First of all, I feel incredibly lucky that my employer covers any of this at all, especially since I am part time there (shout out to Vox Media!). That said, anytime you have to deal with insurance, it will make you want to stab yourself and/or others, so just mentally prepare for lots of stress.
The big lesson I learned is that your company’s HR department/benefits coordinator will likely be able to help you with questions if you are getting nowhere with your insurance. I started asking Cigna about my benefits back in December, and was told by customer service that I didn’t have coverage for the main services of IVF (egg retrieval/embryo transfer), which was part of why I went down the road with Fora for so long. However, my benefits coordinator verified for me that I did have coverage for those procedures, and even offered to have Cigna call the clinic to tell them that.
The takeaway here is that your benefits coordinator is going to be the one who really knows what’s up with your benefits. If you are dealing directly with your insurance, ask to talk to the team of infertility specialists. Calling the regular customer service line might not give you correct answers (one person tried to tell me I didn’t have infertility benefits and I just hung up on them).
The game of hell telephone happens because insurance is terrible for so many reasons. I couldn’t get something in writing of all the fertility services that were covered under our plan — this existed, and they referenced it when I called after I finally learned who to talk to, but they couldn’t share it with me.
To the credit of the insurance companies, figuring out how much IVF is going to cost is basically impossible on both the doctor side and the insurance side because the exact protocols vary from person to person. You can’t call a clinic and ask for an estimate because they don’t know what services you’ll need, and thus your insurance can’t give you an estimate either. It’s a bad and frustrating system and most of these calls resulted in me on the verge of tears, feeling dumb for not asking the right questions.
Figuring out costs and insurance BS was by far the most stressful part of IVF for me, which was amplified by having a clinic that wasn’t communicating clearly or promptly. Switching to Aspire with a doctor who listened to me and a clinic that provided an understandable breakdown of costs per procedure made all the difference in this department.
That said, my insurance did provide pretty great coverage, and I am extremely thankful for that.
Okay so now let’s talk numbers.
Like I said, I had already spent about $6,000 by the time I started IVF. Let’s also acknowledge I am in an extremely fortunate situation to be able to afford all of this. (Dear scammers: Please do not take this to mean I am wealthy, I absolutely do not have spare money to give you.)
Here’s the breakdown of costs I got from Aspire for egg retrieval:
Patient responsibility (Any expected insurance deductibles/coinsurance): $1,483
Patient responsibility (Any exclusions, services not covered by insurance): $4,850
These services were the exclusions that weren’t covered:
$150 Medication Teach with Fertility Coach
$700 Assisted Hatching
$1,500 Embryo Biopsy
$2,500 Preimplantation Genetic Screening (PGS/PGT-A)
TOTAL AMOUNT DUE: $6,333
Clearly, doing the genetic testing (biopsy + screening) made IVF significantly more expensive for me. I think if I did not have insurance, this would have been in the realm of $13K (including genetic testing).
Then, there’s the medications. Here’s where shit got real exciting.
My medications for egg retrieval cost me $105 out of pocket which is a goddamn miracle. Their wholesale price (what they billed to my insurance) was $15,483.
However, that is not what they charge you if you are paying for the meds without insurance. The self-pay price was $4,220 because sure.
So the full cost of what I paid after two years of trying to get pregnant and one round of IVF was around $14K.
Embryo transfer was much less expensive (it’s generally a much less invasive process, which I’ll get into later). The meds were $55 (they billed my insurance $2,131) and my procedure was 100% covered.
Something to check with insurance about is whether or not there’s a lifetime maximum for your infertility benefits. What that means is if there’s a certain amount that you can spend after which your insurance won’t pay anymore. This comes into play with medications because sometimes it makes more sense to pay out of pocket for the meds than take the $15K hit against that lifetime maximum.
Anyway, if you want to see my ongoing cost spreadsheet, that’s here.
Part One: The Lead-up and the Tests
Part Two: Choosing a Sperm Donor
Part Three: The IUIs
Part Four: Getting Started with IVF and Finding a Clinic
Part Six: Egg Retrieval and Needles Galore
Part Seven: Creating Embryos and the Numbers Game
Part Eight: ~*fEEliNgS*~