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Shared Risk 100% Refund Program FAQ

frequently asked questions

Can I use preimplantation genetic screening (PGS) or preimplantation genetic diagnosis (PGD) with the Shared Risk 100% Refund Program?
Yes, PGS and PGD can be added for an additional fee.

Are there additional pre-screening tests and procedures needed in order to apply for the Shared Risk 100% Refund Program?
No. The medical evaluation and pre-screening used in preparation for an IVF or donor egg cycle is the same.

Do patients in the Shared Risk 100% Refund Program receive different treatment than those not in the program?
No. Just as there are no differences in the pre-screening tests, there are no differences in the IVF therapy of a Shared Risk patient compared with a patient who elects the traditional fee-for-service program. We closely track our own data, including the amount of medications used and the number of embryos transferred. We have found no differences in these or other parameters. We are fully supportive and follow the Society for Assisted Reproductive Technologies and American Society for Reproductive Medicine (ASRM) guidelines for limiting the number of embryos for transfer to limit the risks of multiple pregnancies. We follow these guidelines equally for Shared Risk and non–Shared Risk patients alike. Shared Risk is only a financing plan and is not used to dictate or determine any aspect of your medical care.

What is included?
All the medical and laboratory services at Shady Grove Fertility for up to six complete IVF cycles—from the start of medications through the first blood pregnancy test—are included. This includes assisted hatching of embryos and ICSI, if clinically needed. If using an egg donor, the costs of her monitoring, completed at SGF, and egg retrieval are also included.

Also included are the cost of cryopreservation of viable embryos not transferred during any of the "fresh" Shared Risk cycles as well as the cost of FETs, until you have a baby or choose to withdraw from the program.

A completed IVF cycle is considered one in which an embryo transfer takes place. A cycle cancelled during the stimulation and monitoring phase, or one in which a woman had no eggs to retrieve for fertilization, does not count as one of the six cycles to which you are entitled. We do not earn our fee if the cycle is incomplete.

A cycle in which you conceived but lost the pregnancy any time before delivery is considered in the same way as a cycle in which you did not conceive—one of the possible six completed IVF cycles, but not one in which we have earned our fee.

What is excluded?

  • Standard IVF pre-screening and screening tests
  • Medications
  • Monitoring done outside of SGF; such as ultrasounds and lab tests
  • If utilized, fees associated with recruitment and screening for:
    • Donor egg, if using an agency or known egg donor
    • Gestational carrier
    • Donor sperm
  • Costs associated with complications or non-IVF surgery, procedures, or care such as hospitalizations, dilation and curettage (D&C) for miscarriage, or fluid aspiration for ovarian hyperstimulation
  • Urologic male sperm retrieval procedure
  • PGD laboratory analysis

Do I have to complete all six cycles?
No. You can stop therapy at any time. You are under no obligation to complete any number of cycles.

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What are the penalties for early withdrawal before six cycles are completed?
There are none. If your treatment doesn't result in a child or you choose to withdraw, you will receive a full refund. (some conditions apply; see contract for detials)

Just as you have the right to withdraw, we must share the right to withdraw you from the Shared Risk 100% Refund Program, such as if you have an unexpectedly poor ovarian response to stimulation. In this rare event, we will issue you the same refund that you would receive if you withdrew on your own.

How can you just let a patient drop out without completing the six cycles?
Many patients have a baby after only one cycle, so even if they intention to drop out after one unsuccessful cycle, often they will not need to continue. Second, we do not believe that it is appropriate to force you to do an IVF cycle by holding your money beyond a time that you want us to. Third, many couples do a second cycle after having planned to discontinue because they know that the cycles that follow an unsuccessful first try are increasingly being financed with our share of the money. That is reassuring—as it is meant to be.

