mskeenan --I am soooo sorry to hear about your insurance coverage issues. Unfortunately, insurance companies typically aren't on your side or trying to help you. If the person handling your pre-authorization or claim coverage cant check every box on their pre-printed form, they deny you and send it on its way. You have to keep fighting them tooth and nail. One of the things I did when we were struggling with the insurance company was get my husbands HR director involved. I sent a written complaint to them directly. The employer who buys the coverage is really the insurance company's biggest concern--it's the employer who could leave that insurance company and with that the insurance company would lose a TON of money. It is insanely tedious, time consuming and frustrating, but document everything the insurance company tells you. Ask for everything in writing to be sent to you via email or fax (if they mail it to you it always gets "lost") get a copy of your policy and read the language regarding when you "qualify" to get the IVF coverage that is available under your policy. generally, if there is a dx of "infertility" for you or your spouse, you should be able to obtain the IVF coverage. Don't give up this fight and do not let them win! I talked to them every signal day until I got the answers I wanted and needed. Not fun and stressful, but necessary it turns out! Share everything with the HR benefits director at your or your partner's employer (whichever your coverage is under) and they can help you. They have to and will keep everything confidential.
in terms of cost--your estimate matches what we generally paid for the IVF cycle --that included monitoring (blood and u/s), Egg Retrieval, ICSI, assisted hatching and freezing (not storage). You already know that doesn't include the meds (which I think mine totaled about 7K)
Some facilities do offer payment plans or work with third party financing companies who specialize in fertility treatment financing. There are definitely options so talk to your fertility treatment centers about financial accommodations. We were lucky to get our 1 cycle covered and we have maybe half of a second cycle left in insurance coverage, but after that we are out of pocket going forward. We spent a hefty amount to meet our high deductible and also had to pay for pgd out of pocket. So we skipped our yearly vacation and cut down on our frivolous expenses. It's definitely a stressor and the sticker shock when we first started really threw me.
Our insurance didn't cover our IVF cycle. The drs cost for ICSI, assisted hatching, embryo freeze, monitoring and DH PESA was about $6,000 then $4,500 in medication. Luckily my insurance covers the lab work so i pay $15 per draw. When you get pregnant, you need to pay for ob monitoring and additional meds. We had to charge it. No way we could afford that up front.
My husband's insurance offers $18k lifetime max on IVF procedures and $12k for medication. Our first round of meds only cost me $1200 out of pocket but ate up $9k of our lifetime max. This cycle was cancelled before we even got to IVF because I didnt respond to the meds. While my doctor learned a lot about me from that cycle, we wasted so much of our insurance coverage on that. Now we have no funds left and any medication cost will have to be paid out of pocket. Luckily we completed an Egg Retrieval this time around but it cost is $4000 out of this time around for meds. Each visit to my RE is $80. We only pay 30% of cost for IVF procedures until we max out the $18k insurance coverage. I don't understan why the cost are so outrageous but there are grants out there to assist.
*** Pregnancy & Miscarriage Mentioned*** ME: 34/DH: 33 TTC (On & Off) Since 2008 Diagnosed DOR August 2013 2009-2013 6 Clomid Rounds which resulted in 3 Cysts/Had to take some time off from TTC 10/2014 ~ BFP (Natural Pregnancy) after 3 months Acupuncture/Miscarriage at 10 wks 7/2015 ~ Med Protocol#1: Failed Cycle/Only 1 Egg/Unable to convert to IUI because thin uterus lining 08/2015 ~ Med Protocol #2: Started stims 09/13 ER 10/9 with 6 Eggs Retrieved/3 SNOWFLAKES!!
10/22/15 ~ AF Showed up, waiting for Fibroid removal. 10/28/15 ~ Saline Ultrasound - Fibroids were gone. FET scheduled for December 3rd! 12/08/15 ~ FET of one hatching Embaby
My insurance only covers IUI which was not an option for us. Our clinic charged us $16,000 for a cycle and that covered all blood work, monitoring, retrieval, ICSI, sperm prep, embryo culture, CGH for up to 8 embryos, transfer, freezing and 1 year of storage. Also "unlimited" ET for up to 1 year with the embryos until we get a BFP. Medications were also OOP and that was another $3,500. Sadly, those are normal prices in the Las Vegas area.
