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Tuesday, September 30, 2014

Elizabeth Street

THE FINANCIAL SIDE OF INFERTILITY

Feb 12, 2014

The Financial Side of Infertility

In our “Money Mic” series, we hand over the podium to someone with a strong opinion on a financial topic. These are their views, not ours, but we welcome your responses.

Today, Jennifer Gerson Uffalussy explains why she and her husband chose to undergo IVF treatment in an attempt to have a child, and what she’s learned about the financial costs of infertility treatment. 

Money is emotional and sensitive, so please respect that this is just one woman’s story.

When I found out that I was a carrier for the single-gene genetic disorder Tay-Sachs, a degenerative neurological condition that is fatal for children born with it, there was absolutely nothing to worry about…unless my husband was also a carrier.

The odds of that in my case, I had been told, were “one in a million,” so I wasn’t terribly concerned.

So my heart skipped a beat when I saw I had a missed call on my cell phone from my reproductive endocrinologist two weeks after my husband had finally gotten tested.

“You can imagine my surprise,” she began, “when Matt’s test results came across my desk this morning…and he’s a Tay-Sachs carrier.”

That’s when I found out I would be one of more than 85,000 women in the U.S. annually who undergo in-vitro fertilization, or IVF, as a way to create a family. Utilizing IVF and pre-implantation genetic diagnosis or PGD, the team of doctors and embryologists at our infertility practice would be able to create embryos, and then biopsy those embryos to ensure that only those not affected by Tay-Sachs were among those selected to create a pregnancy.

As I began researching IVF, I also dove into the financial details of the treatment.

Unraveling the seemingly foreign language of clinical terminology and insurance verbiage can be a heavy added stress on a patient struggling with infertility; I offer the below as an introduction to anyone also beginning this process. Here are four things I learned in our journey thus far.

1. How Much IVF Actually Costs

My husband and I were back at our reproductive endocrinologist’s office a week after that first phone call, to learn more about the process…and its costs.

On average, nationally, a “fresh” IVF cycle costs $12,000, before medications, which typically run another $3,000 to $5,000. In a “fresh” IVF cycle, eggs are harvested transvaginally after a closely monitored period of ovulation-inducing medications and then “mixed” with fresh sperm. One or two of the best-looking of the resulting embryos are then transferred to the uterus via a thin catheter.

The PGD step of the process meant we were looking at another $3,000 to $6,000. Altogether, conservatively speaking, about $20,000…for each attempt to have a healthy child utilizing a procedure that is successful (most optimistically) about 40% of the time, depending upon factors such as maternal age and the specific medical circumstances of the parents.

One of the most complex aspects of an infertility diagnosis is that for a patient to have her best chances for conception with IVF, she needs to act as quickly (to ensure that her eggs are as young and thus as viable as possible) as she can upon diagnosis. This biological urgency doesn’t exactly complement the equally pragmatic need to invest in the time to budget and save for treatment.

For some individuals undergoing IVF, if a fresh cycle doesn’t result in a pregnancy, and the remaining embryos from this fresh cycle can subsequently be used during a “frozen” cycle. “Frozen” cycles, often abbreviated as FET or Frozen Embryo Transfer, are much more economical, as they use “frozen” (technically, vitrified) embryos stored for future use. FET averages anywhere from $3,000 to $5,000 per cycle and annual storage fees for frozen embryos are typically an additional few hundred for each year.

Many practices offer “refund” and “discounted multi-cycle” programs. Practices with these kinds of programs offer various plans that provide patients with multiple IVF cycles for a single, discounted fee that costs about 30% to 40% less than the same exact treatment plan if you were to pay for it on a cycle-by-cycle basis.

Should you choose to go with a multi-cycle discount or refund package, you play an odds game. The packages only apply to one child at a time; that is, if you pre-pay for three cycles and get pregnant the first time, you can’t use the subsequent cycles for your future attempts to conceive. Keep in mind, though, that to qualify for these programs, patients must undergo a pre-qualification evaluation, evaluating their odds of conceiving within the first cycle of treatment.

2. The Various Payment Options

In thinking about how to finance your treatments, remember that taking money out of your retirement fund comes with penalties and translates into money that will not be available—and not accruing interest—when it comes time for you to retire.

Using your credit cards as a quick loan will force you into a situation with high-penalty fees and interest, not to mention a swift hit to your credit score. During our research we learned of the Springstone loan program, which is geared toward infertility treatment financing and is reasonable in underwriting, interest rates, and repayment times.

If passed, The Family Act of 2013 would create a new tax credit for the out-of-pocket costs associated with IVF and fertility preservation. The proposed Family Act tax credit will only apply to those whose adjusted gross income falls below a certain combined, determined amount.

Infertility care is medical, and you may also deduct medical expenses that exceed 10% of your adjusted gross income on your taxes each year. Many parts of your infertility treatment will qualify for this kind of deduction, as preventive care, treatment, surgeries and prescription medications are all deductible.