How did the Shared Risk 100% Refund Program originate?
We established our Shared Risk 100% Refund Program in response to a patient's tearful frustration. She told us that, after having paid for an unsuccessful IVF cycle elsewhere, another failed attempt would financially devastate her and her husband and prevent them from then adopting a baby. They could not risk gambling their adoption money on the possibility of another unsuccessful IVF cycle. Therefore, they were not going to try again using the traditional fee-for-service program despite good odds of success. Our response was to initiate the innovative Shared Risk 100% Refund Program.

How many couples have used the Shared Risk 100% Refund Program?
Approximately 5,000 couples have elected to go through our Shared Risk 100% Refund Program since its inception in 1993.

Is the Shared Risk 100% Refund Program a guarantee?
Yes. While a successful pregnancy is not guaranteed, you’ll receive a full refund* if treatment fails to help you have a baby. You may view this in contrast to what is guaranteed in our traditional fee-for-service program: In that program, you are guaranteed to pay the fee regardless of the IVF cycle outcome.

*for patients that undergo PGS and know the sex of the embryos, and opt to discard the embryos and/or withdrawal from Shared Risk, a portion of the fees will be returned to the patient; a 100% refund will not be given

What does the ASRM say about the Shared Risk 100% Refund Program?
The ethics committee of the ASRM thoroughly reviewed shared risk or refund programs in assisted reproduction in its September 1998 committee report (Fertil Steril. 70:414-6). We were humbled to have them adopt our name for such programs and support many of our long-held beliefs about the program. The committee found "that shared risk programs may be viewed as a form of insurance against the risk of failure that might appeal to some couples seeking IVF. The appeal arises from the general absence of health insurance coverage for IVF." In evaluating the concerns inherent in offering a shared risk program, the committee found that "the plans it examined [including ours at Shady Grove Fertility] provided sufficient information to enable patients to make an informed choice about whether to choose this option." In addition, they state that "whereas it is unethical to create unrealistic expectations or make false promises, shared risk plans do not appear to have that intent or effect . . . Whereas the provider's willingness to assume some of the risk of failure may convey a message of confidence in its services, no patient is likely to interpret the arrangement as a guarantee of success. On the contrary . . . what is guaranteed is obviously not success, but a refund if treatment fails." Precisely.

Before and after ASRM published its recommendations, we complied fully with the ethics committee's recommendations that, with full disclosure, informed consent, and identical treatment for patients using shared risk programs versus fee-for-service programs, Shared Risk is a valid and ethical option to offer.

What do patients say about the Shared Risk 100% Refund Program?
Patients love the idea of shared risk—regardless of whether they have had a baby or not. Nearly every day we hear comments that patients feel secure in our program because:

  • The medical team is fully dedicated to their success—medically and financially.
  • The experts at Shady Grove Fertility are confident in our ability to be successful.
  • Patients have "insurance" against the risk of therapy failure.
  • Patients dismiss critiques of “outcome-based fees” as coming from those centers that aren't risking their own money in helping their patients become pregnant.

One typical comment written on our Shared Risk 100% Refund Program Patient Satisfaction Surveys—surveys that attest to the near-universal support from patients—states: "The Shared Risk Program gave us peace of mind while we were going through IVF because we knew the costs were fixed, no surprises. Once pregnant we were comforted to know that even if anything happened to the pregnancy, we could try IVF again or later adopt."

What's the catch?
There really isn't any. As long as you know the following, then you understand the major components:

  • This is a voluntary option to finance IVF as an alternative to fee-for-service programs.
  • We each have some money “at risk.”
  • You can drop out at any time.
  • This is a form of insurance against the possibility of failure and not a guarantee of success.

We urge you to investigate every detail.

Do you accept patients from outside the mid-Atlantic region?
Yes. We have many patients from outside the region and from around the country, many of whom come to us initially because we offer the Shared Risk 100% Refund Program. We have staff members designated to help you with any logistical arrangements, and we are experienced with working with your local physicians to minimize inconvenience to you without compromising your medical care.

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