paying for fertility

December 4, 2014 by Aaron Leave a Comment

Bye Bye Fresh IVF Cycles, and Why This is a Good Thing for Your Pocketbook

2014 is winding down and I really hope that everyone had a great year. I know that sometimes life has a way of throwing curve balls and those who are visiting this site probably know that fact quite well. Still, it is how we deal with the events in our lives that really affect who we are and how we feel. So if you are stressed out about life or are having a hard day I would encourage you to sit still for a few seconds and take a couple deep breaths. I guarantee you will feel better and more relaxed. Then the next time you are stressed out, try to remember how a simple thing like taking 30 seconds to breath can make you feel so much better (seriously, it’s science).

OK, I’ll get off my soapbox now. What I really wanted to talk about today was an exciting new trend in the infertility world that will mean higher success rates for everyone going through IVF with their own eggs. I am talking about the end of fresh transfers (using your own eggs) as we know it. Recent evidence has shown that the medications women take to hyper-stimulate their ovaries in order to force their body to mature many more eggs than it would in a normal cycle can have a negative effect on implantation rates, and thus lower the chances for a successful pregnancy. Essentially the stimulation required for IVF is, in fact, bad for IVF success. (Now some of you might be thinking, “what about minimal stim IVF?” – That is a whole another topic for a different day.)

What this means is that an increasing number of fertility clinics across the country have switched from offering fresh cycles where your embryos are retrieved and subsequently transferred during the same cycle to a fresh/FET (frozen embryo transfer) model where your embryos will be retrieved and grown in the lab then frozen (vitrified, hopefully) and then transferred back the embryo(s) on another cycle in which you will receive no stimulation medications, just like any other FET cycle.

This trend is bolstered by recent advances in freezing technology/techniques. Now the industry standard is vitrification. Where the egg/embryo is frozen quickly and, most importantly, the thaw survival rate is in the 95-98% range. Compare that with slow freeze techniques of the past which boasted rates between 30-50% and it’s a game changer. Effectively, the embryos can be frozen and thawed again with little chance of something going awry.

Most importantly, these new treatments have increased the success rates for all patient populations using their own eggs as much as 10% across the board! That is a huge increase! Higher success rates mean less cycles will be required on aggregate to achieve pregnancy.

What this means to IVF costs is a higher cost to get to the transfer stage, but a reduced average cost per successful cycle, across the board. On a cycle by cycle basis there might be some cost increases, as the newer techniques require more work, but, on average, less cycles will be required. Resulting in lower total average costs. This is a good thing!

If you are looking at IVF clinics right now for treatment I would encourage you to ask about both the clinic’s use of vitrification in the lab, as well as if they offer this type of fresh/FET cycle (often referred to as Freeze-all cycles). If they don’t then you might want to think about another clinic – it could save you money.

Cheers!

August 15, 2013 by Aaron Leave a Comment

IUI Discount Programs

saving on IUI treatment — IUI Discount programs give patients more options. Image credit

Hi! First off I want to apologize for taking some time off from writing for this blog. Life had gotten a little hectic and I couldn’t find enough time to sit down and work on this site. I am happy to say that things have calmed down a bit, and I have started working on a series of new posts! It’s super exciting to be getting some momentum going again on this project :)

Today I wanted to talk a little about IUI, or intra-uterine insemination, treatments. IUI is a great first treatment option for many couples. It is relatively non invasive and much cheaper than IVF. It is often recommended for women or couples who have:

ovulation issues
are unable to properly time intercourse, / sexual dysfunction
mild male factor
unexplained fertility
or for women using donor sperm

An IUI is a type of artificial insemination. Basically, instead of having the male inseminate the female naturally via sexual intercourse, a medical professional uses a tiny catheter to inject a small amount of prepared sperm directly into the woman’s uterus. This procedure is timed to occur right around when ovulation (when a female is most fertile) occurs, and can be done either naturally or accompanied by fertility drugs. The idea is to coordinate the whole operation so that the sperm and the egg can meet in a favorable environment at the proper time for fertilization to occur.

iui explained — Prepared sperm is injected directly into the uterus during an IUI procedure. Image source

The IUI process can increase a woman’s chances of becoming pregnant over practicing timed intercourse and can be a successful treatment for many of the disorders listed above. The procedure is relatively simple, and, as such, does not cost much compared to an IVF cycle. The cost can vary depending on the complexity of the monitoring and if fertility medications are used. I will list out the main varieties in order of ascending costs.

