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Avoiding Sticker Shock

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a blog by Gina Paoletti-Falcone, RN, BSN, July 23, 2010

So you’ve mustered the courage to see a fertility doctor, had your blood drawn and your HSG. The dreaded semen sample has been produced and analyzed (on demand in that room no one likes to discuss), and the decision has been made. You will be using injectable fertility drugs, and you will learn how to do your own injections.

Now, you know you pay a pretty penny for health insurance and have prescription coverage. So you assume your fertility medications (which are medications prescribed for a medical condition) will be covered. But will they? Do you know for sure? How can you find out?

Do Your Research

One resource I would recommend is Ferility LifeLines™. This website, sponsored by EMD Serono, has sample letters you can submit to your insurance provider to predetermine your medical and pharmacy benefits. Or, you can call Fertility LifeLines™ and speak to a Benefits Advocate who will call your insurance company for you to verify your benefits.

You are not alone in this struggle. One in eight American couples will experience infertility, and about 50 percent will be told that fertility medications and treatment are excluded from their coverage. And unlike the really nice all-inclusive resort you’d rather spend a week at than pay for an IUI or IVF cycle, it’s unlikely that your cycle is “all-inclusive,” so you’ll be paying for those drugs on top of the treatment cycle cost. Can you say OMG!!!!!

The high cost of fertility treatments and medications truly come as sticker shock to patients who always assumed they had good medical coverage and prescription benefits. For many young, healthy adults this may be the first time you really want and need to use that health insurance benefit you’ve been paying for all these years. And when you find out that nothing is covered once that infertility diagnosis is made, it just feels like another big hurdle has been placed in between you and the baby that will make you a family.

A Special Offer

One of the responsibilities of a fertility nurse is to provide patients with information that will empower them to make educated decisions. So I want to highlight an offer that you can take advantage of here on the FertilityAuthority website. For the first time in more than 15 years as the leading fertility specialty pharmacy, Freedom Fertility Pharmacy is launching a direct-to-patient coupon exclusively through this website. This one-time only offer is worth $50 off on an order of $500 or more for patients who do not have coverage for their medications.

You should also know that Freedom Fertility Pharmacy has the lowest cash price in the United States on the EMD Serono portfolio of fertility medications and partners with them to provide additional savings through the FertilityAssist2 program. We take pride in the service we provide patients every day and hope this new initiative will allow us to support you as you make your way through this sometimes crazy world of infertility.

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