Medical expenses are not cheap – whether you have insurance or not. It all adds up.
When we found out our only viable option to have children was to go through in vitro fertilization (IVF), my husband and I were scared. Not just physically scared, but financially scared as well.
The fear of what we were going to go through with the medical process and the huge financial aspect were overwhelming.
What is the actual cost for in vitro fertilization? According to the Society of Reproductive Medicine average cost for a basic IVF cycle is $12,000. But that doesn’t include all the extras that are needed such as, medications and treatments. That could all add up to at least $20,000. A huge amount of money.
Was our insurance going to provide coverage, if any? How much were the different procedures for both myself and my husband? How much for the daily prescription medications – injections, pills, suppositories, etc?
If we weren’t successful on the first try, how many can we afford to do? Studies show that it takes a couple an average of 2 cycles of IVF to become pregnant successfully.
We knew the bills were going to add up. As much as we wanted to have a child, could we afford to do this? We didn’t want to end up in debt or worse yet, bankrupt.
My husband is a numbers guy – he takes care of majority of the finances. He’s an accountant so that was his life. We had to make sure we could financially afford the IVF process. Here’s what we did:
Check our insurance plan
We got really familiar with our insurance plan. We read every detail of our schedule of benefits. With every insurance plan, a schedule of benefits is a list of various preventative, hospital, diagnostic, therapeutic, urgent care services, etc. It is essentially what is covered and what you are paying for.
Most of the time when one chooses an insurance plan, most people just check what would cost the cheapest or the least amount taken from their paycheck. Thankfully, we hardly go to the doctor except for our routine annual physicals, so we picked one according to our needs.
But no one really considers that they’ll need fertility treatments in the future as part of their insurance plan. I know we didn’t and didn’t plan for it. So we had to fully read and understand our current insurance plans at the time.
We read our entire schedule of benefits, especially until the end of the list. That’s where most big ticket items – the expensive treatments – are and if they’ll be covered or not. We learned that fertility treatments and IVF was covered for us in our insurance plan.
And if we had questions, we called our insurance provider to get answers. Every insurance plan and its coverage are different and it was a lot to comprehend.
Deductibles and co-pays
We also got very familiar with our deductibles and co-pays. A deductible is a fixed amount a patient pays each year before their health insurance benefits begin to cover the costs.
I was fortunate to have dual insurance coverage. I had insurance from my work and insurance from my husband’s employer. We didn’t have a deductible to meet with my dual insurance coverage. This means our insurance plan benefits started immediately.
A co-pay is a fixed amount a patient pays for covered medical services. The amount varies for the type of services – routine or essential services such as annual physicals have a lesser co-pay than visits to specialists or the emergency room.
During our first IVF process, we didn’t have a deductible or co-pay for our many doctor visits so this was a very good thing for us. Thank goodness for my husband’s insurance – a huge financial burden was lifted off our shoulders.
On our second IVF process, we only had to pay about 20% of our total procedure which was about $2500 – this included our medications.
In network and out of network specialists
We did the IVF process with two different clinics during our IVF journey with different insurance plans.
On our first IVF process, we dealt with all in network specialists so the procedures were all covered. In network health care providers – doctors, specialists, hospitals, etc. – have an agreement with an insurance company to provide medical care to their insured members at a discounted rate.
On our second IVF process, we had to deal with out of network specialists because there were no fertility clinics in our local area. We had to travel out of our area to receive treatment.
Out of network health care providers do not have an agreement with your insurance company to provide care. Therefore, medical costs are much higher with out of network providers.
However, since my husband’s company was based in a state that mandated IVF insurance coverage, our medical bills were minimal during our second IVF process. What a relief!
Prescription medications and all the needed supplies were arriving at our doorstep nonstop for our IVF. Vials of injection medicines, syringes, pills, vitamins, suppositories, disposal container…the list was endless.
The team of doctors and nurses we worked with at both clinics gave us good options to obtain our medications at different pharmacies. When we thought a local pharmacy could provide us with what we needed, we sometimes found out that getting our medications shipped to us from an out-of-state pharmacy was a more cost effective choice.
Insurance paid for everything during our first IVF, including prescriptions. For our second IVF, we paid 20% of the total for all medications needed.
The Financial Reality
Apparently we were the lucky ones. We didn’t think we were lucky when we found out our diagnosis of infertility. But financial luck was on our side because there are two main ways to get insurance with IVF coverage in the United States:
- On our first IVF process, my husband worked for an employer that covered fertility and IVF treatments in its insurance plan. We had no deductible or copay, so our IVF treatments were paid for by our insurance.
- On our second IVF process, my husband’s work was in a state that had mandated legislation for insurance to provide IVF treatment. The most we paid was about 20% or roughly $2500 total.
We were the lucky ones – a blessing in disguise. Having insurance coverage for IVF isn’t something we thought we needed or had, but we sure are glad that we had it when we most needed it.
We know that the overall financial cost of IVF can be overwhelming and everyone’s situation is different and unique. My recommendation is to do your research – there are actually free IVF grants now and some people are crowdfunding for IVF – things that were unheard of more than 10 years ago when we first embarked on our IVF journey.
I know the financial strain of IVF can have a huge impact on your life, so evaluate your finances honestly and trust in your decisions.
Faith, hope, and love always.