My insurance did cover most of the diagnostic portion, so that was only about $2,500 out of my pocket, but that also included an additional procedure to remove a large, stubborn fibroid at the hospital.
We went through the diagnostic portion in Oct 2014, after we found out that IVF would be necessary, we made some big changes to save the money. We work less than a mile from each other so we eliminated a car/car payment and car pooled for a year. Good bye eating out, cut down on the clothing budget, no vacations for the year, no more Target.com after 2 glasses of wine Every dollar we saved went immediately into another savings account.
At 6 months I took what we had at the time and put it into a short term CD, the rate is quite low, but hey, every penny helps.
When we were ready, we paid the clinic with our Southwest Chase card (POINTS BABY!!!!!!!), then I paid it off with my saved funds. Since we didn't have the full amount, the remaining balance I transferred to a credit card deal that came in the mail - 0% for XX months. The transfer fee was minimal, and the CD interest helped pay for some!! The balance transfer will give me several months to comfortably pay it off in the 0% time frame.
This whole CD and credit card thing seems like a lot of work, but I deal with finance in my career so it was easy for us. Our clinic offered financing but I didn't even want to consider that.
I hope this helps others struggling with the finance part. You're not alone!
It sounds like you're very financial savvy ! It's too bad your southwest card doesn't give you triple points for fertility clinic charges ! I understand the no target.com, in my case I needed to delete the Amazon app off my phone. I also try not to go to the grocery store hungry, that ends up costing an extra 50 bucks.
We just did our first IUI this morning and it would be great if it worked and we could save some 15K. However I understand the chance of success is low. We will be prepared to do it the old fashioned way (cash) in January.
So where are you in the process ? Hopefully successful !
I'm reviving this thread so I can flip out a little.
Bravelle has been recalled so my RE is switching me to Gonal-F. Pharmacy just called and for 4 pens (which will be 6 days worth), it is $1,035 with a 25% off coupon. My DH doesn't think we should do it. I almost feel like if we are going to spend that much on meds (will likely be double that plus copays), I might as well save up for IVF. But then I feel like, what if this works and I don't need to save up all that money for IVF. Ugh. I hate this.
@Whiggrrl65 I just had the same problem this past cycle! Since no bravelle we also had to go with gonal-f but I took the 75ius but it was still more pricey than bravelle. Also I had already bought 4 vials of bravelle the past cycle and when you buy 10 you can get 50% rebate via Green Light. But I couldn't buy bravelle so I have no rebate coming anytime soon! My DH is also very upset about the money we have to spend (not great timing since his car just died!) on these injects and he wants to stop trying because we just can't afford it anymore! There are slim chances without injects for me so it's so depressing! I'm hoping this cycle works for you and me both! GL to you and I can relate!
Married to DH since 8/15
TTC since 5/15
PCOS, 35+, diagnosed with pre-diabetes TI for 4 cycles: 1 round of femara; 2 rounds femara/ injectables: all ended in BFN. 3 IUI Cycles: letrozole/Follistim with HCG Trigger,all resulted in BFN. FET #1: Baseline appt 4/28/16, Gonal-F/Menopur stims, Centrotide 5/4/16, ER 5/11/16; 6/8/16 ET, BFN FET #2: Baseline appt 6/22/16, Estrace/PIO shots: 7/12/16 ET, 1st beta 7/21/16: 83 BFP, 2nd beta 7/23/16: 315. 1st U/S: 8/4/16 empty sac. 2nd U/S: 8/10/16 yolk sac appeared, everything stopped growing. Office D&C: 8/11/16, MC. FET #3: Baseline appt 12/28/16, Estrace/PIO shots: 1/17/17 ET, 1st beta 1/27/17: 146 BFP, 2nd beta 1/29/17: 336, 1st U/S: 2/16/17, 2 healthy twin babies measuring 7w0d. EDD: 10/5/17
I'm freaking out because I'm in a state that doesn't do fertility treatments on insurance. We're looking into financing our ivf since it's our only option
I'm reviving this thread so I can flip out a little.
