Insurance & Savings

Muses come in all configurations. Some of the most satisfying, enjoyable art and music are creations inspired by life events that are common to the human condition. The infertility experience is often a catalyst for producing beauty out of pain. It helps a person make sense of calamity.

Lauren Braddock Havey came by her musical roots honestly – her father, Bobby Braddock, is renowned in country songwriting circles – but what spurred her to writing a book was all that it took to arrive at motherhood.

Lauren’s book, A Journey to the Son (Two Harbors Press, October 2009) was her response to the rocky road that she and husband, Jim, embarked upon after learning in 2004 that their only chances for parenthood were through IVF with ICSI, or adoption.

The list of the couple’s trials and tribulations is daunting: male-factor infertility, pregnancy complications including a nearly fatal birth condition called amniotic fluid embolism (AFE), and subsequent postpartum depression and post-traumatic stress disorder.

Jim and Lauren came to Shady Grove Fertility from Nashville, Tenneessee after researching options that would allow them the chance to go through infertility treatments while financially guarding for the possibility of needing to go the adoption route. The Shared Risk program at Shady Grove Fertility provided the resolution they sought.

“We knew we would pay a bit more if the first attempt worked, but the security we had of knowing that we would not have to pay unless we ‘took a baby home’ was amazing. When we met with Dr. Levy, we instantly felt something that we had not had in a while… hope.”

In addition to the relieved financial stress, Lauren believes that their chances were significantly increased when Dr. Michael Levy diagnosed and removed a uterine polyp that hadn’t been noticed by previous physicians. Though the couple had to travel for treatment at Shady Grove Fertility, Lauren describes “the staff was helpful, kind, and comforting. They really helped us to get into the right ‘positive’ frame of mind.”

Their first go at IVF worked, but the Havey’s and their son weren’t out of the woods just yet – bed rest for incompetent cervix was followed by gallstones, pre-term labor, and finally an amniotic fluid embolism, a rare and often-fatal condition. In the forward to Journey to the Son, Dr. Levy refers to the “relentless motivation” that he is privileged to see throughout his reproductive medicine practice.

“I really felt the urge to purge about the experience after my son was born,” Lauren says of the book and companion CD. Her Grammy-winning songwriting partner, Don Henry, suggested they create a new song for each chapter. Some of the titles include “The Waiting Womb,” “Thinking Positive,” and “Breast Intentions.”

“Our project developed into what we are calling a ‘folk-rock opera,’ and from the feedback we’ve been getting from the book/CD signings and performances we’ve been doing, we are about to stage this as a theatrical production,” Lauren reports. “As an artist you use what you know, and I was completely obsessed with becoming a mom for years, so that is what came out!”

All creations – whether of the artistic or human type – are, in the end, revealing about the creators. Lauren Braddock Havey found the meaning for her art through struggling to conceive.

“I learned that I am extremely stubborn,” she says in hindsight, “but it paid off. In spite of all that we went through, when I look at my precious little boy, I would do it all again!”
A Journey to the Son – the book and CD — are now available at www.ajourneytotheson.com.

Collin James Sharp was born December 8, 2010 to Jennifer and David Sharp of Richmond, VA. The 7 lb. 15 oz baby boy’s birth was made possible through a partnership between Shady Grove Fertility and the Cade Foundation.

“We have been blessed beyond our imagination,” says Jennifer. “I’ve always wanted children. Financial assistance from the Cade Foundation and advanced treatment options from Shady Grove Fertility made it possible for us to realize our greatest hope.”

David was paralyzed in a motorcycle accident at 19 years of age. When he and Jennifer married, they knew they would face obstacles in building their family. After adopting a son from China, they were hesitant to pursue fertility treatments to have a biological child because of the costs involved.

The Cade Foundation’s Family Building Grant provides up to $10,000 to help needy families pay for fertility treatment or adoption services. Of the 121 Cade Foundation applicants in 2009, Jennifer and David were chosen along with five others to receive the grant.

