Affording IVF

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When a Higher Cost Health Insurance Plan Makes Sense

Save money by paying more for insurance
You can sometimes save money by opting for the more expensive health plan..
The costs of medical care are sky-rocketing in the United States, and this includes in vitro fertilization (IVF).  If you live and work in a state that does not mandate IVF health insurance coverage, then you might want to consider relocating if your health insurance plan excludes IVF coverage.  It might actually save you financially in the long-term!  According to a 2011 article published in Fertility and Sterility by Patricia Katz et al, a total expenditure of $61,377 was the median cost per successful IVF patient outcome among their study subjects.1  Since the Affordable Care Act does not mandate IVF coverage, it may be difficult to obtain insurance providing IVF coverage outside of the 15 states that do.  If your employer does offer health insurance covering IVF, it may be preferable to choose one with a higher monthly premium if it covers more of the possible costs incurred in the course of your medical visits.

In preparation for IVF, hormonal therapy (i.e., GnRH agonist, follicle-stimulating, and/or luteinizing) will likely be initiated by the physician that may involve daily injections for a couple of weeks.  In August 2012, an article published online in Reproductive Biology and Endocrinology by Sills et al reported higher non-reimbursed medication costs for GnRH antagonists than GnRH agonists.2  Their finding illustrates the importance of clarifying the medication coverage of your specific health plan.

A huge surprise to patients of outpatient clinics at medical centers is that the organizational units generally bill separately.  Therefore, you can receive a separate bill for the office visit, lab tests, pharmacy, and other treatments.  Insurance companies view these as separate claims—and each must be coded correctly for reimbursement.  Many health insurance companies cover medications provided at a medical center and by prescription for use at home at vastly different rates.  If you are unsure of whether your insurance will cover your entire hormonal treatment regimen, contact your health plan’s Member Service representative to understand the coverage terms before you receive a walloping bill!

Even if you are lucky enough to have an employer-paid plan—or an individual policy—that covers the costs of IVF, you need to discuss the terms of coverage with a Member Services representative to ensure that you understand what procedures, lab tests, and pharmaceuticals your insurer will cover.  Clinical staff are hired at health insurance companies to review claims and seek loop-holes to cut costs.  If any therapy undertaken does not meet their exact parameters, they may deny the claim.  If you feel it should have been a covered expense, submit your grievance in writing within the time period allowed by the insurer.  This can result in a reversed decision in your favor—saving you money.

Assuming you don’t plan to pay out-of-pocket, one of the most important decisions you make related to undergoing fertility treatment may be your health insurance.  For that reason, it is wise to plan ahead for the financial costs.  Do you really want IVF or would adoption be a viable alternative for you?  And, the fertilization costs are just the beginning—having a baby is expensive!  Seeking the advice of a financial planner may enable you to budget better for the non-covered costs involved in your fertility treatment regimen—not to mention pregnancy-related costs!  The stress involved in parenting is enough without adding a medical debt burden to the stew.   Outcome uncertainty inherent in undertaking IVF makes it vital that costs—offset by a sound choice of health insurance coverage—be considered along with the emotional need to have children.  After all, you could have twins!

Hope this was helpful! If you have any comments or questions please don’t hesitate to write them below.

Cheers!

References:

1)      Katz P, Showstack J, Smith J, et al.  (2011).  Costs of infertility treatment: Results from an 18-month prospective cohort study.  Fertility and Sterility 95(3): 915-921.

2)      Sills ES, Collins GS, Salem SA, et al.  (2012).  Balancing selected medication costs with total number of daily injections: a preference analysis of GnRH-agonist and antagonist protocols by IVF patients.  Reproductive Biology and Endocrinology 10:67.

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Coping with Infertility around the Holidays

infertility holiday stress
The holidays can be extra stressful if you are dealing with infertility
Both the holidays and infertility an be stressful enough by themselves. Combine the two and you have a potential recipe for an unhappy season. I want to share a few tips both for couples trying to conceive and the friends and family of couples undergoing fertility treatments.