Bravelle has been recalled so my RE is switching me to Gonal-F. Pharmacy just called and for 4 pens (which will be 6 days worth), it is $1,035 with a 25% off coupon. My DH doesn't think we should do it. I almost feel like if we are going to spend that much on meds (will likely be double that plus copays), I might as well save up for IVF. But then I feel like, what if this works and I don't need to save up all that money for IVF. Ugh. I hate this.
I totally feel you ! If my meds weren't covered I really don't know if we would have done IUI and may have just put it off until we save for IVF. It didn't make sense to me to spend all that money on something that has a 15 percent chance of success. At least with ivf it's a 60 - 80 percent chance of success-so If we do the math 4-5 iuis injectables is the cost of one IVF (that's without the meds).
But you're right, what if it does work ? How about try one cycle ? Good luck !
Walgreens specialty pharmacy has some discounts. That's who I used. I used Bravelle and Menopur. I got a discount on top of the IVF Greenlight program.
Our coverage says it covers fertility, but in all reality .... it dont. It don't cover ivf or iui or even sperm freezing/washing. It does cover meds, b/w and u/s though and the actual re visit. But I wish it did cover more because I really wanted to do the ivf vs iui. But it's just way out of budget.... 18k for me. ): so we are going to do the iui which only costs 250 here.
I live in VT, but work in MA, so thankfully my insurance does have some fertility coverage. It's definitely not cheap, our premiums are now $700/month and that's after my employer's contribution. There are a lot of rules and hoops to jump through, but obviously, in the end it's worth it.
We had to pay OOP for an HSG ($900), two semen analysis ($200 each), 3 cycles just clomid & 3 failed IUIs before my insurance would approve IVF, due to my age (<35) and diagnosis as "unexplained". We did those IUIs over the course of 6 months and it was roughly about $400 per IUI. When I went to get approved for IVF I had to also go to nutritional counseling beforehand because my BMI was over 35. However, after all that red tape, my IVF is essentially covered, other than the $20 initial office visit copay, the $120 meds copay and the $20 copay for the IVF package. My EOB said the total was about $8,000 for the meds & $12,000 for the IVF procedure.
Unfortunately our fresh cycle didn't work, so I also had to get approved for an FET that finally (after 5 years of TTC) got me my BFP. I haven't seen an EOB for that yet, but honestly at this point, it's a lot less than I ever thought this whole process would cost us. We also have to pay $40/month for our leftover frozen embryos until we use them in the future.
At the beginning of our infertility journey I was convinced IVF would never be an option for us solely because of the financial aspect.
My best advice is to definitely look into programs, subsidies, etc in your area/state that can help you afford this. Obviously double check with your insurance about coverage, there might just be things you have to do beforehand to see some coverage. Ask for their Infertility Protocol. Ask if you can make payments monthly for the medical bills. Also, ask about fertility drug donation programs, I know that if this pregnancy looks good I will be donating all my unused meds back to the hospital I went to for couples who have to pay OOP.
IMO it's ridiculous that people who so desperately want children but medically cannot, are left in limbo because our country's healthcare system is a complete shitshow.
ShesMermaid our plan also covers meds and it's a huge help! We decided to start with IUI vs go straight to IVF for the same reasons as you, even though our RE was trying to convince us that we're wasting our time with IUI. 500 is not bad at all, is it a medicated cycle? I think I mentioned previously but IUI at our clinic was 2600 for the injectable cycle. which is what we did.
Hopefully you will be successful with IUI and won't have to worry about figuring out financing that IVF!
mmjndiaye first of all, big congrats on the BFP!!!!! WOW 700 a month for your premium??? I hope that pays for all the fun stuff too like massages and gym memberships. It sounds like it's been worth it in your case. I really hope the rest of your pregnancy goes smoothly, 5 years is enough time you really earned that BFP!
The other day my 44 year old aunt was freaking out because she was certain she was pregnant (unwanted) with her #5. It's like can you please just shutup with all of that. We're dying to have our #1.
