When many couples find out that they need fertility treatment help start or add to a family, one of the first questions that they may ask is whether they can afford it. For the longest time, fertility treatments were seen as “for the wealthy” because of the high out of pocket expense and limited insurance coverage. But thanks to technology, increase of insurance benefits and many new financial options, patients of Shady Grove Fertility Center have a myriad of choices when it comes to affording fertility.
From the moment a patient walks into Shady Grove Fertility, they are assigned a financial navigator to help them research which financial options may be appropriate for them. This is just one of many “full service” financial benefits that Shady Grove Fertility provides to compliment the highly successful clinical services that the center offers.
“We are here to help take away the headaches,” said SGFC Financial Services Director Janice Koch. “Our helpful counselors assist the patient by calling on their insurance benefits, provide accurate information about their coverage, and work with them to research financial options that work best for them.”
The Country’s Largest Clinic, One Patient at a Time
Shady Grove Fertility is the largest IVF program in the United States. For some patients, that’s an attractive point; for some, it feels daunting. Amanda Segal, SGFC Patient Services Coordinator who has been with Shady Grove for 16 years, says that size definitely has something to do with affordability.
“Our size is actually a cost-savings factor in the big picture,” said Segal. “With the number of experts we have on board comes the ability to provide the absolute best services out there. Our success rates are solidly superb, which means patients are more likely to need fewer treatment cycles to have a baby.”
She also cites the widely scattered Shady Grove locations as cost-efficient for patients who are worried about the current economy and managing busy working schedules. “As a group, we’re big. But when patients go to their physician’s offices, they feel cared for — individually.”
Insurance Coverage? Do your Homework!
When patients first schedule an appointment to visit Shady Grove Fertility, many are surprised to learn that several types of insurance are accepted for treatment. While some insurance benefits are more comprehensive then others, SGFC financial team says it is important for the patient to research their benefits and know what is covered and what they are going have to pay out-of-pocket.
“We have teams of specialists who are knowledgeable with each insurance plan,” said Koch. “Our team members don’t actually work for the insurance company, rather they specialize in knowing the ins and outs of one payer rather than all payers.”
“By dealing with the same insurance company on a daily basis” Koch added, “our teams can ensure that what the patient is being told about their insurance benefits is accurate.”
Shady Grove Fertility currently participates with over 20 insurance plans. Recently, there’s been a big push by infertility patient advocates for legislating insurance coverage, with some minor victories scattered across the country. However, even in those states where mandates to cover have been created, there are some exclusions so not everyone will be covered.
“The first thing I tell patients is not listen to word-of-mouth reports about which insurance provides coverage or not,” says Segal “Don’t even take what you read in your human resource department booklet as the final word. Go straight to the insurance company and find out if anything is covered. Even if it’s only medications or some diagnostic procedures, get everything from them that they cover.”
Start Low-Tech
Shady Grove Fertility Center’s philosophy has always been to tailor our patients’ treatments to their specific diagnosis and circumstances. We balance the goals of achieving the best possible chance of success with using the simplest and most cost effective approach.
Approximately one quarter of the pregnancies conceived by patients at SGFC are achieved with either ovulation induction (OI) or superovulation, coupled with intrauterine insemination (IUI). In 2007 we performed approximately 4,775 IUI cycles, which is 30% more than the number of IVF cycles performed during the same period.
The number of couples that we have been able to help with our IUI program has increased significantly over the last five years. In many cases, patients will have insurance coverage for this for this relatively low tech fertility treatment.
Sharing the Financial Risk
In 1993, Shady Grove Fertility founded the IVF Shared Risk 100% Refund Program. In this unique program, the patient elects to pay a flat fee, which covers the cost of up to six completed IVF cycles. Should the patient not take home a baby as a result of those six cycles, 100% of the fee is refunded, thus preserving their resources for other family building options. This program, therefore, reduces the amount of money they have ‘at risk’ for six cycles and fixes their costs. Sharing the risk with also establishes a trust in SGFC success rates and our reasonable confidence in the outcome.
“This is a great program for piece of mind; it is a fixed cost that may be fully refunded at any time,” said Koch.
“With the Shared Risk program, you get six no-obligation attempts with a 100 percent refund guarantee,” said Segal. “The bottom line is that infertility treatment is expensive, but Shared Risk has become such a household name now that most patients have heard of it already. I educate them on the details of how it can help. My message is always that if you’re self-pay, Shared Risk is the way to go.”
New Option Makes Donor Egg More Affordable
In 2007, Shady Grove Fertility developed the Shared Donor Egg Program to offer patients more affordable options to donor egg and enable them to have immediate access to the treatment they need. SGFC is the only center, worldwide, to offer such a unique and innovative option to patients who require IVF with donor eggs. This program offers financial benefit by reducing the cost of egg donation while still resulting in a better than 50% delivery rate per embryo transfer.
“The success rates are proving to be incredibly favorable when a donor’s eggs are shared by more than one couple — you want to talk affordability?” Segal said.
Shared Donor means that more than one couple can be matched with one egg donor. The cycles of each couple are synchronized and the eggs that are retrieved from that donor are shared between the recipients. In an average donor egg cycle, 21 eggs are retrieved. 60% (13) of those eggs are fertilized and 60% (8) of the fertilized eggs produce good quality embryos. Our goal is to transfer one or two good quality embryos to the recipient.
There are several variations within the Shared Egg Donor Program which offers patients the ability to truly customize a plan that works for them, from a medical, emotional, and financial perspective. One fee-for-service option allows patients to realize a savings of up to 50% over the cost of a traditional donor egg treatment cycle.
Another all-inclusive Shared Risk Donor Egg option gives patients the opportunity up to six cycles, if necessary, with a 100% money back guarantee if baby is not delivered. Patients pay a flat fee equal to one traditional donor egg cycle that includes the treatment, donor fee, and medications for all six cycles.
Additional Resources
Patients who either don’t have comprehensive insurance coverage or don’t qualify to participate in the Shared Risk program have additional options that can be explored.
Another resource for affording fertility is The Cade Foundation, a non-profit organization focused on helping families struggling with and overcoming infertility. Each year their Family Building Grant provides up to $10,000 to needy infertile families to assist with costs associated with fertility treatment or adoption.
Shady Grove Fertility Center is proud to sponsor the Cade Foundation’s Race for the Family held every July in Columbia, Maryland. For more information on the Cade Foundation, please log-on to their website: http://www.cadefoundation.org/.
For patients who want to preserve their fertility while undergoing cancer treatments, Shady Grove Fertility is a partner of Fertile Hope.
Fertile Hope is the national nonprofit group that provides support to patients with cancer seeking fertility treatment. In addition to providing awareness, education, research and emotional support, Fertile Hope also provides financial assistance for patients whose medical treatments threaten their reproductive function. Shady Grove Fertility is the exclusive provider for Fertile Hope in the DC/Baltimore metro areas, and offers signification financial discounts for patients that qualify.
For more information on any of the financial options or resources available at Shady Grove Fertility, please contact Amanda Segal at 888-483-0500.