David and Jennifer started their first In Vitro Fertilization (IVF) cycle with Dr. Rachana Garde of Shady Grove Fertility’s Woodbridge, VA location in February of 2010. First, David’s sperm had to be surgically retrieved. Then, a single sperm was injected directly into the center of Jennifer’s egg by a process known as Intracytoplasmic Sperm Injection (ICSI). The resulting embryo was later transferred to Jennifer.

“Jennifer and David were perfect candidates for IVF treatment with ICSI,” says Dr. Garde. “The process allows couples with low sperm count or poor quality sperm to achieve pregnancy rates equal to traditional IVF rates. The result is exactly what we hoped for, and we are thrilled to welcome their new son into the Shady Grove Fertility family.”

“Our grant recipients would likely not have had the opportunity to become parents without assistance from an organization like the Cade Foundation,” says Dr. Frank Chang, Shady Grove Fertility endocrinologist and Cade Foundation Board Member. “The Foundation operates on the belief that cost should never prevent a couple who is able to love and care for a child from having the opportunity.”

The Tinina Q. Cade Foundation Inc. is a not-for-profit organization that provides education about fertility and family building options and offers financial assistance to infertile families. Learn moreabout the 2011 Family Building Grant Information.

Since the introduction of the Shared Risk 100% Refund Program in 1993, the way some couples select a method to build their family has been transformed. Patients now have the peace of mind that if IVF does not work, they will still be able to afford other means of family building. The history of Shared Risk plays out like a good drama series. Believe it or not, the Shared Risk Program was once considered controversial and unethical in the medical community.

When Shady Grove Fertility was established in 1991, the only options for some infertility patients were IVF or adoption. Due to the cost of both options, patients had to go “all in” financially. With IVF success rates nearly half of what they are today, around 25% per cycle, it was a hard decision for many patients.

“In early 1992, I had a consultation with a 32-year-old patient. She had severe tubal damage and had been struggling with infertility for 3 years. After paying $10,000 for one unsuccessful IVF cycle at another fertility center, she sat in my office asking ‘what are my chances?’” reflects Dr. Michael Levy, Reproductive Endocrinologist and Co-founder of Shady Grove Fertility Center. “I explained to her that another attempt would give her a 25% chance of success and three more would give her around a cumulative 65% chance of having a baby. She and her husband were devastated. ‘We feel like we have no choice’ she told me. ‘If I move forward with IVF and it doesn’t work, we will no longer be able to afford the cost of adoption.’”

A New Idea Comes to Life

This problem, the decision between IVF and adoption, was something that many patients encountered. “We thought about it as a group and our embryologist at the time suggested something very interesting. ‘What if we guarantee the delivery of a baby or give patients their money back?’ The idea was intriguing, to say the least,” describes Dr. Levy. “We considered it and consulted with the Montgomery County Medical Society and ultimately came to the decision that this program would benefit many of our patients.” Later that year, Shady Grove Fertility rolled out the Shared Risk 100% Refund Program, they were the first fertility center to provide a money-back guarantee for those patients enrolled in the Shared Risk IVF and Donor Egg Program.

“Patients liked the idea but many thought it was too good to be true,” says Dr Levy. “Originally, the Shared Risk Program was not advertised and only offered to our current patients. We gave them an option where there wasn’t one before.” The initial program offered 3 fresh IVF or Donor Egg cycles for patients with adequate ovarian and uterine function. It also included unlimited frozen embryo transfers and, most uniquely, people could withdraw from the program at any point and still receive a 100% money-back refund. There were no limitations to the program. In the first year of the program, approximately 15-20 patients participated.

Shared Risk 100% Refund Program Gains National Attention

A few years later, as the Shared Risk program gained popularity, and started to appear in more fertility centers across the United States, it started to draw more attention, most notably from the American Medical Association (AMA). In 1995, the AMA released an unfavorable stance on the use of what they referred to as “Contingency Fee Medicine” as an unethical practice that should be avoided.

“We believed in our Shared Risk program and felt it was, in fact, the most ethical program we could provide to our patients. Shortly after we heard about the concerns regarding Shared Risk and similar programs, we proactively contacted The National Advisory Board on Ethics in Reproduction (NABER) and were able to participate in a seminar to discuss our Shared Risk program,” says Dr. Levy.