I'm currently 9dpIUI injectable cycle. Beta is in 4 days. So today I found that one of the credit cards I've been aggressively paying off just gave me a 5K credit line increase. Even though I'm trying to avoid getting into further credit card debt, the timing was pretty sweet. If this IUI cycle doesn't work, we have the cash to pay the majority of the IVF cost (about 19K) and the difference we can put on credit without actually maxing out any cards. Thankfully the meds will be covered!
Wow I did not realize how many insurance companies do not cover these treatments. I am blown away and outraged for all of you!!! Also I feel very thankful my insurance in Massachusetts covers absolutely everything, even 5 ivf treatments. Everyone move to MA!
Re: can we talk $$$
mskeenan --I am soooo sorry to hear about your insurance coverage issues. Unfortunately, insurance companies typically aren't on your side or trying to help you. If the person handling your pre-authorization or claim coverage cant check every box on their pre-printed form, they deny you and send it on its way. You have to keep fighting them tooth and nail. One of the things I did when we were struggling with the insurance company was get my husbands HR director involved. I sent a written complaint to them directly. The employer who buys the coverage is really the insurance company's biggest concern--it's the employer who could leave that insurance company and with that the insurance company would lose a TON of money. It is insanely tedious, time consuming and frustrating, but document everything the insurance company tells you. Ask for everything in writing to be sent to you via email or fax (if they mail it to you it always gets "lost") get a copy of your policy and read the language regarding when you "qualify" to get the IVF coverage that is available under your policy. generally, if there is a dx of "infertility" for you or your spouse, you should be able to obtain the IVF coverage. Don't give up this fight and do not let them win! I talked to them every signal day until I got the answers I wanted and needed. Not fun and stressful, but necessary it turns out! Share everything with the HR benefits director at your or your partner's employer (whichever your coverage is under) and they can help you. They have to and will keep everything confidential.
in terms of cost--your estimate matches what we generally paid for the IVF cycle --that included monitoring (blood and u/s), Egg Retrieval, ICSI, assisted hatching and freezing (not storage). You already know that doesn't include the meds (which I think mine totaled about 7K)
Some facilities do offer payment plans or work with third party financing companies who specialize in fertility treatment financing. There are definitely options so talk to your fertility treatment centers about financial accommodations. We were lucky to get our 1 cycle covered and we have maybe half of a second cycle left in insurance coverage, but after that we are out of pocket going forward. We spent a hefty amount to meet our high deductible and also had to pay for pgd out of pocket. So we skipped our yearly vacation and cut down on our frivolous expenses. It's definitely a stressor and the sticker shock when we first started really threw me.
*** Pregnancy & Miscarriage Mentioned***
ME: 34/DH: 33
TTC (On & Off) Since 2008
Diagnosed DOR August 2013
2009-2013 6 Clomid Rounds which resulted in 3 Cysts/Had to take some time off from TTC
10/2014 ~ BFP (Natural Pregnancy) after 3 months Acupuncture/Miscarriage at 10 wks
7/2015 ~ Med Protocol#1: Failed Cycle/Only 1 Egg/Unable to convert to IUI because thin uterus lining
08/2015 ~ Med Protocol #2: Started stims 09/13
ER 10/9 with 6 Eggs Retrieved/3 SNOWFLAKES!!
10/22/15 ~ AF Showed up, waiting for Fibroid removal.
10/28/15 ~ Saline Ultrasound - Fibroids were gone. FET scheduled for December 3rd!
12/08/15 ~ FET of one hatching Embaby
12/21/15 ~ 13dp5dfet Beta 755! I'M PREGNANT!!!/ 12/23/15 ~15dp5dfet Beta 1539!
01/05/16 ~ 1st Ultrasound - 2 little beans and 2 Heartbeats (120 & 125 bpm)
My Fur Baby: Diva Celeste McClendon
Bravelle has been recalled so my RE is switching me to Gonal-F. Pharmacy just called and for 4 pens (which will be 6 days worth), it is $1,035 with a 25% off coupon. My DH doesn't think we should do it. I almost feel like if we are going to spend that much on meds (will likely be double that plus copays), I might as well save up for IVF. But then I feel like, what if this works and I don't need to save up all that money for IVF. Ugh. I hate this.
