Monday, August 20, 2012

Affording Infertility Treatments (Revisited)

I had previously covered various options you could explore in order to afford infertility treatments. I wanted to repost my entry and also direct you to this article from US News, which in part highlights similar options, along with a couple of additional ones.

What else would you add to the list?

"Dollars and Cents: Affording Infertility Treatments"

I was contacted by a reader desperate for some information on affording infertility treatments. Considering the cost of treatments and everything that precedes and follows an actual IUI or IVF, I hope this entry will be helpful to many of you (who reside in the US).

Insurance Coverage/Plans:

First I want you to read your insurance plan very carefully. Unlike the owner's manual to your television, when it comes to your insurance plan, the fine print could give you the most important information regarding infertility coverage.

Find out if you live in an infertility treatment mandated state. For instance, New York provides mandated coverage for IUIs and medications. While Massachusetts residents will be also covered for IVF. Don't limit yourself to your state of residence -- if your employer is in a mandated state, they must offer infertility coverage (let's say you live in NY but work in Connecticut). Some insurers will cover at various percentages while others will give you a "lifetime" maximum amount of dollars to go towards your infertility treatments.

If you are lucky enough to have coverage, make sure there aren't any provisions and pre-requesits to the coverage. In some fashion, they will ask that you prove your infertility. (No, they do not read your blog, but they should.) Also, when you're gearing up for a cycle, make sure you check with your insurer to obtain a cycle number and that you have a letter confirming your coverage for that pending cycle.

Even if infertility treatments aren't covered, some tests (blood or surgical) are often times part of your basic coverage. So for instance, if your RE recommend a hysteroscopy but your insurer won't pay for it if it's done by a specialist, don't be afraid to seek the help of your gynecologist to perform the recommended procedures or tests.

If you're required to pay out-of-pocket to then get reimbursed by your insurer, you have to stay on top of it like your life depends on it (in this case, your wallet). Many insurers will deny claims, to eventually approve them after you've spent hours fighting about it. If you know your coverage inside out, you will be surprised at how much more you know than the representative on the phone. I've said this on countless occasions: you must be your strongest advocate.

With the upcoming changes in the Health Care Bill taking effect in 2014, you will no longer be denied insurance for preexisting conditions. But keep in mind that if  infertility coverage is part of your current plan, it will most likely be dropped by 2014. Universal health care may be coming at the cost of your infertility coverage.

Lastly, if your employer has not signed up to cover infertility, then pick up the phone and call HR. Make your case. Sixty five percent of employers who cover IF said they do so because their employees asked for it. So, petition your employer for IF coverage. Here's a sample letter.


Some pro-bono agencies provide infertility coverage grants offered by Fertile DreamsINCIID and the Cade Foundation. They come with strings attached and are incredibly selective (at times discriminating). But it's certainly worth the shot. Before you commit to any program, be mindful of the restrictions that are involved with pro-bono grants. Here's a link to important questions to ask when reviewing your grant options.

Shared-Risk Programs:

When you take into account the exorbitant cost of multiple rounds of IVF, some clinics and third-party companies are offering what they call "shared-risk programs" or package-deals. These programs cover multiple cycles with a money-back-guarantee if none of the cycles end in a live-birth. Expect to pay a larger sum upfront but you will have peace of mind knowing that you have 4-6 cycles before it all runs out. Depending on the plan offered, after 2 cycles, the consecutive cycles come to a fraction of the cost of just one cycle. Keep in mind though that these programs, similarly to grants, are very selective (FSH, age, past history and reasons for the infertility will be closely scrutinized). Also, they will not cover preliminary tests, medications and certain aspects of the cycle (like the anesthesia).

On a personal note, after paying for 4 IUI and 4 IVF cycles mostly out-of-pocket, we opted for a shared-risk program. The program initially rejected us but we pleaded our case via our new RE. They accepted us, we payed $30K. The first cycle with the program worked.

Other Options:

Medications -- All clinics have donated or left-over medications (injectables or otherwise). This is the time to work your people skills with your nurses. Also, when your RE calls in for your drugs, they often don't qualify whether they approve generic or brand name. Generic drugs are just as effective as brand names and cheaper.

Flexible-Spending Accounts -- Employers offer flexible spending accounts. Use them! If you know you're going to do a cycle (or more), a flexible spending account will allow you to put some of your hard earned pre-taxed money towards your treatments.

401(k) -- Some 401(k) plans allow you to dip into your savings for medical purposes without any tax penalties. This should be a last resort option as you are taking a great risk by dipping into your future for treatments that cannot guarantee success.

Clinical Trials -- Fertility clinics have on going clinical trials. Ask your RE if they are working on any trials that you may qualify for. Make sure you understand what's involved, what's covered and how beneficial it will be to you.

Create an Infertility Fund -- How many of us have received useless gifts for holidays and birthdays. If you have come out to your loved ones about your struggles, I would encourage you to open up an infertility fund. This is also the time to reach out to your community. You may be surprised by the outpouring of support. In the same spirit, contribute to your own fund by doing some spring cleaning. You must have countless things that are buried in the depths of your closet (or house) that you have not touched in ages. Put them up on eBay or do a yard sale.

Lastly, keep records of all of your infertility related expenses and all other medical expenses. If they add up to more than 7.5% of your adjusted gross income, you will receive tax benefits.


Lea@Doula Training HQ said...

I cannot wait to see the upcoming changes in the Health Care Bill... oh 2014.. that's too long for me.

Amanda said...

Despite several calls to my insurance company to confirm that their infertility benefits applied to us, it looks like we will be denied coverage based on my husband's azoospermia. The insurance requires 12 months of (unsuccessful) exposure to sperm before I can be classified as infertile, and... I guess my husband's infertility just doesn't count?

Currently we've been denied coverage because the clinic didn't perform certain tests that the insurance requires, but they tell us we'll likely be denied again once the tests are submitted. We're trying to decide whether it's worth appealing. Initially we were all gung-ho about it, but now we're wondering if it might just be better to assume they won't cover it and save our pennies to pay out of pocket.

It seemed so straightforward when we got started -- I thought, my husband is infertile, so of course they'll cover infertility treatments. I was basically blindsided when I found out they wouldn't. I wish I'd had an inkling going into the process.

Anyway, thanks for this helpful info, we really appreciate it.

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