Negotiating $$ with RE?

Nagem927 · August 2011

Good morning ladies...

I was reading in my Budgeting for IF book last night & came across something I found interesting & thought I would ask y'all's opinion on.... Have any of you ever negotiated price with your RE? The author suggests scheduling a meeting with RE & offering them 60% of what they are charging you OOP; when/if they decline, you ask them what they would be willing to compromise with. The chapter goes on to describe how insurance companies pay at a discounted rate, so why should OOP patients pay a higher price. Just wondering if any of you have tried this & if so, what were your results? Our insurance company pays for diagnosis of IF, but not "treatment". Just trying to expore every angle before plopping down $20K.. Thanks, ladies!

BareBethC · August 2011

Hmm I haven't heard this before, but that's really interesting.

My insurance is a little different too, it's actually pretty confusing to keep track of. Once I reach my OOP max (2K), my insurance co pays up to 50%, and they only do that if there is not an infertility diagnosis. If there is an infertility diagnosis, they won't pay anything and every visit would be OOP. So I'm in the clear for coverage, but certain things like copays don't go toward my OOP max.

Mayan2011 · August 2011

Hey sweets. I live in Canada so the pay structure and total cost of treatments is a bit different, but like the U.S. there is room to negotiate.

In Canada there is no insurance coverage for the actual treatment, but labs and u/s are covered by healthcare and most meds covered through a good insurance program. We paid $6800 (each) for IVF/ICSI 1 and 2, but are currently negotiating a discounted price for IVF 3.

Good luck!

TotallyLoCo · August 2011

I think it's worth a shot. I can tell you that I was shocked when I got my insurance statements for my IVF cycle. I forget the exact amounts, but if my cycle cost $15,000, my insurance paid something like $9,000 and then there was a $1,000 copay for me with the clinic eating the rest. I'm hoping that if my benefit runs out (I have a $25K max), I will only have to pay the amount that my insurance paid -it only seems fair.

I always thought it seemed unfair that OOP patients pay much more than the insurance companies, but I also know that's the way insurance companies work.

saratrying · August 2011

I hadn't thought about that, but I bet they would be willing to negotiate. You have nothing to lose by asking.

They'd probably expect you to sign a non-disclosure of fees (so others don't start asking for the same pricing structure) and pay up front (if they don't already).

jessican08 · August 2011

I would say go for it! The worst they can say is "no", right?

I thought it was interesting when we sat down with our RE to discuss IVF, he said the costs for a round of IVF differ b/t those who have insurance and those who are OOP...he basically said if we had $10k IF coverage we should be able to get two rounds of IVF out of that because the insurance company doesn't pay them as much for each round??? I'm sure we'll find out more when we go for our consult but I thought that was very strange.

I hope you're able to negotiate something with your RE. GL!

Delta04 · August 2011

I love this post. I would say go for it! It makes no sense to me at all that we have to pay more because we are OOP and the insurance company pays less. Angry

Aegis2005 · August 2011

My RE gave me a list of costs. They said the cost for a "typical IVF" is $12,221, but if you pay out of pocket there is a flat fee of $9,170.

I'm covered by insurance and just got the paperwork yesterday. My insurance negotiated rate for an IVF cycle is $9,086 - so not that far off from their flat fee.

That said cryopreservation is not covered by my insurance - I'm paying as much for that as I am the deductible I owe this year.

Does your RE provide you a list of expenses? The "flat fee" comment on mine was in the fine print. If I was OOP I would try to negotiate the fee.

ecleptic · August 2011

jessicandavies:
I would say go for it! The worst they can say is "no", right?

I thought it was interesting when we sat down with our RE to discuss IVF, he said the costs for a round of IVF differ b/t those who have insurance and those who are OOP...he basically said if we had $10k IF coverage we should be able to get two rounds of IVF out of that because the insurance company doesn't pay them as much for each round??? I'm sure we'll find out more when we go for our consult but I thought that was very strange.

I hope you're able to negotiate something with your RE. GL!

The clinic will charge the insurance some amount. Say 12k for each IVF. The insurance will respond with what they believe the reasonable and customary charge for IVF should be. Say 5k. The 5k is all that applies to your insurance and the clinic is forced to write off 7K. Now the insurance may demand that you co-pay some % of that 5k, but as far as the insurance is concerned the 5K is the only relevant number.

The RE can't get away with just charging the insurance 5k though- the insurance will automatically adjust it down from whatever is submitted. So the doctors are forced to inflate their costs to insurance patients to get paid enough to keep the clinic running.

This is why you should never pay the cost that is sent to the insurance company for any medical procedure/visit (not just IF related) if you are out of pocket. Always ask for a "cash" discount (which doesn't need to be paid in cash- it's just the term to refer to out of pocket). You should be able to negotiate at least a 10% discount off the insurance price. Sometimes you can get lucky and get more- but if the clinic gets too cheap with their out of patient rates- the insurance can inform the clinic that they're not going to pay as much on insurance patients either.