Alternately, you can also put some of your income into a Flexible Spending Account, or FSA, which allows individuals to set aside pre-tax dollars for out-of-pocket health care costs. You may set aside up to $2,500 per individual in an FSA. While you can’t deduct expenses paid for from an FSA on your federal income tax return, you also do not have to meet the 10% adjusted gross income requirements needed for medical expense deductions.

3. How Insurance Coverage Works

One of the biggest misunderstandings when it comes to insurance coverage and infertility is what your insurance will actually cover, whether or not the actual physician you are seeing is “in-network.”

Fifteen states (Arkansas, California, Connecticut, Hawaii, Illinois, Louisiana, Maryland, Massachusetts, Montana, New Jersey, New York, Ohio, Rhode Island, Texas and West Virginia) have laws requiring varying levels of insurance coverage for infertility treatments.

Resolve, the National Infertility Association, offers an excellent state-by-state breakdown of these various benefits by state on its website. Even if you do live in a state with a mandate, not all mandates from state to state ensure the same level of coverage of care, so do familiarize yourself with your individual state’s policies.

Some insurance plans, such as my own, provide coverage only for the diagnostic phase of infertility treatment. A good rule of thumb in understanding what your insurance will and will not cover should you have such a plan is to ask if the procedure is something that will determine whether or not infertility does in fact exist and, if so, the cause of this infertility. Keep in mind that when the diagnostic phase ends, any subsequent treatment will not be covered, thus requiring you to pay out-of-pocket regardless of whether you are in- or out-of-network.

Other plans will cover the diagnostic phase and some infertility treatment services, but not all treatment services. If your plan offers some infertility treatment coverage, check with your individual plan to see their coverage policies for all possible avenues of care, from oral ovulation drugs to injectable ovulation induction medications to intrauterine insemination (IUI).

Remember to investigate all the plan options available to you; compare the policy through which you currently have coverage with ones that might be offered by your partner’s employer, and compare its costs and benefits to see if it might offer more comprehensive infertility coverage.

Likewise, the new state and federal Health Insurance Marketplace now open as a result of the Affordable Care Act also allow you to see all possible plans available for purchase in your state. A new plan may come at a higher premium than what you’re currently paying, but could potentially save you tens of thousands of dollars.

4. How to Work With Your Practice’s Financial Services Department

Don’t forget to ask your physician’s office whether the prices for care quoted to you include all blood work, ultrasounds, monitoring and medications, or whether those will all be additional “à la carte” fees.

For example, when a plan covers injectable fertility medications, most plans have a “preferred” brand which they will in fact pay for, and they will deny payment on any of the others. So, if medically appropriate, your physician can choose the one that will be paid for by your insurance company as opposed to the one that will not.

Likewise, most insurance companies have a “preferred” lab to which they send routine lab work. If your practice sends the lab work to the lab that your insurance company recognizes, they will pay for it (if the lab tests are covered by your plan). If those same tests are sent to a lab that is not in-network for your plan, the plan will not pay. Make sure both you and your providers know the ins and outs of your plan.

The Affordable Care Act’s (or ACA) defining attribute is the mandating that certain insurance plans include what is now qualified as “essential health benefits.” Unfortunately, infertility treatment is not classified as an “essential health benefit.”

A huge win for those in the infertility community, however, is that, because of ACA, your insurance company can no longer discriminate against pre-existing conditions, of which an infertility diagnosis is one. That means your insurance company can no longer charge you a higher premium than someone who will not need infertility treatment, nor can you be denied coverage should you be seeking private insurance because of the diagnosis.

Where We Are Now

Because my husband’s and my need for IVF is due to a genetic disorder, there are some interesting questions to be asked—and still to be determined—on the implication of the Affordable Care Act as it defines preventive care.

As our need for IVF is to prevent a child from being born with, and subsequently dying from, Tay-Sachs disease, we have argued to our insurance company that under the Affordable Care Act, our IVF would qualify as preventive care, and thus be required to be covered as outlined by the law.

Pursuing IVF was the right next step for my husband and me. We’ve already taken the very first steps in our IVF journey, submitting DNA samples for the creation of the custom probe which will be used to test the biopsies from our future embryos. We will hopefully begin our first cycle next month. Though we know there is a long road ahead of us, we take such great comfort in knowing that, though the exact circumstances may vary, there are so many other individuals out there also pursuing a similar path.

This time of great uncertainty, a little anxiety, and many things beyond my control seem like the best preparation I could possibly receive as I prepare to become a parent…and plan for my family’s financial future.

Jennifer Gerson Uffalussy, a founding editor of Jezebel.com and the founding fashion editor of RalphLauren.com, now lives and works in Atlanta, where she consults on brand strategy and is working on her first novel.

By Jennifer Gerson Uffalussy

More from LearnVest:

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