please visit r Rscbayarea.com.
If you found this podcast helpful, please share it on your social channels and
check out our entire podcast library.
For topics of interest to you, I'm Amanda Wilde.
Thanks for listening to Fertile Edge, a podcast from the Reproductive Science
Center of the San Francisco Bay Area.
I.