During the seminar in October of 1996, Dr. Levy presented overwhelming data that showed in the 3 years since the creation of the Shared Risk Program, patients were not misled and their safety was not jeopardized, some of the main concerns about the program. Dr. Levy was able to demonstrate a safe program that was in the best interest of each patient individually. Through a detailed patient survey and statistics from cycle data, it was shown that there was no significant increase in the number of embryos transferred and that 35 out of 36 patients surveyed were not under the impression that the program guaranteed a positive outcome in response to the concern that centers would provide patients with a false guarantee.

After an extensive analysis of the information, NABER presented a very supportive position and sided in our favor. “They found the program to be fair with checks and balances making it ethical for us to provide and patients to use,” says Dr. Levy. “It is truly gratifying to think back on the several thousand babies that would have never been conceived over the past two decades had it not been for one interaction with a single couple, sitting devastated in my office.”

Shared Risk continues to be the most popular financial program Shady Grove Fertility offers.

Not all Shared Risk or Fertility Guarantee Programs are Created Equal

Patients from all over the United States and internationally come to Shady Grove Fertility to participate in their unique Shared Risk Program. Since its inception at Shady Grove, almost a hundred fertility centers around the country have created their own version of a refund program. When researching other financial programs, it is important to understand the differences.

For more information or to schedule an appointment with one of our physicians, please speak with one of our friendly New Patient Liaisons by calling 888-761-1967.

Medical Contribution By Dr. Michael Levy

It’s been a year since Shady Grove Fertility announced an innovative program that makes getting pregnant and having a baby an affordable dream for many.

For so very many people, the problem isn’t finding the best technology to get pregnant: the problem is affording it.

Recognizing the financial burden of fertility treatment, Dr. Michael Levy first pioneered the Shared Risk financial concept for IVF treatment in 1991. Then, in 2007, he and his colleagues at Shady Grove Fertility developed the Shared Donor Program.

The Bottom Line, First

The reason for the program is simple, Dr. Levy explains. “A single donor-egg cycle in most parts of the country runs between $25,000 and $35,000. In the Shared Donor Program, a single (fee for service) 1:3 shared cycle is $14,600.”

“If patients choose to also protect themselves against the financial downside, they can combine the 1:3 shared Donor cycle within the Shared Risk Program (which includes six cycles) at $29,000, with a full refund if unsuccessful. This includes all costs: the donor fee, medications, and prescreening costs.”

As the use of donor eggs has become increasingly commonplace due to advanced and successful technology, changes over time have resulted in higher costs to patients. Fees paid to donors are generally around $3,000 more than a decade ago. The most recent FDA regulations for any medical practice utilizing human tissue (such as egg cells) require more frequent and thorough pre-screenings, resulting in more costs.

A Pragmatic Approach to Treatment

Along the same lines, the growing interest by patients in donor egg IVF combined with the more stringent regulations adds up to a shortage of high-quality egg donors. The Shady Grove Fertility Shared Donor Program allows for more ready access — and less waiting for anxious parents-to-be — through sharing this essential yet limited resource.

The Shared Donor Program serendipitously helps resolve another problem: the burden of too many unused frozen embryos.

Levy explains, “We recognized that in two-thirds of our donor-recipient treatment cycles, more eggs were retrieved than necessary for an individual couple, which in turn meant that more excess frozen embryos were created.

Donors and their eggs can be shared through this program by more than one potential recipient, which decreases the patients’ out-of-pocket expenses. The outcome is that far more people who would otherwise not be able to access IVF – and pregnancy – can do so.

The delivery rates in the 1:1 and 1:2 donor programs are 49% per initiated cycle. In the 1:3 Shared Donor Program, the delivery rate is 53% per initiated cycle. The cancellation rate is about 10% for the 1st and 2nd recipient, and 25% for the 3rd recipient. More detailed statistics on all of these Shared Donor Program options will be available in the near future.

An Unexpected Bonus

One of the pleasant outcomes from the introduction of the Shady Grove Fertility Shared Donor Program has been the reversal of a trend being spotted across the United States – Americans traveling abroad for fertility treatment. Plenty of articles have highlighted how fertility patients from the U.S. are finding they can only afford treatment in other countries, for better or for worse. Dr. Levy believes that SGF’s Shared Donor Program is actually leading to more travel in the opposite direction.