The cheapest, and often least successful are natural IUI cycles where ovulation is determined through the use a combination of a best guess based on cycle lengths, temperature readings, and maybe ovulation kits to confirm ovulation. No fertility medications are used. These are less successful then the more monitored counterparts, as more is being left unknown throughout the process.

Next up would be natural cycles with monitoring. These are IUI cycles without any medication but with a clinic monitoring the woman’s cycle to more accurately determine the optimum time for the insemination to occur. The amount and type of monitoring can vary depending on the fertility clinic. Clinic monitoring can be very important as proper timing is very important to IUI success.

Medicated cycles with or without monitoring are the most expensive variant, but also the most successful. These cycles use fertility drugs to increase the chances that a healthy egg will be ovulated. The amount of monitoring can vary depending on the clinic you go to, but most often they will have you come in for one or more blood draws and ultrasounds to precisely determine when ovulation occurs. Sometimes ovulation is even triggered through the use of other medications.

Regardless of the type of IUI cycle that is recommended by your doctor it is probable that you will need more than one cycle to be successful. If you are looking into, or about to start an IUI treatment cycle I sincerely hope you will get pregnant on the first round, but the odds are against you. It has been said that the odds of any given IUI cycle to succeed are around 20-30% for a young healthy couple. Depending on the severity of the issues affecting you or your partner those odds will be go down.

Since the cost disparity between a round of IUI and an IVF cycle is so pronounced many couples will want to pursue a couple IUI cycles before moving on to IVF. Sometimes against the recommendations of their physicians who understand that the chances for success with IUIs will be very low for that patient. I certainly can’t blame a patient for trying an IUI or two even when the odds are stacked against them. However, that money is more often than not just thrown away with unsuccessful cycles before the patient ultimately ends up pursuing IVF.

That doesn’t have to happen! The other day I came across a fertility clinic in Seattle that addresses this issue with two separate programs designed to make the whole decision process much easier for patients. One program is for patients who have a good chance succeeding though IUI treatment, but will likely need more than one cycle to achieve a healthy pregnancy. They call the program an IUI Discount Program, and it basically allow a patient to get a third IUI cycle free, if they prepay for the first two. The best part is that they will refund the patient the second cycle if the first one is successful. They also give an option for patients to go through the program again at a slightly higher rate.

Their next program is called an IUI Credit Program. This one is my favorite of the two as it allows patients to first try a couple IUI cycles, and if those are not successful, apply the money they have already spent against the cost of an IVF cycle. This gives patients the ability to first try the low cost option, before having to commit to an IVF cycle.

Both these programs are innovative and among some of the best I have seen. They give patients the ability to reduce their financial burden as they pursue lower cost fertility treatments before jumping into the much more expensive options. I just wish more fertility clinics would offer programs such as these as they have the potential to really benefit the patient.

Cheers!

May 14, 2013 by Aaron Leave a Comment

Actually Using The HealthCare Blue Book

This is a follow up to my last post about the health care costs website www.healthcarebluebook.com. If you haven’t checked it out yet, give it a read. Basically, the site is a resource that has “fair” prices for medical procedures that can then be used to help you haggle down your healthcare costs. A practice that can be very valuable for cash pay patients that either do not have insurance, or coverage to adopt as practically all the health care in the US is grossly overpriced. What’s more, most providers are more than willing to offer cash pay discounts and bend on their prices for non-insured patients. I am reminded of the old truth that it “never hurts to ask”, because, who knows, you might just get what you ask for.

Anyway, I recently got a question from a reader about how to actually get the fair prices mentioned referenced on the site. This got me thinking about providing some more detailed instructions on what the site was good for using the site to reduce your health care bills.

First, I scoured the interwebs for responses from other people that have used the service to try and find out exactly how useful the service is. I was largely unable to find anything from actual patients that have used the service in the past, only news stories talking about the site.. odd. (I would love to hear from anybody who has successfully used the site to reduce their bills!)

Here are the basic instructions taken directly from the site (link to more FAQs about their service):

How do I ask for a price?

Many people are apprehensive when it comes to asking providers about prices, but don’t be afraid to ask. Providers expect patients to ask about treatment cost. You will find requesting a price from a provider surprisingly easy – just follow these steps:

Know what specific service you need – Write down the name of the service and, if possible, ask your doctor to provide the billing codes for the services. (These codes are called CPT codes for doctor’s office visits, and DRG codes for hospital treatments.) The more specific you can be the easier it is for a provider to give you a price.

