paying for IVF

February 18, 2013 by Aaron Leave a Comment

Should you take an IVF Vacation?

IVF abroad — Make sure you do your homework before taking an IVF vacation!

Taking an IVF vacation, (travelling to a different country with the sole purpose to save on IVF costs) can be a tempting choice for some. By seeking fertility treatments outside the US, patients can save thousands on their IVF costs over what they would pay at home. These women are seeking IVF in places like South Africa, the Czech Republic, or India.

Even factoring in the airfare, a several week stay, and the actual costs of treatment it is still possible to save many thousands of dollars off the typical IVF cycle cost ($12k average) in the US. Sounds pretty good right? Well, there are more things to consider besides cost before you decide to do a little globetrotting for your treatment. Before you decide one way or the other, you should consider the following things

Safety and Standards of Care

One of the reasons IVF is so expensive in the US is the high degree of regulation. This regulation helps ensure that patients will receive a basic levels of quality care no matter where they go. Think of this as a quality control for the field, something that is often lacking abroad. Many of the countries that appeal to US patients have no overseeing body that enforces basic standards of care and treatment. This is not to say the clinic you are looking at will provide unsatisfactory care – just that it has no accrediting body that makes sure it follows any standards of care.

Success Rates Abroad

IVF success rates are reported using standardized methods in the US. This ensures that all clinics report their rates in the same manner. Even with these standardization practices, you will see a whole slew of different stats out there that clinics can use to promote their practice. Clinics abroad may report their statistics in different, more favorable ways. If you are comparing rates abroad with your local clinic make sure you are looking at the same rates. Otherwise you may be comparing apples to oranges.

Also worth noting that, overall success rates in the US are very high compared to other countries. While you may be saving money – less total cycles may be required if you are treated in the states.

Patient Information

All patients treated in the US can be assured a certain degree of privacy and have uniform standards regarding what information is available to which parties. Clinics in the US are required to keep all information about patients, donors, and any children born confidential. If you are looking at an IVF clinic abroad then there are a few questions you should obtain the answers to.

What happens to the personal health information you provide during the treatment?
Who will have access to it?
What happens to the medical information if the clinic closes?
If donor materials (sperm, eggs, embryos) were used in your treatment cycle, who will be able to access the information about the donor?
Can you get your records transferred to the US?

What happens if something goes wrong?

The field of medicine is extremely regulated in the US. All doctors and facilities may not be created equal, but you can rest assured that they all answer to strict guidelines regarding ethics and standards of care. If something were to go awry with any medical treatment in the US, an unhappy patient would have methods of recourse. If something were to happen overseas, you may or may not have any recourse. It is advisable to do a little research on these worst case scenarios to see how complaints and concerns would be followed up on in the country you are looking at. You may also want to look into obtaining legal advice to clarify how enforceable the contracts or agreements between you and an outside clinic are.

Multiple Birth Rates

Multiple birth rates are a significant health risk associated with fertility treatments like IVF. In the US there are strict regulations regarding how many embryos that can be put back (thanks Octomom!). Many clinics might transfer additional embryos in an effort to boost the rate of success, however this also increases the risks for both the mother and baby(ies). There may not be any regulations in the country you are looking at so make sure the clinic in question has standards in place to reduce the risk of having multiples.

There can also be legal and ethical issues surrounding donor and surrogacy cases (I will get into those a different time).

Researching your IVF Vacation

Even though there are many potential issues with seeking medical treatment overseas, it doesn’t necessarilty mean that it is not a appropriate course of action for your particular case. If you decide you want to look into a specicf clinic a little more there are some guidelines you can follow to help you make an informed decision.

If possible, try to speak with someone who has been treated at the clinic, or the country in question. You will be able to find out a lot about the quality of care through their experiences, although, take it with a grain of salt. Look at the clinic’s website, and see what kinds of information and statistics they provide. Check the qualifications of the staff and if the clinic is accredited in any way. If it is accredited, look into the accrediting body to make sure it is legitimate, and not just a pay-for-entrance type of organization. Other things, like if they have English speaking staff, and how much time they will spend with you discussing their treatment can also be telling of the type of establishment it is. Be wary of any clinic that is not interested in your medical history. A good clinic will want to see all your relevant tests and medical history.

