CHAPTER 6

Show Me the Money

Nobody can say that infertility treatment is cheap. IVF cycles can easily run from $10,000 to $20,000 each, depending on your level of insurance coverage and the amount of medication you'll require. Quite often, even if you have insurance coverage, there are stipulations in your plan. You may need to complete a certain number of IUI cycles first, or only have three lifetime medication fills from your pharmacy. So, how do you make sense of it all and find the solution? Read on.

Health Insurance

There are no easy answers when it comes to insurance questions. Using your health insurance is the obvious answer to addressing the medical needs you are experiencing, but you may run into many problems when you submit your procedures for coverage.

Insurance Basics

Chances are, your health insurance is employer-based, meaning it is provided as a benefit through either your or your partner's employer. What your particular health insurance covers is not up to you; the employer determines your health insurance coverage. You may still have some choices, however.

It is very important that you let your employer know what coverage you want or need. Your employer may even be willing to add coverage for fertility treatments if they know that there is a demand, so this is worth looking into.

Just because you work at the same company and have the same insurance carrier as another employee does not mean that you have the same coverage. Always be sure to read your policy before determining what your specific insurance covers.

Reading your policy is just the beginning. You are usually given a summary of benefits when you sign up for your health insurance. While this is a nice and tidy document, it is not your actual coverage list. Remember that it is your right to see your coverage in full detail. Ask your human resources department to see the contract they have with the health insurance carrier. You will want to read the sections that might particularly pertain to the treatment of infertility. Look at exclusions of coverage, as well as at limitations of coverage and of benefits. This might even include monetary limits on how much the insurance will spend on fertility treatments. If need be, ask for help with this document, as you need to be able to understand it in detail.

State Laws

A few states have a mandated insurance coverage for infertility treatment. However, that is not as promising as it seems. The majority of these states actually have a mandate that encourages employers to offer the services, but does not require coverage. This means that insurance companies in the state must offer a policy for purchase that covers infertility, but the laws don't require that the employer pay for the infertility services.

It probably goes without saying that you have a much better chance of getting coverage in states where coverage is mandatory. When a state mandates this kind of coverage, employers must provide insurance to cover the cost of infertility treatment in every premium, not as a separate expense.

Only fifteen states have passed legislation that requires some degree of infertility insurance coverage: Arkansas, Connecticut, California, Hawaii, Illinois, Louisiana, Maryland, Massachusetts, Montana, New Jersey, New York, Ohio, Rhode Island, Texas, and West Virginia. These laws vary widely according to the state in which you live. Check out www.resolve.org/family-building-options/insurance_coverage/state-coverage.html for more detailed information.

Some infertility patients have gotten wise to the games insurance companies play. Be sure to have your care provider use diagnosis codes that do not reflect infertility as a diagnosis; rather, they should list the disease, like endometriosis or anovulation, instead of infertility secondary to anovulation. This is one way to get all or part of your treatments covered.

One loophole that many women can take advantage of states that you do not necessarily have to live in the state that has a mandate. If the company you work for is headquartered in a state that has mandatory infertility treatment coverage, even if it's not the state where you work and live, your health insurance is most likely provided through the state with the mandate. In this case, you'll be able to get the coverage too.

Even when your health insurance covers infertility testing or procedures, there are often exclusions or other problems with actually using the insurance. You may find that your insurance will only pay for certain procedures, like repairing your fallopian tubes, but not for in vitro fertilization.

Perhaps you are one of the lucky ones with great coverage, but you find that your insurance has a cap on it. This means that your plan will cover almost anything, but only up to a certain amount. After that, you're on your own.

Shared-Risk Programs

Shared-risk programs are designed to let you, funnily enough, “share the risk” of the costs with the fertility clinic. It usually only applies for IVF cycles, and not other forms of treatment or testing.

The typical way a shared-risk program works is that you pay, in full and up front, a certain reduced fee in exchange for a particular number of fertility procedures and cycles (usually three to five cycles). The promise is that, if you have not given birth by the end of the number of cycles initially agreed upon, all or a portion of your money is refunded to you. The amount of money refunded to you may depend on how many cycles you actually completed.