“We have had great success with international patients. We have established relationships with fertility caregivers in the UK, and have had many international patients ‘cross the pond’ and seek our services, especially with the Shared Donor Program,” Levy reports.

An Idea Comes to Life

When the staff of Shady Grove Fertility first let the world know about their unique Shared Donor Program a year ago, they expected the news to be big. A year later, they like what they’ve been able to offer to the patients who’ve come forth to give the donor sharing concept a try. They’ve also learned a few things.

“Most patients thus far are choosing the 1:2 (one donor, two recipients) option,” says Dr. Levy. “And they seem particularly pleased with the ability to review and select donors on our website, which is phenomenal.” He expects more fertility patients will become accustomed to the idea of sharing 1:3 as they learn about the program’s success.

The process by which patients choose their egg donor is conducted online. Information on the available donors—including their own early childhood photos – is placed online in a secure way for recipients’ viewing. Donors are grouped according to whether or not their eggs can be used in a 1:2, 1:3, or all (1:1) possible treatment cycles. Their grouping is determined by a mix of variables, such as age and ovarian reserve, that combine to impact how many eggs might be retrieved from a given donor.

Just as the idea of Shared Risk Programs started at the Shady Grove Fertility and is now frequently offered at clinics around the country, fertility patients in the future can expect to see the idea of sharing egg donors for purposes of affordability and practicality boom eventually as well. For now, Shady Grove Fertility offers patients who want to use donor egg to conceive the chance to share a donor with up to two other recipients for significant savings and the most optimized chances.

Imagine being told that the answer to your longing for a child is available — but the price is more than you can afford. Imagine trying to have a baby for eight years, finding out that your infertility is treatable, but the treatment is out of your budget’s reach.

This was 36-year-old Selena’s reality. She and her husband were trying to get pregnant in spite of both polycystic ovarian syndrome (PCOS) and male-factor infertility.

“Our insurance paid for testing, not treatment,” Selena recalls about their initial research into obtaining fertility services. “When it got to the point of being told that we would probably only get pregnant with IVF, but that we had to pay for it… we pretty much gave up on the idea of having a child.”

The couple was referred by her OB/Gyn to Shady Grove Fertility several years ago. Selena recalls thinking, “‘Why bother?’ But we decided to go and talk to them. What they offered us cost way more than we could afford.”

The couple returned to Shady Grove Fertility in 2008. “We were going to inquire about getting a loan for treatment,” said Selena. Dr. [Robert] Stillman was incredible, offering to discount his physician fees, which just brought me to tears.” That’s when the Patient Financial Services staff informed them about a new program that could bring an end to their longing and bring a baby into their home.
It’s called Shared Help.

Big News, Again

Years ago, Shady Grove Fertility made news when co-founding physician Dr. Michael Levy created the innovative Shared Risk 100% Refund program for making infertility treatment more affordable. The program, which allows patients to pay one fixed fee for six IVF attempts with a full refund if the patient doesn’t successfully have a live birth, has been duplicated by centers around the world. Thousands of babies have been the result for couples who might otherwise be unable to access IVF.
As the economic climate became increasingly tough for so many, Levy and the rest of the Shady Grove Fertility staff opened their minds again, exploring ways to make fertility treatment available to everyone who needs it.

“The Shared Help program was started in recognition that there are a lot of patients who couldn’t access the necessary treatment because they couldn’t afford it,” Levy says. “Many times we found that people who couldn’t afford treatment weren’t telling us about their financial struggles, while people who could afford the treatments were asking for help. We created this program to help the right people.”

Following a pilot program in the spring of 2008, the Shared Help Program was opened in September to all eligible patients.

How Shared Help Program Works

Now, patients of Shady Grove Fertility who have a household income of $95,000 or less can apply for Shared Help. Those who are approved for the program will receive a discount off the cost of most fertility services provided by Shady Grove Fertility.