Some questions you should ask the IVF clinic

What type of fertility regulations are present in their country? Are there regular inspections?
What is the clinic’s record of safety, and do they follow any standards?
Does the laboratory follow set procedures?
How is patient’s medical confidentiality kept?
Are there any possible language barriers to communication?
What degree of travel is require? How many trips, and how long will you need to stay to complete your treatment?
Does the clinic offer the treatment you desire?
What are the clinic’s success rates and how are they calculated? You should get a few year average for your age group and also donor eggs.
What is the multiple birth rate at the clinic? Do they follow any guidelines to reduce the risk of multiples?
Does the clinic store embryos? If so, for how long?

As you can see, choosing to take an IVF vacation is not an easy choice to make. On one hand you will probably be saving money, on the other hand you will have to do a lot of investigating to make sure you will be receiving the quality of care that you deserve. If you are thinking about having your IVF done overseas make sure you do your due diligence to be certain that you are making as an informed decision as you can.

Cheers!

February 13, 2013 by Aaron Leave a Comment

How IVF Costs Could Reduce Your Tax Bill

IVF costs tax deductible — Your large medical bills might be tax deductible!

A lot of people might not know that they have the option to deduct a portion of their medical expenses from their yearly taxes if they choose to itemize their deductions. The expenses must pass a certain threshold in order to be deducted.

This limit is based on your yearly income. For the this tax year (2012), any medical expenses that exceed 7.5% of your adjusted gross income (AGI) can be deducted. The limit is higher for those of you who are subject to the alternate minimum tax. Only medical expenses that fall under the IRS guidelines can be deducted. So make sure you double check if you are unsure something qualifies.

Let me give you an example to help straighten things out. First off, let’s say that your AGI for last year is $50,000, so 7.5% of that is $3,750. If you happened to spend $3,500 on medical expenses last year you wouldn’t be eligible to deduct any of those expenses as they do not exceed the 7.5% threshold. However, if you spent $10,000 on medical expenses last year you could deduct $6,250 of those expenses as that is the total amount of the expense over 7.5% of your AGI. Which would be some serious tax savings.

Be aware that these limits will change with the passing of the Affordable Care Act last year. Next year (tax year 2013) the threshold will be increased in to 10% of your AGI.

So what does this mean for you?

Fertility expenses, like IVF, are a covered expense as of writing this article. So if you cycled last year, or are going to cycle this year and your expenses exceed the threshold set by the IRS you can deduct those expenses from your taxes! Now this is hardly free money, but it should save you a few bucks! Another tactic you can utilize to bunch a few medical expenses together in one year to maximize your tax savings. For example, if you know you want to get laser eye surgery, but are not in any hurry to get it done, you could either get it done sooner if you already had a bunch of medical expenses this year. Or you could wait until next year in order to try to push your medical expenses over the limit for the next calender year.

Fertility treatments are expensive, and insurance coverage is spotty, so they make the perfect example of when this deduction could kick in. Especially when considering sharing risk programs that usually make the patient pay a large fee upfront (the cost of several IVF cycles). Since you paid this entire amount at one time, you would be able to claim it on your taxes , even if they treatment stretched out over until next year. If you end up getting a refund from the clinic be aware you will have to update your taxes and will owe some additional money.

Hope this helps!

February 9, 2013 by Aaron Leave a Comment

The Costs Before IVF – Diagnostic and other workup costs

IVF costs — Getting ready for an IVF cycle can be a costly journey!

So last time I talked a little about why an advertised IVF price may not actually reflect you total costs, today I want to keep going on the same topic and focus a little more on the potential costs leading up to your IVF cycle. Assuming the clinic is being completely straightforward with their IVF pricing and explanations you should be able to plan your IVF costs pretty accurately (Hopefully you only need one cycle to get pregnant – average is 2 – 3). The problem is that it can take a good deal of work and money to get you ready for your IVF cycle.

The diagnostic phase or workup is an integral part of all fertility treatments. Put quite simply, if you don’t know the source of the problem, it can be hard to fix it. A thorough diagnostic workout allows the doctors to tailor their treatment to maximize your chances of success. Not really something you want to skimp on. It is far better to spend a little more money upfront than to waste more later on unrealistic treatments that have little chance of succeeding.