TI for 4 cycles: 1 round of femara; 2 rounds femara/ injectables: all ended in BFN.
3 IUI Cycles: letrozole/Follistim with HCG Trigger,all resulted in BFN.
FET #1: Baseline appt 4/28/16, Gonal-F/Menopur stims, Centrotide 5/4/16, ER 5/11/16; 6/8/16 ET, BFN
FET #2: Baseline appt 6/22/16, Estrace/PIO shots: 7/12/16 ET, 1st beta 7/21/16: 83 BFP, 2nd beta 7/23/16: 315. 1st U/S: 8/4/16 empty sac. 2nd U/S: 8/10/16 yolk sac appeared, everything stopped growing. Office D&C: 8/11/16, MC.
FET #3: Baseline appt 12/28/16, Estrace/PIO shots: 1/17/17 ET, 1st beta 1/27/17: 146 BFP, 2nd beta 1/29/17: 336, 1st U/S: 2/16/17, 2 healthy twin babies measuring 7w0d. EDD: 10/5/17
But you're right, what if it does work ? How about try one cycle ? Good luck !
My RE and @emgem819 mentioned Green Light. Are there others?
PCOS baby due October 09, 2016
Beta #1: 22.5
Beta #2: 74
TI for 4 cycles: 1 round of femara; 2 rounds femara/ injectables: all ended in BFN.
3 IUI Cycles: letrozole/Follistim with HCG Trigger,all resulted in BFN.
FET #1: Baseline appt 4/28/16, Gonal-F/Menopur stims, Centrotide 5/4/16, ER 5/11/16; 6/8/16 ET, BFN
FET #2: Baseline appt 6/22/16, Estrace/PIO shots: 7/12/16 ET, 1st beta 7/21/16: 83 BFP, 2nd beta 7/23/16: 315. 1st U/S: 8/4/16 empty sac. 2nd U/S: 8/10/16 yolk sac appeared, everything stopped growing. Office D&C: 8/11/16, MC.
FET #3: Baseline appt 12/28/16, Estrace/PIO shots: 1/17/17 ET, 1st beta 1/27/17: 146 BFP, 2nd beta 1/29/17: 336, 1st U/S: 2/16/17, 2 healthy twin babies measuring 7w0d. EDD: 10/5/17
PCOS baby due October 09, 2016
Beta #1: 22.5
Beta #2: 74
We had to pay OOP for an HSG ($900), two semen analysis ($200 each), 3 cycles just clomid & 3 failed IUIs before my insurance would approve IVF, due to my age (<35) and diagnosis as "unexplained". We did those IUIs over the course of 6 months and it was roughly about $400 per IUI. When I went to get approved for IVF I had to also go to nutritional counseling beforehand because my BMI was over 35. However, after all that red tape, my IVF is essentially covered, other than the $20 initial office visit copay, the $120 meds copay and the $20 copay for the IVF package. My EOB said the total was about $8,000 for the meds & $12,000 for the IVF procedure.
Unfortunately our fresh cycle didn't work, so I also had to get approved for an FET that finally (after 5 years of TTC) got me my BFP. I haven't seen an EOB for that yet, but honestly at this point, it's a lot less than I ever thought this whole process would cost us. We also have to pay $40/month for our leftover frozen embryos until we use them in the future.
At the beginning of our infertility journey I was convinced IVF would never be an option for us solely because of the financial aspect.
My best advice is to definitely look into programs, subsidies, etc in your area/state that can help you afford this. Obviously double check with your insurance about coverage, there might just be things you have to do beforehand to see some coverage. Ask for their Infertility Protocol. Ask if you can make payments monthly for the medical bills. Also, ask about fertility drug donation programs, I know that if this pregnancy looks good I will be donating all my unused meds back to the hospital I went to for couples who have to pay OOP.
IMO it's ridiculous that people who so desperately want children but medically cannot, are left in limbo because our country's healthcare system is a complete shitshow.