If you do get pregnant, carry that baby to term, and give birth to a live infant, even if after only one cycle, you do not get any of your money back. The fertility clinic keeps the rest of the money that you gave them, even though you only needed one cycle of treatment.

You will usually have to meet certain criteria to enter a shared-risk program. You will probably have to be within a certain age. You may have to have a certain need for treatment, like IVF. And certain diagnoses may exclude you from participation in these programs.

In essence, you are banking on the fact that it is likely to take more than one cycle to get pregnant. If you do get pregnant on the first try, you have spent more money than you would have had you only paid for a single cycle. But if you do not get pregnant even after several cycles, you have lost no money, or at least considerably less money than you would have spent if not for the shared-risk program. Different clinics handle the particulars of the “refund” differently, so be sure you understand fully what your clinic's specific program entails.

How can I find a clinic that has a shared-risk program?
Not all fertility clinics offer shared-risk programs. If you are interested in this concept, ask around to find out what center closest to you participates in this type of program. Many couples actually travel great distances to take part in shared-risk cycles at fertility clinics that are far away from their homes.

You may also be expected to pay additional money for certain procedures. If you require intracytoplasmic sperm injection or the use of donor eggs, you may need to pay more money into your cycle. You may know this initially and have to pay right away, or your doctors may discover it as late as the day of your retrieval, in which case you'll be asked for the money then. Be sure to ask questions about these potential additional fees.

Special Programs

Another possible source of funding to help you pay for infertility testing and treatment are special programs. These may be run by universities or other groups doing studies, or even by drug companies. Programs like these sometimes pay for all or some of your treatments.

Medical Studies

Occasionally you may be able to find a university or other group doing a study that you can take part in. The researchers may be studying your particular diagnosis, or they might be studying a new medication or procedure that could help you achieve a pregnancy.

To find out if there are any of these types of programs near you, call your local medical school and ask to speak to someone who is conducting human research in reproductive endocrinology, or whatever subject your fertility issue would fall under, like urology. You may be referred to a general human studies center or you may be put through to a research nurse. You will likely be interviewed to see if you qualify for the study.

If you are lucky enough to find something that can help you foot at least part of your bill, you will likely have to give something in return. Typically, this is information in the way of data from your testing or procedures. This may mean that you have to have more blood work or additional procedures like ultrasounds so the researchers can get the data they need. You will also be asked to sign multiple waivers and releases.

Scholarships and Drug Companies

Another way to find some help paying for your medical expenses is to talk to drug companies. This can be a big help since the medications that are often required for the most advanced reproductive technologies can be a large portion of the bill. Several companies have programs set up to help you cover the costs of these medications.

Ask your fertility team if they are aware of any such programs. If they are, ask about how to get a hold of their contact person, normally a drug representative through a particular company. If your team is not aware of any such programs, have them ask. It certainly can't hurt, and it can only stand to benefit you and other patients in their practice.

These types of programs may have certain stipulations. For example, couples may have to meet certain income requirements — having a combined income under a certain amount — to qualify. It may also be diagnosis-related or even age-related. Follow up and see what you need to do to apply for such programs if you find them available to you and your partner.

Loans

Borrowing money may not seem like the ideal way to pay for treatments, but it is a way to make possible something that might otherwise not be.

The most obvious type of loan is a traditional bank loan, but this option is not available to everyone. It may depend on your credit rating, though there are some companies willing to overlook slightly negative credit ratings to help you out. Get a letter from your fertility practitioner that outlines how much money is required, what therapy is needed, and a breakdown of what each procedure will cost. He may also include any other information that he feels will help you get the loan. This will be a valuable document in your quest for a bank loan.

Make sure to read the fine print very carefully before you take a loan. You don't want to be surprised by high interest rates or unreasonable payments that you can't afford. It might be helpful to discuss the terms with your accountant or financial planner beforehand.

You may even try asking other fertility patients what type of loan program they used. There are loan programs designed specifically for IVF patients. You should be sure to talk to previous customers to ensure you have some idea of how the service is for the program. Ask for references whenever possible. Your fertility center may even have a loan program available.

Another idea is to look into a second mortgage on your home. This is a fairly typical way to obtain extra cash for medical expenses, and it may actually have a lower interest rate than traditional loans.