Of course, if your clinic is already recommending IVF it means that they probably have a good reason to do so, either it is the best course of treatment due to your age/case or that you have already underwent most of your workup.

Even if you have already done some diagnostic work, most clinics will have a more thorough workup that they have their IVF patient go through. These diagnostic tests can cost thousands dollars depending on your insurance coverage and your particular case. The good news is that many insurance companies will cover some of the diagnostic costs. Insurance coverage for IVF is less common so once IVF is decided any workup required to get you 100% ready for your cycle would no longer be considered diagnostic.

There are a few things that can add large additional costs to your cycle such as endometrial polyps or fibroids. These often require surgical intervention, and what’s worse, polyp removal is often seen as a fertility treatment – since you are getting it removed to prep you for your treatment – and might not be covered by your insurance. Adding many thousands of dollars to your final bill!

The main thing you can do is be prepared for these costs. It can be difficult for a clinic to give you an exact price before actually talking to one of the doctors, as they will not know which tests will be required. After you see the fertility MD you should be able to get a good picture of what the recommended tests are, and hopefully a picture of the financial costs of any diagnostic testing or procedures required to get you ready for your treatment. As always, if you are confused about any of the prices be sure to ask your doctor’s office.

Cheers!

February 7, 2013 by Aaron Leave a Comment

Looking Past the IVF Sticker Cost

Hello, I regret that it has been a busy week so I am just now getting a new post off. I will do better in the future! Today’s topic is going to be why you should look a little closer at any clinic advertising cheap IVF cycles. There can be a whole lot of additional charges involved the process and your cheap IVF cycle may get a whole lot more expensive.

One of the problems with putting a single price tag on something as complicated as an IVF cycle is that not every doctor/clinic will carry out the procedure in exactly the same way. More importantly, different clinics may include or exclude certain auxiliary procedures that may not be needed in every case. They can then charge extra for these services – resulting in a higher bill than expected. While this makes perfect sense, as they might be doing more work in certain cases and should be compensated for their work, the tactic can surprise patients with unexpected charges. In my time working with patients, I have noticed that it is not necessarily the total cost of the services that surprised or upset patients as much as the fact that the charges were unexpected. Most fertility clinics try to make their costs known to patients, but this can vary tremendously depending on where you go.

Unfortunately, this is reflective of one of the core issues in healthcare today. That prices and costs to consumers are generally opaque to them. It is very difficult for a patient seeking care to get a concrete price for their care, and to compound the issue, when someone really needs the care, they often don’t have the liberty of time to shop around for the lowest price (not to mention the fact that patients want the best care possible and there is no easy way to compare similar services from different doctors/clinics).

One simple issue can be that the clinic will have a financial discussion earlier on in the process and during the course of treatment something unexpected comes us that requires an additional service (ICSI is probably the most common one). The clinic may have even mentioned the possibility of the additional service in the financial discussion, but it might not have been emphasized much or the patient just forgot it with the multitude of other information they were trying to absorb.

Another thing that can help patients sort through all this stuff is just being proactive. Ask, ask, ask! Ask your financial counselor if the lump sum you paid includes everything required, or what are the common additional procedures tacked on. More importantly, if you are unsure, or confused by the costs – ask your clinic for help. They would much rather have to take a few more minutes out of their day to explain something that you might not understand than have you find out unexpectedly and be upset. As much as they want to help you, they can be really busy sometimes and can assume you heard them the first time. If not, give them a little nudge to get another explanation.

From the clinic standpoint it is important to beat this stuff over your patients heads as much as possible (I mean that in the nicest way possible!). You want to do your best to make sure the every patient is aware of what they will be charged, and what possible additional services might be needed. You want to give them the best, more clear picture of the possible costs as you can. They will thank you for keeping them in the loop!

Cheers!

January 28, 2013 by Aaron Leave a Comment

Shared Risk Programs

What are they?

Shared risk programs, aka IVF Refund programs, are an interesting vehicle for reducing the financial risk of having to undergo multiple IVF cycles. Getting pregnant through IVF, despite the best efforts of the brightest physicians and doctors around the world, is still an odds game. Patients trying to get pregnant through IVF are basically rolling the dice for a successful pregnancy. Depending on your age and condition, these odds can vary from under 10% per cycle to upwards of 75/80%, if using donor eggs. As such, it is not uncommon for patients to need several rounds of IVF treatment in order to take home a baby.

