Daniel Levine, MD, FACOG
Introduction: The diagnosis of infertility can be emotionally devastating for the many women and men who struggle in their desire to have a child. Thankfully, excellent modern medical treatments exist to help individuals and couples with infertility . A major non-medical obstacle to success, however, is the high price tag of the best treatments, such as In-Vitro Fertilization (IVF). Finding a solution to this problem is therefore critical to ensuring access to the best medical treatments. It is incumbent on all physicians to be aware of the best affordable options to help their patients achieve success with their reproductive dreams.
1. Types of treatment- while IVF is the most successful reproductive treatment, in many cases success can be achieved with lesser treatments. A review of natural conception issues, such as timed mid-cycle intercourse and home ovulation testing, is one example of cost effective treatment. Identifying and treatment of basic medical conditions, such as thyroid disease, is also part of of cost-effective fertility treatment. Discussing life-style modification, including nutrition, stress and smoking cessation, is also part of a cost-effective early treatment strategy. In addition, using oral medication for ovulation induction, where appropriate, rather than injectable or other advanced treatment, can also be successful as well as cost-effective.
2. Insurance Participation- Though most insurances cover diagnostic and basic treatments, including injectable medication and Intrauterine Insemination (IUI), many do not cover the most effective treatments, such as IVF. Knowing ones’ insurance benefits can help to decrease some of the emotional angst regarding coverage. Patients and reproductive practices often work together to help ensure knowledge of coverage, and that appropriate pre-authorizations are done in a timely fashion to ensure access to coverage. Often patients must do their own registration with their carriers in order to be eligible for benefits. Increasingly, many carriers are imposing stricter regulations and limitations on infertility coverage, including caps on medical and pharmacy benefits, with specific dollar amounts or limited numbers of treatment cycles. Given the constantly changing world of insurance, it is crucial to continually be in contact with ones’ insurance company when one contemplates fertility treatment. Extensive insurance participation with insurance carriers by medical practices is important for access to the best medical care for patients. Some insurance policies also have out- of- network benefit, and this also can be helpful in financial affordability of treatment.
3. Self-Pay Packages- Self-pay packages that encompass a full treatment cycle of expensive treatment, such as IVF, is also an effective way to make infertility treatment affordable. These packages can also be expanded to include medication, as well as medical treatment, for maximal affordability. These packages can also incorporate a multi-cycle component, in which the person or couple can get multiple attempts for one price. Though mostly utilized for the more expensive IVF, self-pay packages and multi-cycle plans can be used to make even the less expensive IUI cycles more affordable as well.
4. Infertility Grants- many foundations and organizations offer grant money for infertility care. These funds are generally used for the most expensive treatments, such as IVF. Many states also offer specific programs to residents of the particular state. These grants tend to involve a significant application process, and are need-based. Grants also exist for special populations, such as cancer patients, for special grants for Fertility Preservation prior to cancer treatment.
5. Discount Programs- Most of the pharmaceutical manufacturers of fertility medications have need-based and non-need based discount programs for fertility medications. Specific details of these programs can be obtained via the reproductive practice, or on the fertility companies’ website. Many reproductive practices may also offer their own discounts for military, law enforcement and teachers. Most also have drastically reduced prices to help cancer patients with Fertility Preservation treatments.
6. Infertility Loans- Low interest loans, with special flexible financing terms, are also available to help with fertility costs. A special application is generally required, and credit history as well as a review of personal finances may be needed for the application process.
7. Employer Medical Flex Accounts- Many employers offers their employees the ability to contribute to a Medical Flex Account program. These programs can be used by employees to pay for uncovered medical treatments, such as infertility, using pre-tax dollars. This approach can also help to achieve significant savings on infertility care. Individuals who are interested in this approach should contact their employer regarding the limits for this contribution, as well as the procedure to access these funds. For many individuals who are planning expensive treatments such as IVF, adequate planning with advance contributions to these accounts can be the difference in helping ones’ goal.
Conclusion-Affordable Fertility can be achieved in the journey of infertility treatments. Through awareness of these possibilities, physicians and other reproductive providers can help empower our patients to have access to the most effective treatments. This access can ensure that we can help our patients achieve their dream of having a child and building a family.