“The only fees that aren’t discounted are those that aren’t directly provided by us,” explains Shady Grove Fertility’s Director of Patient Financial Services, Janice Koch. “For example, tests or procedures done at outside facilities are not covered in this program, as well as medication.”
Still, Dr. Levy continues to polish this new program further, with his sights set on even more assistance for patients. “We have total support from the pharmaceutical companies on this initiative. There is tremendous positive reinforcement from the companies that we work with. They are very happy to collaborate with us.”

To apply for Shared Help, patients must be younger than 42 years old; yet those who are older may apply for Shared Help if they also qualify for the Donor Egg program. In the case of a Shared Help program patient with insurance coverage, only parts of prescribed treatments that are not covered by insurance will be discounted.

According to Koch, a patient’s approval for the Shared Help program is good for one year, and reapplication with updated tax returns is necessary if a patient needs treatment beyond that year.

How Shared Help Worked for One Couple

After being surprised at how simple application was — a very brief questionnaire and the previous two years’ US Federal tax returns — Selena received news within one week that “literally floored” her. Shady Grove Fertility offered the couple IVF with ICSI at a significant discount.

“I always thought of fertility treatment as something that’s just not for people like us,” Selena elaborates. “I don’t know how to say this, but it’s one of those things in life that you start to feel like nobody really cares if you have it or not. The Shared Help Program made everything equal. Shady Grove Fertility gave me and my husband what I don’t think any other center would have.”

In spite of the fact that their first IVF cycle did not result in a successful pregnancy, Selena and her husband are still qualified for the same discounts in subsequent treatment attempts. Shared Help has afforded them the chance to continuing trying to make their dreams happen.

She says everyone she knows is finding out about Shared Help from her experience. She calls the simplicity of the application and the generosity of the program guidelines “phenomenal.”
“I don’t know what the average United States household income is, but me and everybody I know would be able to qualify for this program. Every clinic should be doing this,” the very satisfied patient expresses.

Satisfied hardly describes what Selena really feels right now about her Shady Grove Fertility experience. “Even beyond the Shared Help Program, everyone there — all of the staff we had contact with — always treated us like our needs were important. Nobody ever treated us differently because we were receiving this extra financial help.”

For more information on Shared Help, please call our friendly New Patient Liaisons at 888-761-1967. 

Referrals, deductibles, lifetime maximums, eligibility requirements, preferred pharmacies – the fine print on insurance policies can be dizzying – but understanding what to look for when it comes to your fertility insurance coverage can save you both time and money. Take Sharon and Jason for example.

The couple was married in 2000 and started trying to have a child the next year. They were both sure they wanted a big family, so they thought they should get started right away. Sadly, Sharon’s first pregnancy ended in miscarriage. She remembers, “It didn’t worry us that much because we knew it happened to a lot of people. Plus, we got pregnant again, so we thought everything was fine.” With that pregnancy, they had a son, and a year later, they started trying for a second child.

This time, things were different. “We went about a year and a half without getting pregnant, so we started to worry that something might be wrong,” says Sharon. Their ob/gyn recommended Clomid, an oral medication that would help Sharon ovulate regularly.

After several months without a positive pregnancy test, they were feeling discouraged. “We are very active in our Jewish community, and everyone around us was having their 2nd or 3rd child, so it was really hard on us having these disappointments every month,” Sharon says.

They decided to get more aggressive. “We thought we should be more proactive and see a fertility specialist but were not sure where to start.” says Sharon. “We also had lots of questions. Did we need to have a referral from our ob/gyn? How were we going to pay for treatment?”

Turns out they did not need a referral from their insurance company and they couple started saving to pay for treatment. At their first appointment with Dr. David Saffan at Shady Grove Fertility’s Annandale office, their financial counselor gave them some great news – their insurance actually covered their fertility treatment.

But just what did “having coverage” mean?

Call Us and We Can Walk You Through the Process

Healthcare policies vary from person to person and from company to company, therefore it’s hard to determine the exact coverage you will have. When in doubt, call Shady Grove Fertility’s New Patient Center to get an idea if you will need a referral or not.