IVF is not an inexpensive treatment and the financial burden of having to go through many cycles of treatment can be overwhelming. To help put fertility patients financial worries at ease clinics developed programs that would, for eligible patients, put limits on the potential costs of their treatment cycles. You can think of them as a form of infertility insurance that helps protect the patients from financial loss. And thus shared risk programs were born.

How do Shared risk programs work?

Essentially, these programs offer patients a flat-fee that will cover a set amount of treatment cycles and, if the treatment is not successful, offer a partial or full refund of those fees. These programs are beneficial to both parties. They give patients a clear amount that they know will get them to their goal of getting pregnant, or they will get a refund that they can use to pursue alternate avenues of reaching their goal. For the clinic, there are several benefits: they allow them to collect a larger fee (usually the equivalent of several full IVF cycles) upfront from the patients; since it is a flat fee collected, the clinic stands to make a profit if they can get the patients pregnant on the first cycle with decreasing profits with subsequent cycle. However, the clinics will lose a lot of money if they are unsuccessful and cannot get the couple pregnant. In this fashion both parties share risk. The patient might end up paying a little more for their IVF costs, but have the ability to cycle several times and even get their money back if all cycles are unsuccessful. The clinics have the opportunity to collect a greater fee if they provide quick success, but also balance that with the potential of losing part/all of their fees if the treatment ultimately doesn’t work.

How much do shared risk programs cost?

These IVF refund programs usually cost between 2x-3x the cost of a single IVF cycle, and will usually cover all clinical appointments and procedures required in the cycle. Cycle medications are almost always extra as they are sold by third party pharmacies so be aware there will be additional costs each cycle that will not be refundable. If you are choosing to participate in a shared risk program I would clarify this detail, and make sure you know what is and is not included in the program fees.

What are the eligibility requirements for Shared Risk Programs?

Since the IVF clinics bear a significant financial risk in offering these types of programs, and that the average success rates of IVF range between 10-60% depending on the age group they place restrictions on who can sign up for this type of program. It is in their best interest to offer this type of program to the patients who get pregnant most easily. This means an age cutoff and other medical qualifiers that like normal day three hormonal panels, a normal uterine cavity, and sperm parameters within certain ranges. These will vary clinic to clinic, so if you are interested in this type of option be sure to ask your doctor if you are eligible.

Are Shared Risk Programs Ethical?

Shared risk programs have been reviewed by the Ethics Committee of ASRM (American Society of Reproductive Medicine) and found to be perfectly ethical. They ruled that “that shared risk programs may be viewed as a form of insurance against the risk of failure that might appeal to some couples seeking IVF. The appeal arises from the general absence of health insurance coverage for IVF”. They concluded that as long as clinics were upfront with the costs and benefits of such programs vs regular pay-per-service models, and did not create false expectations, or promises, shared risk programs were an ethical and potentially valuable method of paying for treatment.

Should I use a Shared risk program?

This is not an easy question, and certainly not one I should be answering for you. Shared risk programs offer a great way to control the costs of your fertility treatment, but at a potential higher cost if you are successful right away. You should carefully weigh the benefits and risks the program(s) offers you and make your decision after considering what is best for you and your family.

What is the best Shared risk program in the Pacific Northwest?

Now down to the nitty gritty. This is not an easy question, and as a Seattleite I admit I did not fully research the options in Idaho or Oregon. However, after looking at the programs offered by all the major clinics in the area I have concluded that the Peace of Mind 100% IVF Refund Program offered by Overlake Reproductive Health to be the most comprehensive program out there right now. It rises above the others programs such as Seattle Reproductive Medicine’s Attain IVF Refund program, or Oregon Reproductive Medicines IVF Refund Program in that it offers a complete refund and more treatment cycles! So if you are considering an IVF refund program and live in the Seattle Area then ORH’s is the best one out there right now.

Well there you have it. I hope I was able to answer your questions about shared risk programs. As I said in the beginning of this article these refund programs are an interesting vehicle that offers patients a means to help control the costs of their infertility treatment. If you have used a shared risk program before, have any questions or comments, or just want to say hello, please do so in the comments.

Cheers!