Determine what a fair price is – Before calling a provider to request a price, look up the services on the Healthcare Blue Book website and write down the price. If you can’t find your service, then submit a request to Healthcare Blue Book to see if we can find the fair price.

Call the office staff – Ask to speak with the person on their staff who can discuss pricing.

Make sure to let them know the insurance company you are using or if you are paying for the service yourself – If you are using an insurance provider network, then you will get the insurance company’s discount. If you are paying for the service yourself, make sure to ask for a self-pay discount.

Ask what their price is for the service you need – If your treatment is a surgical procedure, make sure to ask about pricing for all components of care, including the surgeon, hospital and anesthesia fees. Also ask if there are any fees related to the procedure that you have not covered in your conversation.

If my provider’s price is higher than the Healthcare Blue Book fair price how do I get a lower price?

If you are using an insurance provider network, you will need to call other in-network providers to request their pricing. Most network providers have to use the network rates. You may also contact your insurance company and ask them to help you locate a different provider.

If you are paying for your own services, then you can either ask your provider for a discount or call other providers to request their pricing. It is OK to ask the provider if they will accept Healthcare Blue Book price. If the provider is not comfortable with the Blue Book fair price, then ask them what they accept as payment from Blue Cross/Blue Shield patients for the service. (Why should you have to pay more than the other patients they treat when you are paying cash?)

Most providers understand that cash paying customers want the best value, and many will give a discount. However, the first provider you call may not offer a price that you are willing to accept. It is helpful to request prices from at least three providers before making a decision.

As you can see from the description above, negotiating for the best prices may not be an easy task. If you lack health insurance, and need healthcare it is definitely in your best interests to do some haggling. Because, as I said above, most providers are very willing to offer at least a token cash pay discount, and some might be willing to offer significant price cuts. They already give huge discounts to their insured patients, and paying in cash also reduces their overhead when it comes to billing and managing insurance claims. A little time and effort can end up saving you thousands of dollars.

Hope this is of some help. Again, I would really love to hear from someone who has actually used the site’s fair prices in their negotiations, and what their experience was. If anyone has any questions feel free to post them in the comments.

April 3, 2013 by Aaron Leave a Comment

IVF Doesn’t Cost That Much

I know what you are thinking. Everyone knows that IVF (in vitro fertilization) costs a whole lot of money, what is this guy talking about.

Let me explain.

Sure, the price tag on an IVF cycle is certainly not insignificant. IVF can cost upwards of $20k a cycle when you include medications and other auxiliary services like PGD of ICSI. However, when you compare the costs of IVF to say, other medical/surgical treatments it doesn’t seem all that bad. For example, the average cost of a 30-45 minute surgical procedure in a hospital is about $15-20k. Now this is the billed price, not the negotiated price that people with insurance would be responsible for, but you can start to see where I am coming from here. IVF is not just one single procedure, in fact, there are probably about 20 different services spanning several weeks that go into a full cycle. So when you actually look at what you are getting, IVF can be pretty inexpensive compared to some other procedures.

I know this is a flawed analysis. For one thing, there is a much greater chance that you will have insurance coverage for your surgery in a hospital than you would for an IVF cycle, unless you live in one of the few states with mandated coverage for infertility. Some fertility clinic don’t even accept insurance at all. They expect to collect the money they ask for, and not the much reduced rate negotiated by your insurance company. There are still plenty of people out there who do not have health insurance and would be paying these prices. For these people, having a minor knee surgery would cost more than an entire IVF cycle

No matter how you look at it, the 20ish thousand dollar price tag on an IVF cycle is still a lot of money – at least for most of us. At the end of the day, it does not matter how the price of IVF compares to other medical procedures. The only thing that matters is what the cost of the procedure/service that you need or already went through.

I am really just trying to put things in perspective here – health care is expensive (very expensive for those of us living in the US). If you need to see a doctor, and don’t have insurance – lets hope not! – it is going to cost you. However, there are ways that all of us can save on our healthcare costs. So, like many things in life, it pays to be proactive.