When new patients book an appointment at Shady Grove Fertility, you will be asked for your insurance information so that our financial team can check your insurance policy for coverage after your initial appointment. “Most patients have coverage for the initial consultation,” says Nick Dominy, one of Shady Grove Fertility’s financial counselors, “but they may have a deductible that they need to meet before coverage kicks in, or they may need a referral. In that case, they need to know who the referral has to come from and allow some time for it to be processed.”

“Our prescreening insurance benefits team will check your coverage, and we’ll meet or talk with you to review the results after your first appointment,” says Nick, “but it’s really best if you have some knowledge of your policy. That way, we can compare notes after your appointment. If we received the same information from the insurance company, it’s great. If we got different information, then our team can go back and find out why.”

Sharon agrees that calling ahead of time would have helped. “In our case, we just assumed we didn’t have coverage, and we came in and told them that. The financial counselor said that she would verify anyway, just so we had the denial in writing. Lo and behold, it came back that we did have coverage. That was when we pulled out the benefits booklet that Jason’s work had provided and started to look into the details.”

Verifying Diagnosis and Testing Benefits

“Ninety percent of patients have some level of coverage for their initial consultation,” says Nick. “After your consultation, your physician will likely require a complete fertility evaluation and it’s good to know what will be covered by insurance.”

By the time Sharon and Jason started their diagnostic workup, they had confirmed what the financial counselor told them and knew that their testing would be completely covered.

“If you are curious to know if your insurance company will cover your fertility evaluation, you should call and ask if diagnostic testing is included in your policy,” Says Nick. He cautions, though, that there are policies that have what’s called “a complete exclusion” on fertility services. “That would mean that anything billed by a fertility center, like Shady Grove Fertility, would be denied.”

What are Treatment Benefits?

After diagnostic testing, patients return to review the results with their physician and decide on a treatment plan. At this appointment, patients meet with their financial counselor again. Now, they are able to talk specifics about treatment costs and how their insurance can or can’t be used.

“Our tests didn’t reveal any major fertility issues,” says Sharon, “so we were diagnosed with unexplained infertility.” Dr. Saffan suggested they start treatment with a low-tech treatment option called Intrauterine Insemination or IUI.

Sharon adds, “Once we knew what our treatment would be, we called the insurance company ourselves to verify what the financial counselor had told us about treatment coverage.”

Nick says this is a great idea because patients need to understand all the details about their coverage. “Seventy percent of patients have some level of coverage for treatment, but you should never accept a simple yes or no answer about treatment coverage. An insurance company will rarely cover everyone 100% of the time. It depends on their review of your case and the claims that are submitted and – in many policies – a lot of additional details.”

For example, some policies will pay to treat underlying medical conditions that cause infertility but won’t pay for fertility treatments like IUI or IVF. Sometimes, there are criteria that the patients have to meet in order to be eligible for treatment coverage. “They might have to be married or never have had a sterilization procedure like a vasectomy,” says Nick.  “We were really worried that we wouldn’t qualify for treatment coverage because we already had a child,” says Sharon. “So, we asked specifically about that. It turned out that it didn’t matter because we have what is called ‘secondary infertility’ and that was covered.”

Lifetime Max

Policies with a lifetime maximum can sometimes be confusing for patients. “Patients need to know what contributes to the max,” warns Nick. “Are all services including diagnostic testing? Do medications count? Or is it just treatments that contribute to the lifetime max and is the max defined by the number of cycles the patient is eligible for or a maximum cost of services?” Some patients will have a limit on the total number of cycles they can use while others may have a dollar point that they cannot exceed.

Sharon and Jason discovered that they were covered for up to 6 IUI cycles and 3 IVF cycles of treatment per live birth. They used 3 of their 6 IUI cycles and did not get pregnant. Dr. Saffan recommended moving to In Vitro Fertilization (IVF) as a next step. That triggered the couple to sit down with the financial counselor again to make sure they would be covered for the new course of treatment. “We needed to get approved for the IVF before we started,” says Sharon.

Nick says needing authorization for treatment is common and patients are often frustrated by how long it takes. “Patients are anxious to get started with treatment. That is completely understandable, but sometimes it takes a while for the insurance companies to send us the authorization. I might be calling back and forth with them for a few weeks; sometimes providing additional documentation to support the treatment will help get the approval needed to move forward with treatment.”

