Many insurance companies don’t cover I.V.F. But there are ways to ease the financial burden.
By Amy Klein
This guide was originally published on June 20, 2019 in NYT Parenting.
I always knew that raising a child would be expensive, but I never knew that trying to have one could be — until I discovered my husband and I needed fertility treatment.
One of the worst parts of in vitro fertilization was dealing with the financial burdens it created.
I had partial, limited fertility coverage, which seemed like the worst of both worlds: I had to deal with insurance, but it still did not cover everything. In the four years it took my husband and I to have a baby, I spent countless hours on the phone with insurance companies, pharmacies, doctor’s office billing departments and even shipping companies (“Where are my meds!”) to understand my coverage, its cost and how to receive what I needed in time for treatment.
Now, after speaking with several fertility experts who deal with finances; an economist studying fertility and insurance; and parents, bloggers and advocates who’ve gone through I.V.F., I’ve discovered some ways to make the financial process a little less painful.
Before you visit a fertility clinic, the first thing to know is whether you have any fertility coverage — and what kind.
“If you have health insurance through your or your partner’s employer, talk to the benefits person and find out exactly what is covered from your health insurance,” said Barbara Collura, president and C.E.O. of Resolve: The National Infertility Association. Collura noted that the exclusions on most full health benefits plan documents are “typically over 100 pages in teeny tiny font.”
If you have an insurance plan through your state’s exchange, you might have coverage if your state has mandated fertility coverage. According to the National Conference of State Legislatures, only 14 states require insurance plans to cover infertility, and two — California and Texas — require insurers to offer coverage. Though typically, only a small fraction of the cost, such as that of medications, is covered.
If you do have fertility coverage, ask your insurance coordinator these questions:
Are initial consultations covered — and if so, how many? (This may help you determine whether you can visit several clinics before choosing one.)
Does insurance cover diagnostic testing? While I.U.I. or I.V.F. procedures might not be covered, your blood work and ultrasound monitoring may be.
Are medications covered, and do they need to be from a special pharmacy?
Which treatments are covered? Are both intrauterine insemination and I.V.F. included in coverage?
Is there a waiting period before qualifying for I.V.F.? Do you first have to try certain treatments, such as I.U.I., for example? (Some insurance companies require a few months of trying to conceive or a number of I.U.I.s before beginning I.V.F.)
Is there a cap on your coverage? Is there a dollar amount, a cycle amount or a lifetime limit?
It may be challenging to get all the answers you need from your insurance company (take down the names of everyone you speak with so you’ll have a paper trail). Once you have chosen a clinic, another good resource is the billing coordinator there, who may be able to provide additional details.
It’s difficult to know what treatment will cost before you begin, and pricing can vary depending on where you live. According to the N.C.S.L., the average I.V.F. cycle can cost anywhere from $12,000 to $17,000 (not including medication). With medication, the cost can rise to closer to $25,000. Clinics define an I.V.F. cycle as one egg retrieval and all the embryo transfers that result from that retrieval.
There are add-ons, including genetic testing of the embryos and surgical procedures (such as sperm extraction or laparoscopy), which can increase the cost of I.V.F. by thousands of dollars.
Most people will require more than one round of treatment, though exactly how many cycles you’ll need is hard to predict. Some studies suggest that most women can get by with three; others suggest that number may be closer to six.
But trying for more than one cycle isn’t financially feasible for everyone, said Dr. Lucie Schmidt, Ph.D., a professor of economics at Williams College in Massachusetts. “Some people can afford one cycle on their own, but not two or three,” said Dr. Schmidt, who studies how states’ insurance mandates affect I.V.F. treatment. “Lack of insurance (or less generous insurance) puts additional pressure on women to transfer multiple embryos, which can then lead to costly and risky multiple births.”
At some point in the process, it’s helpful to set financial and treatment goals with your partner and your doctor. Discuss, for example, how many I.U.I.s you might try before you move on to I.V.F.; and how many I.V.F. cycles you will undergo before considering next steps, such as using an egg donor, a sperm donor or a surrogate. Would you pursue other family-building options, like fostering or adoption? Each progressive step can cost more money, so it’s important to budget for that.
“How will you know when enough is enough?” Collura suggested asking yourself, noting that you should create benchmarks to evaluate and decide on next steps. She said that financing family building is a huge issue for many couples, and if you’re not careful, it can derail your journey and your relationship.
Although fertility treatment can be expensive, it isn’t just for the independently wealthy. People pay for I.V.F. in many different ways, from refinancing their homes to borrowing from family or putting payments on credit.
Jennifer “Jay” Palumbo, author of The Two-Week Wait Blog and a mother who had the first of her two children through I.V.F., won a free cycle from a clinic-sponsored contest. “I was someone who ran out of money to get pregnant. I don’t own a house now because we went through treatment,” said Palumbo. “We were in a very bad place; our whole savings account was empty, it was just … bad.”
There are other ways to pay for fertility without breaking the bank, though some options are more feasible than others:
Some people start social media fundraising campaigns.
Others move to states with mandated health insurance to get coverage (or find a new job at a company that’s based in a state with mandated coverage).
Some apply for grants; which can be based on various factors, like location or income.
You may also qualify for a clinical study, which you can peruse and sign up for on websites like ClinicalTrials.gov, Center Watch or Find Me Cure.
Some clinics offer lotteries for free cycles or money toward a cycle.
You can join a shared risk program, which offers a bulk number of cycles for a flat fee to qualifying patients – guaranteeing a baby or your money back. Your health and age will usually be considered to qualify for the program. Keep in mind, however, that shared risk programs are a gamble: Many people who qualify might not need the full number of cycles included in a bulk package, and end up spending more than they would have without it.
With smaller clinics, you can try to negotiate with your doctor or billing department — especially if it’s not your first cycle.
People sometimes take breaks between treatments for financial, physical or emotional reasons. While the quality of the eggs inside your body never improve with time, according to Dr. Eric Forman, M.D., the medical and laboratory director of Columbia University’s Fertility Center, a wait of six months or less can be “safe and reasonable” for many patients.
“Sometimes insurance changes and it’s preferable to wait for a new plan to be in place,” said Dr. Forman. Other people may need a break for medical reasons, or to take a vacation they planned before the embryo transfer. “Sometimes people just need a break and can emotionally recharge for another attempt after a couple of months,” said Dr. Forman.
It took Regina Townsend, a librarian in Chicago, more than seven years to have a baby. Townsend started trying to conceive at 25, but because of several health issues — including polycystic ovarian syndrome, hyperthyroidism, blocked fallopian tubes and Type 2 diabetes — her reproductive journey was complex. To make matters worse, her husband had his own suite of fertility issues, and their insurance coverage was spotty. She wrote about her experience on The Broken Brown Egg, a website she founded to increase awareness of African-American infertility and reproductive health.
According to a study published in the journal Fertility and Sterility in 2018, it can take African-American women a year longer to seek infertility treatment, and treatment can be 14 percent less successful than it is for white patients.
Townsend said that she and her husband would try I.V.F. for about six months, then something would come up that would force them to take a break. “I lost my job, or he lost his job, or we didn’t have insurance, then our clinic wouldn’t take our insurance,” Townsend said.
They finally had their son. “This whole journey of trying to become parents is exhausting,” she said.
Amy Klein wrote the Fertility Diary column from 2013 to 2015 for Motherlode, a New York Times blog. She is the author of “The Trying Game: How to Get Pregnant and Survive I.V.F. Without Losing Your Mind.”