7 Tips to help with the holiday stress

  1. Reserve the right to say no: With the holidays come holiday parties and get togethers. Think carefully about which events you agree to go to. If you know it is going to be too painful to be around a couple with a newborn, or visit with certain friends, it is OK to decline the invitation. At the end of the day your needs to come first, although often times visiting with friends and family can be a great stress reliever.
  2. Use your support system: The holidays are a great time to visit with the people who love you. Take comfort and strength from their love. If visiting is not an option, call someone who you can talk freely with and vent your frustrations or just use the time to catch up. If you haven’t told anyone in your family about your infertility troubles yet, then it might be a good time to broach the subject to one or more of them. Having at least one member of the family in the know can be boon as they can lend you strength and run interference for you.  Just talking about your troubles can lighten the load significantly, even if it does nothing to solve things.
  3. Prepare an answer to the “kids” question: If your infertility, or even desire to have kids is known you will likely be asked about it. A lot of the uncomfortableness around these conversations can be avoided if you plan ahead and have an answer ready. Remember, your friends and family probably mean the best, even if their good-intentions bring up a painful subject. Perhaps, if you are ready, the inevitable questions this year could precipitate sharing your burden of infertility. (#2)
  4. Look for the best in every situation: While it is OK to avoid events or people that will cause you distress or pain, but you shouldn’t shut yourself in this holiday season. If attending multi-function events pick and choose the parts that make the most sense to you. You can change your plans to either arrive or leave early or late to make things easier for you.
  5. Take a fertility vacation: If your infertility treatment is getting really stressful and you have failed one or more courses of treatment then maybe the best option is to take a break. Take a month or two off this holiday season, go on a vacation, or just unwind for a bit. Stress can be counterproductive for treatment, and strain relations with your partner. Take this time to do something you have always wanted to do. The holidays can be stressful enough without having to undergo fertility treatments. However, if you have met your insurance deductibles, and would be saving money by continuing your treatments the remainder of your calender year, or plan year then it might make sense to postpone your break.
  6. Find company in other couples: This holiday season remember you are not along in your struggle. Infertility is a common problem that affects 1 in 8 couples. It is very likely one of more of your friends have either already had treatment, are undergoing treatment, or will have to have medical help to conceive. Talk to your friends that have gone through this before, they will understand the stress and pain infertility causes you. Just spending more time with couples without kids can be a help. If you don’t know anyone who has gone through infertility before, there are always online chat groups, forums, and other support groups that can  offer support  during this stressful time.
  7. Start a new holiday tradition: This holiday why not take a ski vacation, or a romantic trip out of town with your partner. Do something fun and/or adventurous to take your mind off of your treatments. Taking a fresh approach to the holidays can make it much more enjoyable.

6 “Infertility Etiquette” Tips for Friends & Family:

  1. Don’t try to belittle the problem by talking about how hard it is to have kids, or how much worse things could be. Infertility can be a very, very difficult thing to go through, and no one wants their sufferings belittled.
  2. Don’t talk about your own pregnancies past or present, it is a very sensitive subject. Couples working through infertility hope for the day they will have to worry about morning sickness or swollen feet.
  3. Don’t try to tell the couple to relax. Although stress has been shown to correlate with infertility, the reality is the human reproductive system is quite complex and is affected by a large number of biological and physical factors. And for God’s sake don’t ever say anything along the lines of, “..if it is meant to be, it will happen.”
  4. Don’t tell them how to fix their problem, whether it is exercise, food, lifestyle. If the couple has seen a infertility doctor, they specialist has already covered these issues. It is common for people coping with infertility to blame themselves and the last thing they need to hear is that they are doing things wrong and are the cause of their own problems.
  5. Don’t push adoption. Every couple has their own  idea of building their family and are aware of the options. The decision to adopt or not is a very personal one that they may have already considered or struggled with.
  6. Do be supportive. Be there for them, be generous with hugs and encouraging words. Show them you care and how much you love them with or without a baby. Plan activities that don’t focus on kids. Your support and kindness can go a long way!

