"Employers have been telling us that they don't want to pay more for their insurance," said AHIP spokesman Susan Pisano. "If state laws makes you cover a, b, c, d, maybe you can't afford to do that. We have been traditionally opposed to mandated benefits because what it ends up doing is raising the cost of coverage. In some cases, access to services is out of reach for employers."
"Relative to the rest of the world of medicine, infertility care is not as expensive as you think, primarily because it is outpatient," said Paulson, who is professor of obstetrics and gynecology at University of Southern California Keck School of Medicine. "Because people pay cash for it, there are market forces that have kept prices down."
"An infertility work up can be completed for about $1,000," he said. "Each IVF cycle is about $12,000 or $13,000. A few visits to the emergency room can run higher than that."
"Really, it's a question of allocation of resources," he said. 'If my fertility care is going to cost $20,000, that's a lot of money, but it's the cost of an Accord. We see couples who drive the old car for another few years and postpone the addition on the house and put up with the old washing machine."
Employers also often provide tax-deductible flexible spending accounts that can be used to pay for pregnancy and ovulation tests.
In the RESOLVE survey, a surprising 38 percent of respondents said they "did not know" about adoption benefits that are provided by many companies, she said.
"People need to find out what family building benefits they even have in order to make sound and informed decisions," said RESOLVE's Collura.
Collura is pushing for a national action plan to address fertility and reproductive issues. On April 28, she will brief Congressional staff during National Fertility Awareness Week, accompanied by Rep. Debbie Wasserman Schultz, D-Fla., and Sen. Kirsten Gillibrand, D-N.Y.
In the meantime, RESOLVE hopes to influence the Department of Housing and Human Services as it defines the "essential health benefits package," which will serve as a guideline for new insurance exchanges that will be available in 2014, when all Americans will be required to have coverage.
"We have a couple of opportunities, but there are a lot of unknowns," said Collura. "We are going to do everything we can to make it happen but it's anyone's guess how it will play out."