Paying For Fertility Therapy

By John Preston Parry, M.D., M.P.H. and Steven T. Nakajima, M.D.

As pregnancy rates continue to improve with advances in fertility treatment, more patients are finding that it is easier to get pregnant than it is to pay for the necessary therapies. Effective and efficient care, maximizing potential insurance benefits, and optimizing financial resources all play a role in minimizing costs.

Effective care refers to receiving treatments that are likely to increase a patient’s chance of pregnancy. For example, a recent article from the British Medical Journal showed that, by itself, clomiphene citrate is less likely than previously thought to lead to pregnancy in women with unexplained infertility. This has always been an inexpensive intervention, but given that there is growing evidence that it is not effective, other approaches are better. Efficient care is slightly different from effective care in that it tries to maximize the likelihood of pregnancy for a given intervention. For example, in vitro fertilization may be very effective for a patient who doesn’t ovulate; however, oral medications such as clomiphene citrate or letrozole can make many of these women ovulatory, helping them achieve pregnancy at far lower cost. Given that what will be both effective and efficient varies significantly for each patient, it is important for patients to find a health care team they trust and that will explain clearly why a particular path may be the best.

There are multiple ways to maximize insurance benefits. For example, many plans have some coverage for fertility treatment, but often it takes a financial coordinator familiar with these issues to streamline access to these benefits. Alternatively, appropriate treatment of medical conditions, such as endometriosis, for indications that exist independently of whether or not a patient is trying to conceive can be a way to make the most of one’s insurance. However, if an intervention is solely to treat infertility, expect that your physician will bill it as such since any other activity would be insurance fraud. With advance planning, many geographic and employment choices can enhance fertility benefits. For example, fifteen states including Ohio, Illinois, and West Virginia mandate varying degrees of fertility coverage for insurance plans. Not all mandates cover in vitro fertilization. For example, Ohio’s mandate only applies to managed care companies and additionally is only for care deemed “medically necessary;” in vitro fertilization specifically is not recognized as meeting that standard. An alternate approach is seeking employment with companies that respect the importance of family building, as reflected by their offering coverage for some, or even all, of their employees. These companies include Ford, UPS, Limited Brands (Victoria’s Secret, Bath and Body Works, Express, and The Limited), Chase Bank, and others. When wanting to know more about states that mandate coverage, fertility friendly employers, and how to address insurance claim denials, talk to a specialist, such as a fertility financial coordinator or look at discussions on the websites of fertility support organizations such as INCIID or RESOLVE.

Optimizing and organizing financial resources can be difficult with the current economy. One option for those without personal wealth or financial support from family members includes Capital One who offers loans for fertility care. However, because a second mortgage on a house can sometimes yield a better interest rate, this second option is also frequently used. Another way of financing one’s IVF cycle is IntegraMed’s Attain IVF program. For women with a reasonably good chance of conceiving, this program effectively gives a money back guarantee for patients to bring home a baby. More than 75% of the patients who enroll in this program have a live birth Patients using their own eggs, but not achieving a live birth, get a 70% refund of the enrollment fee and patients using donor eggs get a 100% refund of this fee. This is a popular choice among patients since it reduces the pressure that many feel, which in turn improves not only fertility but relationships as well. Insurance that guarantees a live birth is a way of controlling the maximum costs required to conceive. An example of this program working well is with a recent patient of ours, who became pregnant but unfortunately had a miscarriage at 19 weeks. Because this patient had been in the IntegraMed Attain IVF program, she received another two fresh IVF cycles through this insurance and is currently pregnant. Other companies offer similar guarantees, but patients should be careful to make sure that they are obtaining an agreement for a live birth and not just pregnancy some fertility plans would not offer additional IVF cycle if one has a miscarriage. Again, knowing your options for your infertility therapy is critical to results and peace of mind on the road to parenthood.

Dr. Parry is a third year fellow in Reproductive Endocrinology and Infertility at the University of Louisville. He completed medical school at New York Medical College, obtained his M.P.H. from Columbia University and finished residency in Obstetrics and Gynecology at Tufts University/New England Medical Center.

Dr. Nakajima is the Chief of the Division of Reproductive Endocrinology and Infertility at the University of Louisville. He is a board-certified obstetrician and gynecologist with a subspecialty board-certification in reproductive endocrinology. Dr. Nakajima was previously chosen as one of the “Best Doctors for Women” by Good Housekeeping magazine and he was been voted one of Louisville’s Top Docs.