Only a few states require insurers to cover infertility treatment, according to an infertility advocacy group. (Monkey Business Images/Bigstock)
Infertility treatment is a numbers game in some respects: How many treatments will it take to conceive a child? And how much can you afford?
Even as insurance plans are modestly improving their infertility coverage, clinics and others are coming up with creative ways to help would-be parents reduce their financial risk for procedures that can cost tens of thousands of dollars. Some even offer a money-back guarantee if a patient doesn’t conceive.
Shady Grove Fertility, a large center with sites in Maryland, Pennsylvania and Washington, has a number of programs to help its patients financially. The center pioneered a “shared-risk” approach to in vitro fertilization (IVF) years ago that offered a 100 percent refund if a couple didn’t have a baby. Now the center offers a similar program for couples who use donor eggs to conceive. Other fertility centers do likewise.
Both of Shady Grove’s shared-risk programs allow couples to try up to six cycles of IVF or donor eggs for a flat fee. If they conceive right away, they may end up paying more than if they had opted for a single cycle, but if they don’t have a baby, they get the full amount back; couples can also stop at any point in the process and get a full refund. The program costs twice as much as a single cycle: $20,000 for shared-risk IVF and $30,000 for shared-risk egg donor.
“In reality, patients who get a baby on the first cycle are subsidizing those who don’t get a baby,” says Michael Levy, president and IVF director at Shady Grove. “We see this as an opportunity to give patients security regarding the financial risk that they face.”
Tina and Jimmy Stone opted for the $30,000 plan. Tina’s uterus was healthy, but her ovaries weren’t producing viable eggs. The Hollywood, Md., couple became pregnant with twins on the third try. The twin boys are now 2, and their daughter, who is adopted, is 8.
“For us, it was worth it,” says Tina Stone, 35, who says the couple financed the treatment through a private personal loan. “It kept our options open if it didn’t work, whereas if you pay per cycle, you’ve paid for nothing if it doesn’t work.”
A report by the ethics committee of the American Society for Reproductive Medicine found that shared-risk programs can be acceptable if patients are fully informed about the criteria for success and about program costs, among other things.
Shared-risk and other programs are popular in part because health insurance coverage for infertility treatment, while slowly improving, is still sparse. Fifteen states — Maryland is among them — require insurers to cover infertility treatment to varying degrees, according to Resolve, an infertility advocacy group.
Among employers with more than 500 workers, 65 percent cover a specialist evaluation, 41 percent cover drug therapy and 27 percent cover IVF, according to human resources consultant Mercer’s 2013 employer benefits survey. Thirty-two percent of large companies don’t cover infertility services at all.
Glow, a company best known for an app that helps women track ovulation and other pregnancy-related health data, recently began offering Glow First, a program to help address the financial uncertainties posed by infertility and treatment.
Participants pay $50 monthly for up to 10 months. Each person’s money is pooled with payments from people who started the same month. At the end of 10 months, those who haven’t become pregnant split the money; more exactly, Glow agrees to pay their share to an accredited infertility clinic they visit for fertility testing or other services.
The program isn’t open to people who have already received treatment for infertility.
The first group, which began making payments in October 2013, has just ended. Roughly 50 people participated, according to the company. The average age was 34, and the typical participant had been trying to get pregnant for a year. The payout to those who didn’t become pregnant was $1,800.
“This relatively minimal contribution will help to offset those downstream and very high costs” of fertility testing and treatment, says Jennifer Tye, Glow’s head of marketing and partnerships.
There are other ways to manage the cost of infertility treatment. In addition to shared-risk programs, many fertility clinics offer discounts and financing options. Other companies also offer financing and/or infertility insurance to help cover the costs for couples who are working with a surrogate to have a baby, for example, or for IVF treatments.
“I think it can be confusing for people,” says Barbara Collura, president and chief executive of Resolve. “There’s no one place to go to learn all the different financing options.”
Most fertility clinics have someone on staff who will talk with prospective patients about the costs they’ll be responsible for and financing options that are available, Collura says.
“Exhaust all the obvious choices with your insurance and whatever financing programs the clinic might participate with,” Collura says. “Then do research to fill in the gap if there still is one.”
This column is produced through a collaboration between The Post and Kaiser Health News. KHN, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health-care-policy organization that is not affiliated with Kaiser Permanente. E-mail: questions@kaiserhealthnews.org.