The difference at some infertility clinics- especially in states where insurance is not required to cover infertility procedures- is that they have far more out of pocket patients than insurance patients. So they can take a loss on insurance patients to offer OOP patients a discount- thus making them more attractive to their biggest potential client base.

My clinic has a separate price list for out of pocket patients- it's nicely discounted. They've also negotiated a discount with labcorp for the lab testing they don't do in house- patients pay a discounted cash rate (example: RPL was 4500$ at lab corp. 1100$ through the clinic) to the clinic, and get the blood drawn at the lab corp. They also offer the second (and third and fourth and so on) IVF at an even bigger discount if you've used all of your frozen embryos without a viable pregnancy.

So we can ask for a discount- but our clinic is already offering their best cash price.

jessican08 · August 2011

ecleptic:
jessicandavies:

I would say go for it! The worst they can say is "no", right?

I thought it was interesting when we sat down with our RE to discuss IVF, he said the costs for a round of IVF differ b/t those who have insurance and those who are OOP...he basically said if we had $10k IF coverage we should be able to get two rounds of IVF out of that because the insurance company doesn't pay them as much for each round??? I'm sure we'll find out more when we go for our consult but I thought that was very strange.

I hope you're able to negotiate something with your RE. GL!

The clinic will charge the insurance some amount. Say 12k for each IVF. The insurance will respond with what they believe the reasonable and customary charge for IVF should be. Say 5k. The 5k is all that applies to your insurance and the clinic is forced to write off 7K. Now the insurance may demand that you co-pay some % of that 5k, but as far as the insurance is concerned the 5K is the only relevant number.

The RE can't get away with just charging the insurance 5k though- the insurance will automatically adjust it down from whatever is submitted. So the doctors are forced to inflate their costs to insurance patients to get paid enough to keep the clinic running.

This is why you should never pay the cost that is sent to the insurance company for any medical procedure/visit (not just IF related) if you are out of pocket. Always ask for a "cash" discount (which doesn't need to be paid in cash- it's just the term to refer to out of pocket). You should be able to negotiate at least a 10% discount off the insurance price. Sometimes you can get lucky and get more- but if the clinic gets too cheap with their out of patient rates- the insurance can inform the clinic that they're not going to pay as much on insurance patients either.

The difference at some infertility clinics- especially in states where insurance is not required to cover infertility procedures- is that they have far more out of pocket patients than insurance patients. So they can take a loss on insurance patients to offer OOP patients a discount- thus making them more attractive to their biggest potential client base.

My clinic has a separate price list for out of pocket patients- it's nicely discounted. They've also negotiated a discount with labcorp for the lab testing they don't do in house- patients pay a discounted cash rate (example: RPL was 4500$ at lab corp. 1100$ through the clinic) to the clinic, and get the blood drawn at the lab corp. They also offer the second (and third and fourth and so on) IVF at an even bigger discount if you've used all of your frozen embryos without a viable pregnancy.

So we can ask for a discount- but our clinic is already offering their best cash price.

Great info! Thanks ecleptic!

Nagem927 · August 2011

Thanks for your responses, ladies! I am scheduled for my IVF lab work on Friday, so I plan to hopefully talk to them then. Ecleptic...I am also on the gulf coast & my clinic also offers a discounted rate if you pay OOP for labwork. Which clinic are you using? Our clinic does offer an "attain" program...which means that you pay a set price & get 3 fresh & 3 frozen IVF cycles. It evens out to a buy 2 get 1 free kind of deal, but DH & I haven't decided if we want to go that route yet. I will keep you guys posted on any negotiating that gets done!

ecleptic · August 2011

Nagem927:
Thanks for your responses, ladies! I am scheduled for my IVF lab work on Friday, so I plan to hopefully talk to them then. Ecleptic...I am also on the gulf coast & my clinic also offers a discounted rate if you pay OOP for labwork. Which clinic are you using? Our clinic does offer an "attain" program...which means that you pay a set price & get 3 fresh & 3 frozen IVF cycles. It evens out to a buy 2 get 1 free kind of deal, but DH & I haven't decided if we want to go that route yet. I will keep you guys posted on any negotiating that gets done!

We're through Houston Fertility Institute. We have the Attain option- but DH and I were overconfident and decided not to go for it with our first IVF- and it seems a little silly to do it for the second (assuming this FET doesn't work) because our practice discounts the second+ IVF (again assuming you use all frozens before going back for another fresh) down to about 6k before meds if you're out of pocket. Attain wouldn't be much cheaper- and it would require that we pay upfront for three and we're still being told we're in the highest chance of success category despite failing at rolling the dice twice now.

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