February 28, 2013 by Aaron Leave a Comment

5 Ways You Can Save on Your Healthcare Costs

IVF costs — These simple tricks can save you hundreds on your health care costs

Everyone knows that health care can be expensive. Even if you have decent insurance, those trips to the doctor can add up quickly. Figure in some diagnostic testing and medication or two… well, you get the picture. Even with skyrocketing costs, it is possible for you, the patient, to save money on your health care, without cutting any corners. Below, I list 5 ways that you can save money on your healthcare costs. I hope you find them useful.

Use the internet (with care!) for medical advice

Google is your friend. The internet is full of great information about health problems. The most important thing is to know when you should seek medical care and when it is OK to stay home. some things like abdominal pain could be a range of conditions ranging from temporary ailments like heartburn or food poisoning, to serious conditions where delay can just cause more problems. Don’t be afraid to do some research on your condition, just take it all with a grain of salt and use your head! If you think it might be serious it is better to error on the side of caution and get it checked out by a professional. While skipping a few doctor’s visits will save you money, not going and then having your codition worsen will just lead to more doctors visits and higher medical bills. One good source of information on basic family medicine is The Family Doctor, a site maintained by the American Academy of Family Physicians. Remember to use reputable sites for your information. Sites maintained by professional organizations or doctors offices are always good bets.

Make the most out of every visit to the Doctors

Lets face it, going to see a doctor is expensive. So whenever you need to see your doctor it is best to be prepared for the visit. Things like having your symptoms all written down, with details like when each happened, and in what order can be very helpful for your doctor to accurately diagnose your condition. By writing all this important information down before hand you can be sure to have it all for your doctor when you go in for your visit. Often, especially with more complex symptoms, it can be easy to forget a minor detail about this or that. Seeing a doctor can be stressful for some people, and that stress can cause them to forget something about their ailment. What they forget, or the minor detail left out, could be just what your doctor needs to nail down a diagnosis. Often one of the most important tools available to doctors in their effort to obtain an accurate diagnosis is what you tell them. Making you you present the whole story in full detail can save you from unnecessary diagnostic poking and prodding, all of which costs more money.

Ask questions

This is one of the most important things you can do to help save yourself money at the doctors office, be it for infertility treatment, or at your family doc, is to ask questions. A lot of doctors are very busy, and they might recommend testing or prescriptions that are more expensive than necessary or fail to take the time to fully explain why the more expensive test is important. By simply asking them if the test is really required, you can get the pros and cons of the decision and use those to better analyze if you really need that test to be done. Often if you just mention that you are concerned with costs and ask if there are any less expensive options available, they will offer less expensive testing, or even say that the test is not 100% required… imagine that. Asking these questions of your doctor is very important to making sure you get the care you need and not the care you don’t. Besides, it is your health and you should be proactive!

Reduce unnecessary and duplicate testing

It is your health, you should be proactive enough to have personal copies of all your health records. When you switch doctors or see multiple specialists for different conditions it is important that each doctor has your complete medical record. Keeping and sharing your complete medical records can save you from repeated tests ordered by your new physician, or a test ordered by a specialist that you already had done last year and don’t need it repeated yet.

Primary care doctors

Having a good primary care doctor can save you money. Health care is confusing. Being bombared by adverts on television about this medication or that condition can fill patient’s heads with all kinds of ideas, and conflicting thoughts about whether they should be taking X or they need to get Y test done… Having a primary care doctor that you can go through to coordinate your care can be invaluable. They can act as stewards to your health and make sure you are getting the care you need and not anything more. They are your health experts. Use them as such.

Optimize your prescriptions

You can save money on your prescription medications by using a few simple tricks. First, and foremost, the most important thing you can do is to shop around. Price compare your medications between pharmacies. Medication prices can vary immensely, think 5x to 10x, from pharmacy to pharmacy. By calling around and talking to either the pharmacist or pharmacist tech, you should be able to get quotes over the phone. Make sure you have the medication name, strength, and quantity before you call or you could end up comparing apples to oranges. Next, if you are taking combo pills, medications with two or more active ingredients, you can often save a bundle by purchasing them separately. If you are not sure you are taking a combo pill, ask Google, or your doctor. Lastly, be sure to apply the tips above as well. If you have access to your medical records make sure you aren’t taking a medication that was ineffectual in the past. Also, ask you doctor if a generic version would be appropriate.

With a little common sense and being a proactive patient it is possible for you to save on your health care costs. Asking questions and shopping around can be powerful tools in your money saving arsenal.

Cheers!