Finances deserve an entire blog to themselves, let alone a post (or two). They are so confusing when it comes to the IVF process! I will try to keep things simple, but also give you an idea of what questions you should be asking and enough detail that things hopefully make sense and you can avoid common pitfalls.
When we originally met with our fertility clinic (2 years ago) they told us IVF generally costs $13,000-$15,000 out of pocket, plus your medications which are anywhere from $4,000-$6,000. Whew, that's a lot of money!
The crazy thing is that when you use insurance, the costs are actually
significantly less because your clinic has contracted rates with your insurance. So the clinic may charge you $300 for an ultrasound, but they've agreed with Cigna to pay them $75 for an ultrasound. And to make things even more confusing, they've agreed with UHC to pay them $50 for the same ultrasound (those are just made up numbers, I don't know the specifics!). Every clinic is going to have different rates with each carrier because every clinic does their own negotiations.
First you must check to
see which insurances your clinic is in-network with! If the insurance isn't in-network with your clinic then don't use them.
You also want to make sure the insurance is in-network with the embryology lab, anesthesia, and any outside labs they send bloodwork to. I lucked out that everything at my clinic was in-house, but I've heard other's stories who ended up with a big bill because they didn't realize part of the equation wasn't in-network. Starbucks insurance still covers things out of network, but they don't cover as well so you'll have to pay more out of pocket.
I discovered my clinic has one helpful billing lady, and one not-so-helpful one. Thankfully for the first consult, I dealt with the helpful one! Even though I didn't have active insurance, I had printed out (from the Starbucks website) some of the plan breakdowns. She, so kindly, gave me a cost estimate for the Cigna and Premara BC Gold plans. All she needed to know was the deductible and the out-of-pocket max. She plugged these numbers into her handy excel sheet and out popped an estimate!
I'm attaching these estimates so you can see how big a difference the price is with and without insurance. Why is this important? When people hear that Starbucks insurance covers $15,000 of infertility benefits, they assume this will cover one round of IVF, because if they've ever been quoted a price without insurance or looked on the internet, this is the general cost you see. However, when it gets billed through insurance, it may only cost $6,000, so you could get two cycles (or more!) for $15,000!
Another reason I strongly encourage you do have a consult and meet with a financial counselor before your insurance becomes active, is so
they can give you an estimate based on multiple insurances. With my two estimates, you can see that Cigna will use almost $1500 less of the $15,000 than BCBS. Note, this is the estimate only through the egg retrieval. These do not include the transfer because we are doing that at a future date.
Cigna Cost Estimate
Total billed to Cigna: $5,207
Blue Cross Price Estimate
Total billed to BC: $6,678
This is where helpful insurance lady and unhelpful insurance lady come in. As I said, the helpful one gave me the estimates for both of these insurances. When I called back a different day and talked to the other one (because the helpful one was on vacation for 2 weeks) she said it's their policy to not give more than one estimate as they cannot endorse a specific insurance company.
I tried explaining to her that I was in the unique situation of choosing between a few insurances and I wanted to get the most "bang for my buck." In order to make the best decision, I needed to see what the cost would be for multiple insurances. Why, with 4 insurance companies, would I just blindly pick one and hope for the best?! That doesn't make any sense!!!! She said they used to give you 20 estimates if you wanted but now they will only give one. I told her I completely understood them not wanting to give 20, but I just wanted 2 more. And honestly, the helpful lady got those numbers in a matter of minutes for me. I was fuming (I've also had problems with their billing dept in the past telling me certain things were covered and then they weren't so I have a negative opinion of them in general, especially the unhelpful one who is technically the one assigned to me haha).
Okay another reason I like the helpful insurance lady is that she was upfront with me about how it is to work with the different insurance companies.
This is super important to ask your clinic! Even though each insurance company offers $15,000 they have their own regulations on how to qualify for it and how many things need a pre-authorization (something your clinic has to submit to insurance asking for permission to perform "X" procedure before it's actually done). The helpful insurance lady told me that from her experience, Cigna was the easiest to work with as they did not require any pre-authorization. Aetna is very difficult to get things approved and they also usually require you to try 6 IUIs before paying for IVF (this depends on what your infertility is caused by). She said BCBS will pay for things and then come back later and say they won't pay for it, and she didn't have much experience with UHC but believes they require pre-auth for a lot of infertility procedures.
Now, don't take anything I'm saying as law. I'm sure every clinic and every person in every clinic will tell you a different story about each provider. But I think asking your clinic if there is someone that is, from their experience, easier to work with, it can provide invaluable information.
Since I'd previously had a bad experience with my clinic's billing, it made a huge difference to hear that the helpful insurance lady liked Cigna because they were easy and you don't have to fight much with them to get claims paid.
Besides the costs billed to insurance, you will want to ask if there are any additional costs your clinic charges. Mine charged $1000 for "cycle management" and "operating room supplies" for the egg retrieval process that they did not bill insurance. They charge an additional $425 for "cycle management" for the FET. So right off the bat, there's $1500 out of pocket I'm paying. If you are choosing between multiple clinics, this is good to ask them this so you can make an informed decision!
Another great resource that I haven't mentioned yet, are the
Starbucks Advocates. Once you are a Starbucks partner, you can call these super nice people and ask them all sorts of questions about insurance. They even have specific people that deal with the Starbucks infertility benefits! These people have a lot of knowledge regarding which insurances need pre-auth and if there are qualifications you need to meet for certain ones to cover IVF. They cannot give you cost estimates because each clinic will be different, but can tell you what's covered and what isn't. Usually at the end of a conversation with one of them, I would always ask
"Is there anything else you think I should know?" I mean, if they are dealing with this stuff everyday they hear it all and if there's a mistake they see a lot of people making, I want to know about it!
