Affording Treatment

You've tried unsuccessfully to get pregnant 'the old fashioned way' and come to a decision that help is needed. That part of the journey is tough enough. Now, you're looking at treatment options and wondering how you'll afford it all.

Most people don't have a savings account tucked away for things like infertility treatment and, unfortunately, many people don't have insurance coverage for it, either. How can you move forward with decisions that will impact your dreams of building a family?

First, don't assume that you fully understand your insurance coverage without a thorough look at the fine print. Misinformation from disgruntled co-workers abounds at the water cooler and on the Internet. People are often surprised to learn that at least part of the diagnostic and/or treatment process is actually covered by their employer's choice of plans. The details aren't always listed in the handbook you receive from human resources. Sometimes, the only way to find out for sure about exclusions is through your company's assigned representative or, if you've got a self-purchased policy, through the agent or insurer's liaison. However, many fertility patients find that the best way to get a handle on their coverage is through the physician's office.

Administrative staff at fertility clinics are well-versed in finding coverage on an item-by-item basis when necessary. Even if it appears at first that your insurance won't help, you could learn differently after speaking with the financial representatives at your specialist's office.

Pamela Schumann, Vice President of Consumer Services for IntegraMed America and a former fertility patient herself, boils it down to expertise. "Here's an example of how it happens: employees call their human resources or insurance agent and ask 'Do I have coverage for IVF?' and they're told 'No.' But as a matter of course, every fertility practice will check your insurance benefits themselves when you come in, and they often find that you don't have coverage for IVF per se, such as for the egg retrieval and embryo transfer procedures. But you often do have coverage for diagnostic procedures, ultrasounds, office visits, blood draws, and maybe even medications. In effect, you can have half of your treatment cycle covered."

Next, learn to think of infertility treatment as a process, not a one-step procedure. There are so many variables involved in reproduction, infertility is sometimes caused by a combination of systemic glitches rather than one culprit. This makes diagnosis by a specialist crucial to your eventual outcome. It also means that once you've decided on a treatment plan, flexibility must be built in to that plan.

Take IVF as an example. When a couple goes through diagnostics and arrives at in vitro fertilization as a solution to their personal situation, it's easy to go from hopeful optimism to unrealistic expectations. The truth is that most patients don't wind up with a successful pregnancy as a result of their first IVF; it usually takes more than one cycle. However, each cycle of unsuccessful IVF can add to the potential for success of subsequent cycles, by increasing the treatment team's knowledge about a couple's reproductive responses to medication and procedures.

So, once you've nailed down understanding if and when your insurance will help, and you've broadened your view of treatment as a process, where do you turn?

Some couples turn to understanding family members for financial loans and gifts. Some use credit card accounts to cover treatment. Some patient organizations offer their members occasional "cycle giveaways" or raffle-type discounts for services from specific clinics.

A crucial part of IntegraMed America's purpose is to assist fertility patients in accessing the treatment they need. The company does this by offering consumers pharmaceutical access, treatment financing, and the well-known Integramed™ Shared Risk® Refund Program.

How IntegraMed Helps

Medications:

Through a partnership with IVP Pharmaceutical Care, IntegraMed Pharmaceutical Services, Inc. (IPSI) is able to provide all the fertility medication services that any patient needs.

Pam Schumann explains that pharmacies that specialize in infertility treatment provide a level of experience that is unmatched. "We chose to work with IVP Pharmaceutical Care because of their expertise in offering patients free comprehensive drug benefit verification. They're able to find insurance coverage for medications that the patient and even the practice didn't think existed."

Schumann emphasizes the point that people interested in pursuing fertility treatment shouldn't stop abruptly when it seems their insurance handbook is pronouncing they've come to a financial dead-end. "You should alway verify your benefits," she encourages, "even when you don't think you have any, and most fertility practices do [verify benefits] for the patient." A recent report by IVP Pharmaceutical Care on one clinic found that they were able to obtain insurance coverage of medication for the majority of patients even when both the patient and clinic staff had believed there would be none.

Shared Risk Refund Program:

IntegraMed America clinics offer the popular Shared Risk Refund Program for patients utilizing IVF to become pregnant. The program is based on the documented national statistic that less than half of initiated IVF cycles result in a baby to take home. The program works by offering patients a significant discount on the price of a treatment package that includes up to three IVF cycles and three frozen embryo transfers (FET). If a patient has used all of those opportunities and still fails to have a baby, the program refunds from 70 to 100 percent of the fee.

Schumann explains that virtually all patients enrolled in the IntegraMed Shared Risk Refund Program don't want the refund -- they want the opportunity to stick with treatment until they have their heart's desire: a baby at home.

"If you look at the statistics and you're committed to staying in treatment long enough to get the desired results," she emphasizes, "then Shared Risk is a no-brainer." Schumann states that of the patients who have entered and finished the IntegraMed Shared Risk Refund Program, approximately 75 percent have left with a baby and the remaining 25 percent have received a partial refund.

For more information on the program, see "Is Sharing the Risk Right for You?"

Conventional Financing:

Through a partnership with Capital One Healthcare Finance, IntegraMed clinics offer unsecured loans up to $25 thousand specifically marked for treatment and medications. It may be used in conjunction with the Shared Risk Refund Program or not. The loans have no prepayment penalty and offer interest rates that are better than most credit cards. Hundreds of patients took advantage of this treatment funding avenue last year.

Schumann says that many patients use loans to bridge gaps in ability to afford treatment and to buy time, a particularly important aspect of treatment for female infertility issues. "If, for example, a patient has some savings or gift money, then one of these loans to make up the difference in treatment costs could make a big impact in how quickly they can be treated." Patients interested in more information on the loan program can visit the related website or obtain brochures from their physician's office.

Shared Goals

IntegraMed's goals for patients are to improve treatment outcome, improve affordability, and improve patient education. The company's mission statement plainly outlines a commitment to conducting business "in a manner that values the rights of fertility center patients." In addition to IntegraMed Vice President Schumann, other leaders of the company, like CEO Jay Higham, share personal knowledge of the fertility patient struggle and use that knowledge to continually promote the company's mission.

Each patient encounters a unique situation with regard to their medical and financial needs. IntegraMed physicians encourage patients to weigh the costs and benefits of fertility treatment. Hard choices must often be made -- whether or not to begin treatment, to continue, or to change the focus. If you had the chance to ask any former patients-turned-parents whether their struggle was worth it, the only answer you'd likely hear is a resounding "Yes."