Sharon and Jason got their approval and did a cycle of IVF. They got pregnant and even graduated from fertility care, but then, tragically, they lost the pregnancy at 17 weeks. “That was a really rough period for us,” recalls Sharon. “I had had a miscarriage before, but this was so much worse because I had gone through all this treatment and made it through my first trimester.”

After Dr. Saffan did some additional testing and made changes to her treatment protocol, Sharon and Jason tried again with another round of IVF. This would be their 2nd cycle of treatment out of the 3 IVF cycles they had covered, so they were nearing the maximum allowed by their plan. Happily, this cycle was a success. Sharon got pregnant again and carried the pregnancy to term without any problems. Their second son was born in 2006.

“We were thrilled about having another child,” says Sharon. “Even better, we had a whole bunch of good embryos from the cycle that were frozen, so we knew we had a chance to have another child.”

Two years later, they came back to Shady Grove Fertility to try for a third child. Their policy allowed for a new set of cycles for this child. They did a Frozen Embryo Transfer (FET) cycle, but it didn’t take, so they tried again. On FET cycle #2, they got pregnant. In 2008, they had another baby boy.

Verifying Medication Benefits

After their first FET cycle, Sharon and Jason found out that medication benefits can have different rules than treatment benefits. “During all our previous treatment cycles, my medications were covered,” says Sharon. “Then, after our first FET cycle, we got this big bill for medications, and we were confused. When we called the insurance company, it turned out they wouldn’t cover the meds for the FET cycles – only for the IUI and IVF cycles.”

Medication benefits are separate from diagnosis and treatment benefits in most insurance policies. Often, insurance providers even rely on separate companies to handle medication benefits for their policyholders. Shady Grove Fertility’s financial counselors can’t provide information about medication coverage.

“We don’t dispense medications to patients, so we can’t verify medication coverage, however we help patients identify the correct information for their pharmaceutical benefits verification.” says Nick. “Also, the pharmacies can verify your coverage in the same way we do for treatment. In fact, the specialty pharmacies that do fertility medications usually have dedicated insurance specialists that will help you get the most out of your coverage.”

It’s also a good idea to check with your nurse to find out if there are any medication discount programs offered from pharmaceutical companies.

What if Insurance Doesn’t Cover Your Expenses?

It doesn’t happen often, but sometimes patients are better off using one of Shady Grove Fertility’s financial programs than using their insurance benefits.

Nick explains, “One example might be if you have a low lifetime max for treatment, like $2,000-$5,000, and medication costs contribute to the max. Or, sometimes after our initial benefit review, we find that insurance will not cover treatment at all. In those cases, it might be better to do the Shared Risk program and use your insurance coverage for medications.”

The Shared Risk 100% Refund Plan gives you up to 6 IVF cycles of IVF and the related frozen embryo cycles. If you don’t take a baby home, your money is 100% refunded (some exclusions apply). Nick adds, “There are also other programs like the Multi-Cycle Discount that might better fit the needs of our patients.”

Another common scenario is when policies have a cycle max, meaning they will cover a certain number of cycles, regardless of what kind of treatment those cycles are. In this case, you might want to pay out-of-pocket for less expensive treatment cycles like IUI or FET so that you can save your insurance benefits for more costly cycles like IVF.

“This is where your financial counselor can really help because he or she knows our financial programs and can sit with you and compare your specific coverage against out-of-pocket costs,” says Nick.

Knowledge is Power…and Money

Every insurance policy is different and they have an incredible range of rules and procedures. That’s why Shady Grove Fertility verifies coverage for every single patient and encourages every patient to call for him or herself as well. By using the help of our financial counselors, you can get the most out of your coverage and reduce the stress you may have about affording treatment.

Though Sharon and Jason started out in the dark about their policy, they quickly got up to speed and it proved to be a great blessing for them. “We are so happy with our family. Having three boys means a lot of chaos and craziness, but its wonderful chaos and we love it.”

For more information or to schedule an appointment with one of our physicians, please speak with one of our friendly New Patient Liaisons by calling 888-761-1967.