Another option is to get a home equity loan that usually offers reasonable payment amounts on a monthly basis. You can also have a home equity line. The nice thing about a home equity line is that, once opened and partially paid off, you can always use it again and again. It can be used for multiples cycles over time.

Your Medication Coverage

Fertility medications can be quite expensive, sometimes up to fifty or sixty dollars per vial for your stimulation. If you're taking five or six vials a night, it can add up quickly. Coverage for your medication varies widely according to your insurance policy.

It can be helpful to call ahead of time to determine what, if anything, is covered. Sometimes a particular drug is on their preferred drug list, meaning it is the only one of its type that is covered. It's usually quite easy to clear this change with your doctor, though it may mean that you have to take more than one injection because of the way the medication is mixed.

Some people have tried to save money by skimping on their dosages. This is a bad idea. Each dose is specifically designed for you and is calculated to your body's response. But there are other ways to save money on purchasing medications.

You may be tempted to buy medication online or at a store other than a pharmacy that deals consumer to consumer. This may result in significant savings, but it comes with greatly increased risk. Be sure you have adequate safeguards in place to protect your interests financially, physically, and legally before you enter in to such a deal. Also bear in mind that medications have expiration dates. While they may not be harmful after the expiration date, they also may not work as well. You may find that you are left without medications or money or, even worse, that you are now ill from the medications that you purchased.

You may find your medications are less expensive if purchased from a pharmacy other than your local one. There are a multitude of pharmacies that do mail order or specialize in infertility medications, and these may be a better bargain for your buck.

If you choose a mail order pharmacy, make sure you have an adequate supply of all of the medications you'll need over the course of your cycle. It can sometimes take a few days to get a delivery, and there are times when you need your medication right away; not having it can potentially screw up your cycle.

You may find that some fertility patients have medications left over from previous successful, or unsuccessful, cycles and are willing to sell these medications to you at a greatly reduced price. Your fertility clinic may even take part in this exchange of unused medications. Ask the program coordinator at your fertility clinic if she is aware of any such program locally.

Determining What You Can Afford

The difficult part about the financial decisions that accompany fertility treatments is that, of course, there is so much more involved than money. You have the basic need, urge, and right to become a family with children. You may feel like there are a lot of players making decisions for you about your own fertility — often without even knowing you. Be careful not do anything rash that would jeopardize your future, for you or your hopeful new family. Take the time to rationally think through each and every option. Do not take the first option that becomes available.

Shopping Around

One way to find the best bargain is the old-fashioned way — shop around. You may find that one fertility clinic offers you more in a cycle package than another does. Or you may find that overall costs are lower at a certain facility. Even better is when you find out that your insurance will cover some or all of your treatments or procedures if done at a certain location. Your fertility treatments cost too much financially and emotionally to leave any stone unturned.

One thing that many fertility patients are doing is being better consumers. You may be surprised to learn that not every doctor or clinic charges the same price for everything. Know up front what each cycle will cost and what that cost specifically includes. This means knowing what extra costs might creep up on you.

Price other local fertility centers, not just the first one you go to. You might find that what you thought was a great deal is really the opposite when you look at all the potential “extras” you may have to pay for. The middle of your cycle is not the time to find out that you need more tests or more medications or an additional medication. While these things can legitimately crop up unexpectedly, there should be very few surprises like this in the course of your treatment. You have a right to know about all of the potential medical and monetary expenses that may come your way.

Be Responsible

As always, be sure that you are financially responsible when dealing with loans. It is sad to say that many couples have gone into bankruptcy or gone through other monetary troubles in pursuing fertility treatments. Don't let the pursuit of a family jeopardize your ability to pay your bills.

If you are considering a shared-risk program, be sure it's a wise investment. Does your diagnosis make it seem more likely than average that you would get pregnant on an early attempt? It's a difficult question to answer, but it is also a tough gamble to make.

Budgeting and saving are ways to look into the future. They are also beneficial habits to get into, no matter which program you may ultimately decide on to help you finance your fertility treatments. Ask if your fertility clinic offers support in these areas. No matter what you decide to use to help you make the money to afford your fertility treatments, remember that you will be living with these decisions for a long time. Choose with guidance and wisdom. Seek help and support. In the end, do what works best for you to build your family.