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Infertility Costs and Insurance Coverage: What You Need To Know

Photo: Momsolo.com

Sometime ago we found out that we needed to utilize IVF in order to have a baby and I can’t say that I was surprised.  Deep down I knew something was wrong but I wasn’t ready to talk to my doctor openly about it.  Women, *sigh* we just have this intuition and we just know, right?  Well, I did.  It was after 2-3 years of my GYN (who is also a fertility specialist) pleading with me to take some more tests because he realized that my husband and I didn’t use birth control and here we were 2 years later with no baby.

We weren’t trying on purpose to have a baby during that time, but something was really wrong and we didn’t know it.  Being in my late 20s at the time, infertility did not cross my mind. At all.  But now that we do know something is wrong, I can’t stress the importance of finding this stuff out early and understanding your financial options.

That was in 2010.  Fast forward 2 years later and I’ve spent some time researching our financial options for IVF.

The process is costly at $10-$15k for each go around.  That is, unless you have a fabulous group health insurance policy that covers not only testing, but the procedure and even better the medication. However, with the increasingly negative climate around health insurance and the dubious ability of our economy to sustain it at an affordable rate, this isn’t an option for many families.

Even with ObamaCare, until 2014, pregnancy is considered a pre-existing condition.  And, for women that means any thing related to maternity isn’t (typically) covered unless you are in a generous group health insurance plan.  If you want to understand your options, I’ve done some of the research for you.

You may be asking:

Is in-vitro fertilization covered by insurance?”

“Does health insurance cover in-vitro fertilization?”

Paying For IVF

Out of Pocket

IVF costs are not for the financially faint of heart.  Easily, you’re looking at $10k-15k each time and this may or may not include medication ($1.5k-4k).  The obvious option is to put aside the funds needed for the procedure once you’ve talked to your doctor’s office billing department about all itemized charges that the doctor has authorized in your case.

Clinic Payment Plan

This option is available for very few clinics as most want their money upfront before the procedure.  However, some do offer this option and will give you up to a year to pay them back before applying fees, interest and penalties if you fail to do so.  Some patients split the cost by taking out money of an IRA, HELOC, cash advance on a credit card etc.  I hate the idea of going into more debt so if you can save half and then pay the other half on a payment plan then that would be a good option.

Health Insurance

Research your health insurance policy, especially when in open enrollment season because your employer may have access to plans that cover the cost of IVF and the medications. Find out specifically, what it covers and does not cover.  This is best done by calling the clinic and giving them your insurance information.  They usually know based on your carrier and plan what’s covered which can be really helpful if you’re planning ahead financially.

Tip:  Aetna is known to have great IVF coverage so check with your employer to see if an Aetna plan is available to you.  If so, dig into the policy to check their exclusions.

State Mandated IVF Insurance Coverage

Resolve.org has a great list of the following states that mandate individual and group coverage for IVF along with instructions on how to go about finding out more information about your employer’s coverage based on state law:

Arkansas Louisiana New York
California Maryland Ohio
Connecticut Massachusetts Rhode Island
Hawaii Montana Texas
Illinois New Jersey West Virginia

 

  • Click on the state name above for a summary of the law, and get the full text from your state legislative website.
  • Learn whether your employer plan is fully insured or self insured. Fully insured plans follow state law. Self insured plans follow federal law and are exempt from state law.
  • Learn if your employer plan is a “greater than 25″ plan, “greater than 50″ plan, etc. In this cases, employers with fewer than a set number of employees do not have to provide coverage.
  • Learn if your employer’s policy was written in the goverened state. Generally, the policy must be written and/or reside in the state that has an infertility coverage law.
  • Learn if your employer offers more than one plan. If so, investigate which are fully insured plans in the state with an infertility coverage law.

Personal Loans/Credit Card

If you’re in a position to secure a personal loan or using a credit card then this is an option.  Just make sure that you understand the costs and have a plan to pay it back pronto, especially if you have a high rate.  If you’re able to secure a 0% introductory card for a good amount of time (6-12 months) then this is just as good as cash.

