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What Happens When Your Insurance Runs Out?

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by Rachel Lehmann-Haupt, Jan. 14, 2010

When health insurance stops covering treatment, limits the number of IVF attempts, or restricts a couple to a specific dollar amount, most stop treatment because they can't afford the out of pocket expenses. But often IVF isn’t successful the first time. "With appropriate treatment, approximately 75 to 80 percent of couples would conceive if they were able to pursue multiple treatments, as the success rate is cumulative,.” says Dr. Michael Levy, Founder and IVF Director at Shady Grove Fertility Centers in Rockville, Maryland.

So how do you continue your treatment when your coverage runs out?

Don't panic. You still have options. They differ depending on the state you live in and your financial brackets, but some states have programs that offer sliding scales and others offer grant programs. Many clinics also have financing programs or 2-for-1 one specials that can help you lower your costs.

Occasionally doctors will even negotiate with you on an individual basis if they understand your financial limitations. "If a patient has a needs-based request, she should absolutely ask her doctor to work with her on pricing," said one doctor. It never hurts to ask, but when insurance is involved it is illegal to charge different patients a different fee for the identical procedure, according to Dr. Daniel Stein, an RE with St. Luke's - Roosevelt Hospital in New York. "As IVF involves several different procedures, it is legal to choose to not bill a particular code to a patient if there is financial need, " says Dr. Stein. "I follow the law but I am able to help out those in need."

Here are 5 options to consider:

    1. Look into Refund Programs and Money Back Guarantees.
    Some clinics have refund programs that allow patients to prepay a certain number of in vitro fertilization (IVF) cycles, and, if the patient is unsuccessful after a certain number of attempts, then she may receive some or all of her money back.

    For example, Shady Grove Fertility offers a “Shared Risk” program in which patients pay $20,000 upfront for six IVF treatment cycles. If you don’t have a baby after six IVF cycles, they’ll return your money. But since 50 percent of the patients get pregnant on the first try, the down side of this program is that if you do indeed get pregnant on the first try, you’ll be paying $20,000 instead of $10,000 (the cost of paying for one treatment). (They also offer another option in which patients pay a flat fee for all medication and don’t have to worry about paying for new medication each cycle.)

    Another clinic, East Coast Fertility in Plainview, New York, offers a Single Embryo Transfer Program which includes free cryopreservation of embryos, free storage and free frozen embryo transfers until you have your baby, for the cost of one IVF treatment.

    2. Apply for Compassionate Care or Discounts on Fertility Drugs.
    Many of the pharmaceutical companies that make fertility drugs will work out a payment plan with patients and offer deep discounts depending on the medical situation. For in-depth information on drug companies that offer discounts on fertility drugs, click here.

    3. Look for Fertility Financing.
    Other places to look for financing include specific reproductive financing companies such as Fertility Finance, Advanced Reproductive Care, Inc. and Springstone Financial. There is also a program called the Attain IVF program in which you pay a single, discounted fee and receive up to six cycles (three IVF and three frozen embryo transfers) and, if you don't take a baby home, you get a 70 percent refund.

    Make sure you check with your clinical team for their suggestions of other programs.

    4. Apply for a Grant.
    Some organizations offer grant programs. The Tinina Q. Cade Foundation, a non-profit that promotes awareness of infertility, provides educational resources and financial assistance, offers selected infertile families up to $10,000 to assist with the costs associated with infertility treatment or domestic adoption. In 2009, the foundation awarded eight grants. There are also $10,000 Fertile Dreams scholarships. The International Council for Infertility Information Dissemination (INCIID) has also arranged for a number of IVF clinics in the US to donate expertise and facilities to patients in need, and to cover the cost of most basic IVF expenses.

    Again, ask your clinic if they are aware of other such programs you may be eligible for.

    5. Ask about Sliding Scales.
    Many clinics offer a sliding scale on fees, based on the patient’s household income level. Ask your clinic if they offer such a program.

Even though securing financing is stressful and takes some time, you're not alone. There's help out there!

Rachel Lehmann-Haupt ( is a journalist and the author of In Her Own Sweet Time: Unexpected Adventures in Finding Love, Commitment and Motherhood (Basic Books, 2009).