Reproductive health lies outside basic plan

Although not uncommon, fertility is not covered by health insurance, but a problem arises when other conditions are discovered in the process.

Treatments for infertility, sexual disorders and some reproductive health issues are also excluded from Daman's basic plan.

This policy is similar to those of other insurance regulators in the region and in the West.

The Council of Cooperative Health Insurance in Saudi Arabia does not include treatment for infertility or sexual dysfunction in its basic coverage. The US Medicaid, public insurance for the poor, does not cover infertility treatment or drugs used to treat sexual dysfunction.

Doctors say complications can arise when one condition is discovered while a patient is being treated for another.

"Sometimes we discover that hormone imbalance is the cause of the infertility," said Dr Mona Furniturewala, a gynaecologist with Emirates Health Limited.

"But because we found it while looking into infertility, insurance companies will not cover it."

Dr Furniturewala cited polycystic ovary syndrome (PCOS), an imbalance of hormones that can result in cysts in the ovaries.

"These hormone imbalances need to be treated as they affect the physiology of a patient," she said. "PCOS can lead to irregular bleeding."

But insurance companies remain steadfast in excluding such conditions.

"It comes from a background of toying with insurance companies and playing on the topic of disease and infertility," said Dr Jad Aoun, chief medical officer at Daman.

"You can never say infertility is due to PCOS or not. That's why those who decided on the general exclusions just took it out, because this is the easiest way to just say no to a disease."

Erectile dysfunction for men and sexually related conditions are also excluded. One example is the treatment for varicocele, a common condition where the veins in a man's scrotum are enlarged.

"Only a few men with varicocele have symptoms," said Dr Michael Bitzer, chief executive of Daman.

"If the person is experiencing pain or any other discomfort, then it's covered. But if it's related to infertility then it's not paid. The same goes internationally."

Most insurance companies, including Daman, offer maternity packages, which usually cover routine ultrasounds and delivery. But doctors say they must choose their words carefully when filling in claim forms.

Dr Afshin Pour Mirza, a gynaecologist at the Foetal Medicine and Genetic Centre in Dubai, said issues arise when an advanced ultrasound, called a nuchal translucency scan, is needed.

This can determine whether a baby has Down syndrome or similar disorders. Coupled with a blood test, the procedure costs Dh1,350 and is 92 per cent accurate.

"If you put first-trimester ultrasound on the claim form it will be covered," Dr Pour Mirza said.

"But if you put nuchal translucency, they will say they have nothing to do with genetic problems."

This "burden of science" falls on the shoulders of all stakeholders, he said.

"There are people misusing the same situation, for example for sex determination," Dr Pour Mirza said.