Reducing The Cost of IVF

Shop Around

Yes, just like comparison shopping for the cheapest pack of toothpaste, you should do the same with IVF.  Ask specificaly about the the itemized costs that will be on your final bill so that you can plan for it.  The only variable will be the cost of medication which can vary depending on your location and specific needs.

Some women (and men) need more medications than others and depending on your physical location, your pharmacy may be cheaper than mine.  To complicate matters further, the prices of the medications change daily.  So if you’re concerned about cost, then once your doctor tells you what meds you’ll need price them at your local pharmacy.  Tip:  Walgreens is known for having some of the best rates for fertility drugs.

IUI

Think of IUI as the turkey baster method. Momsolo.com candidly explains it this way: “IUI similar to the turkey baster method – the doctor shoots the sperm into the uterus via catheter. Not too expensive – like between $200-$400, in my experience. There may be an additional fee for the sperm wash, pre insemination, of around $150.”

I asked my doctor about this option and he explained that it’s a good option for couples with issues like low sperm count other other unexplained fertility issues.  What you need to consider is that you may end up spending more on IUI than you would IVF before you realize it.  This is why it’s important that you have a doctor that understands all of your medical, emotional and financial needs.

Natural Cycle IVF

This option allows you to complete a cycle without being stimulated to produce eggs with the help of fertility medications.  So your costs may end up being around $1.5k-4$k cheaper depending on your specific situation.  For example, a typical procedure may be $12k-$15k with medications.  When using natural cycle IVF, the meds may reduce that cost by $1.5k-4$k.  Again, if you’re in a situation where your body needs to be stimulated to produce more eggs, then this option may not be for you.

My Final Thoughts

Just keep quality in mind when you settle on a doctor.  Cheapest isn’t always the best.  Something I learned in my search for the “cheapest fertility doctor” is that given the sensitive nature of the procedure, it was important to me that we work with a doctor that made us comfortable.  As I called various clinics in my area within a 300 mile radius of our home, I realized that I was more comfortable with my doctor, even if he did come in a few thousand over cheaper docs who were only 2 hours away.

As I read the reviews, being comfortable with the process and the doctor were paramount to each patient and sometimes cheaper meant having a doctor with horrible customer service and bedside manner.  Research each doctor until you find one that you like:

  • Ask about their experience:
  • How many procedures has he or she completed?
  • What’s their track record on live births to procedures completed?
  • Do they have experience with your specific issue?
  • Where were they trained?
  • Are they board certified?
  • If your doc is uncomfortable with any of these questions, then find another one.

If you have any tips or if I’ve missed anything, please post them in the comments below.  I should also mention that I will be speaking at the Fertility Plan It Show in a few months.

Find all the information, support and inspiration you need for building your family:

  • Meet experts and thought leaders in fertility medicine and family building
  • Learn from nutrition, yoga, acupuncture and mind-body-spirit therapists
  • Hear personal stories from experts and new parents
  • Join our community before, during and after the show online at FertilityPlanit.com

Your admission ticket includes access to:

  • An exhibit hall with experts from across Southern California and the USA
  • Your choice of presentations with inspirational speakers
  • A schwag bag with giveaways and offers from sponsors and exhibitors

If you want more information about the show, please visit the website for more information.

 

  • http://www.growingfamilybenefits.com/ Kevin Haney

    Ginger – great job! Most people commenting on insurance issues miss the point that insurance plan regulations are based upon where the group plan is issued.

    When picking health plans couples should consider coverage for maternity and hospital deductibles. Although not related to upfront IVF costs, if successful they will be pregnant and probably will deliver in a hospital.

    Most costs of un-reimbursed medical expenses are tax deductible, but only after expenses top 7.5% of adjusted gross income. That number climbs to 10% in 2014. Plan accordingly.

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