I hope these ideas help, if you have any comments or concerns please voice them with the form below

Happy Holidays!

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Putting a Price Tag on IVF

cost of IVF
Putting a price tag on IVF can be difficult at times
Everybody knows IVF is expensive. But when you want to find out exactly how much the IVF cycle will cost you it can often be very difficult to obtain an accurate quote. However, this is often more of a fallacy of how things are billed than any shortcomings of the clinic you are working with. This post discusses two of the different ways a clinic might bill you for IVF and what each means to you. The most common pricing models that fertility clinics use are either a pay-for-service (what most doctors/practices use in medicine) where you pay for each service rendered, or a grouped model where you pay a global fee for all the services required to undergo treatment and that one fee will cover the vast majority, if not all of services required for your particular fertility treatment.

Many clinics work with a pay-per-service billing model, where they only bill you for the services rendered. The amount of work that goes into an IVF cycle is staggering: all the doctors consultations, blood and diagnostic work, the egg retrieval, the andrology and embyrology services carried out in the laboratory to grow your embryos, the egg transfer, and all the monitoring involved to make sure everything is carried out at the proper time. Whew! Not a short list there, and I was generalizing a lot too. In this model each individual service is marked off on the day the service is rendered. This is great in that when all is said and done – you only pay for what was needed in your particular case. However, if there was a mistake made in billing – it can be very difficult for the patient to sort it out amongst the multitude of different charges on their final bill.

Another shortcoming of this model is that it makes it more difficult for fertility clinics to provide you an accurate quote for your infertility treatments. The main problem lies in that the clinic cannot know exactly what services will be needed in your particular case. Every patient is different and might require different care/services throughout the IVF cycle to maximize their chances for a successful treatment cycle- something that all parties deeply want. These uncertainties are usually pretty minimal, and IVF clinics will be able to provide you with pretty accurate quotes in most cases. However, it is not uncommon for for doctors to change the plan half way the through treatment when it is indicated. The most common expensive additional services that can sneak up on you are things like ICSI (intracytoplasmic sperm injection – a fertilization method where the embryologist manually injects a single sperm into each mature egg) when the sperm sample is abnormal on the egg retrieval day, or additional stimulation medications when the female partner is not responding to the fertility medications as planned. It is not uncommon for there to be an occasional additional blood test or monitoring ultrasound on a case by case basis, but those are relatively inexpensive services in the grand scheme of things.

The other common billing method is to batch a whole bunch of services together into one global fee. In this model there might be just one large fee for the whole IVF cycle, and it would cover all the monitoring, diagnostic work, surgical procedures, and, quite possibly, all the lab work that would be needed to get you and your partner through the cycle. This model is often preferred by many clinics and patients in that it puts the myriad costs of IVF into a single figure. Patients have the peace of mind knowing that most/all of their costs are known up front and they can plan accordingly, and it makes the clinic’s job of collecting money and explaining the costs to the patient so much easier.

This model is also suffers from the same downfall as the pay-per-service model in that sometimes additional services will be indicated, care that might not be included in the original quote. This is more rare, as the global fee model often allows for some extra care throughout the IVF cycle. This, of course, presents the issue that you might be paying extra for your services than you would have if you just paid per service rendered. That is simply the cost of offering this type of pricing model – the business has to recoup the costs of the more expensive patients somewhere. This model often makes it a little more difficult for the clinic to ask the patient for additional funds as the patient could think that everything was already included in the global fee. Good communication on the clinic’s part is essential here to reduce these types of issues. Nobody ever wants to be hit with charges out of the blue.

As the patient it is very important that you be proactive every step of the way. Make sure you understand which pricing model the clinic uses, and what is covered by any global fees you might be paying. More importantly, make sure to ask what is not covered by the global fees. Being prepared might not change the cost of your IVF cycle at the end of treatment, but it could save you a lot of stress by making sure you understand the costs every step of the way.

I wish I could provide more detail on this topic, but every clinic prices their services a little differently, and if they have a global fee, what it covers can vary. If you have any questions or comments please use the form below to ask.

Cheers!