Many couples struggle with paying IVF bills.
Many couples are financially unprepared for the high cost of in vitro fertilization (IVF) treatments for infertility. Because many couples don't have insurance covering IVF, they have explored other financial help options for infertility treatment bills.
Background
In vitro fertilization treatments typically cost around $12,000 per treatment cycle. A treatment cycle includes the monitored ovarian stimulation of the patient's ovaries to produce eggs, surgical collection of eggs, laboratory procedures for fertilization and embryo culture and an embryo transfer procedure to return the embryos to the uterus of the intended mother. The costs for a single treatment cycle is usually broken down into thirds with one-third going to the IVF laboratory, another third to the physician and a third to pay for ovarian stimulation drugs. Most patients do not have complete insurance coverage for IVF, although 15 states have some level of mandated coverage. Individual state mandates vary widely and may limit or prohibit coverage to some groups; for instance, gay couples or single women. Because of limited insurance coverage and high expenses incurred from IVF, patients need other non-traditional methods to finance IVF treatments.
Types
The most common type of financial help is partial insurance coverage. For instance, even in states without insurance mandates to cover IVF, employers may elect to provide some generous insurance coverage to attract employees. Even if the patient does not have infertility coverage per se, they may have a drug benefit that does not specifically exclude fertility drugs which can be used to pay for ovarian stimulation drugs.
The International Council on Infertility Information Dissemination Inc. (INCIID), an infertility support group, offers an IVF scholarship program for patients who can demonstrate both medical and financial need. Specific assisted reproductive technology (ART) programs have agreed to partner with INCIID to provide donated IVF services.
The Internal Revenue Service will allow you to deduct your medical expenses on your tax return if these expenses exceed 7.5% of your annual adjusted gross income. The specific eligibility requirements and limitations of these deductions are described in full in IRS Publication 502.
Controversial Financing
Some fertility programs offer "shared risk programs" in which patients pay a higher up-front fee for IVF but are guaranteed a pregnancy in three tries or they get 70% to 100% of their original up-front payment back. Eligibility requirements to enter these programs are often based on the expected ease of achieving a pregnancy, generating criticism that some shared risk programs cherry pick only good-prognosis patients. The Integramed Fertility Network of IVF providers' Attain IVF Program and Shady Grove Fertility's Shared Risk 100% Refund Plan for IVF and Donor Egg are two examples of shared risk programs.
Government Coverage Debates
With health care reform, the question of fertility treatment coverage has created debate among patients, the public, insurers and medical providers. Because fertility is not a life-threatening condition, fertility treatments are defined by some insurance providers as "optional" treatments similar to cosmetic surgeries.
Not covering IVF may seem to offer cost-savings but actually increases costs by driving up the multiple birth rate that drives up premature births which increase the use of expensive neonatal intensive care units (NICU). In their July 2003 study published in the journal Fertility & Sterility, Dr. Meredith A. Reynolds and her colleagues at the Center for Disease Control and World Health Organization determined that the occurrence of high-risk multiple births was lower in states that mandate IVF insurance coverage. Patients without insurance coverage for IVF felt more financial pressure to transfer multiple embryos per attempt to increase their chances of pregnancy, even though this practice also increased their risk of twins, triplets and higher order multiples. Having insurance coverage allowed patients to feel they could transfer fewer embryos because they could afford more than one IVF procedure to become pregnant.
In countries with generous government health plans such as the United Kingdom and Canada, low-cost or free IVF is available but often includes long waits or other patient eligibility requirements used to limit patient enrollment and maximize the effectiveness of IVF. For example, maximum age cutoffs are used to exclude older women from covered IVF treatments. Because obesity is known to reduce the success rate with IVF, one controversial proposal in the U.K. is to impose certain maximum allowable weight criteria in order to be eligible for IVF services.
Financial Planning
The patient should expect to receive a written estimate in advance detailing what the proposed medical treatments will cost. Each procedure the lab or the physician performs has a Current Procedural Technology (CPT) code list attached to it and should be provided with the written estimate from the provider. The insurance company can reference these codes and inform the patient in advance which of them are covered and how much will be the patient's responsibility. Most fertility programs work with their patient's insurance company in advance to determine which part of the treatments may be covered. Some fertility providers may offer discounts for self-pay patients if they pay cash.
