LOWER YOUR INFERTILITY COSTS (Part V) Initial Treatment Options with the RE; IVF and How to Lower Costs; Understanding the Insurance Maze

LOWER YOUR INFERTILITY COSTS    (PART V)

·      Initial Treatment Options with the RE;

·      IVF and How to Lower Costs;

·      Understanding the Insurance Maze

Initial Treatment Options with the RE

Following the initial visit with your RE, additional diagnostic testing may be needed, based on the level of investigation you have had previously. Depending on the woman’s age (and ovarian reserve), sperm function testing, a couple’s work schedule and time commitments, insurance, finances and risk tolerance, we can help most couples decide on the treatment options that may be best suited for them. Overview of some options:

             Natural / IUI Cycles

$          IUI works much better than just having intercourse on your own. For women over 40 or women with elevated FSH levels or significant male factor infertility, success rates with IUI’s are much lower than IVF and may not be worth your time and money. You may often be better off moving quickly to IVF. 

             Medicated / IUI Cycles (OI/IUI)

$          A major downside of medicated IUI’s is the risk of multiple births.

$          Numerous studies suggest trying 3 or 4 Clomid/IUI cycles  is appropriate before moving on to either injectable and IUI or IVF.

The Move to Assisted Reproductive Technology (IVF)

$          Since the first IVF baby was born in 1978 more than 1 million babies have been born through IVF worldwide.

$          IVF is more expensive and third party reproduction gets even worse. 

$          IVF is also invasive and did I mention … expensive. 

$          Reasons RE specialists may recommend IVF include: 

·         Blocked fallopian tubes

·         Severe male factor issues

·         Endometriosis 

·         Diminished ovarian reserve

·         Advanced maternal age

·         Unexplained infertility

$          Costs for a basic IVF cycle vary greatly from clinic to clinic from about $10,000 to over $25,000, not including medications. The vast majority of clinics fall somewhere in the $10,000 to $15,000 range plus medications for single IVF attempts. 

Ways to Lower Costs Should You ‘Fast Track’ IVF

$          Numerous studies have recently begun to encourage certain women to skip multiple rounds of IUI (especially injectables) and go straight to IVF, saving them both time and money

$          With IVF, doctors are able to control how many embryos are transferred back, allowing for a much safer approach. 

$          Numerous studies* have shown that fast track IVF pregnancies occur approximately 3 months faster and approximately $10,000 less expensive than patients following the conventional protocols. 

Understanding the Insurance Information Maze

$          The truth is, it can be tough to get your insurance company to pay for infertility treatment. Infertility treatment is a gray area—it’s potentially very expensive and they are going to try to avoid paying if they can, even if it’s covered. 

$          Obtain free assistance:  By calling Fertility Lifelines at 1-800-LETS TRY or by visiting their website, www.fertiltylifelines.com you can talk to a trained benefits specialist or a fertility nurse provided by EMD Serono… this service can save you lots of time by helping you understand your health benefits and any fertility coverage you may have. 

$          Know what your policy covers before you see your specialist.

$          If you’re an enrolled in an employee sponsored health plan you should have received what is called a Summary Plan Description. 

$          Contact your employer’s Human Resources Department for a copy of what is known as the “Evidence of Coverage” or “Certificate of Insurance”. 

$          Your doctor cannot deliberately file an incorrect code—it’s insurance fraud. In other words, if it really is an infertility treatment the office can’t file it as something else. 

$          Check with your HR person. You may have an opportunity to comparison shop various options within your own company. While some companies will let you change at any time, many limit insurance which is to a specific time period called the open enrollment. Find out when yours is by calling your HR Department.

 Insurance coverage examples:

     Self Pay

                 Diagnostic Only

                 Lifetime Max ranges from $5000 -- $35,000

                 IL State Mandate (includes Medications; IUIs then IVF 4/2)

$          Don’t get too excited about having infertility coverage until you find out exactly what your lifetime maximum is. Here’s the bummer. Lifetime maximums often cap out at $5000 to $15,000.  If you can go to your gynecologist or PCP and get your hormones checked, it may be covered under your wellness care and not be counted towards your lifetime infertility maximum. 

Remember Your Doctor’s Clinic

$          All fertility clinics have at least one person and often 2 or 3 staff members who deal only with insurance. Get to know these people since they can be a great resource.