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Insurance Information

Medical insurance has gotten extremely complicated. The situation for infertility coverage is even worse. Different patients may have coverage by the same insurance company, work at different companies, and have plans that don't resemble each other because of different riders that their company has purchased. The situation is completely unfair.

It doesn't make any difference why a couple has infertility. The cost of care is also not the issue, since more expensive, more elective medical conditions are routinely covered while excluding infertility coverage. For example, the cost of hip replacement surgery would pay for three IVF cycles (the most expensive infertility therapy). Many infertility therapies are extremely inexpensive compared to medical care in other areas. The cost of infertility care is lowest in settings in which it is universally available through insurance coverage. The cost of providing infertility insurance coverage in states that require it be part of regular insurance is similar to the cost of providing medical nutrition services.

All of the states surrounding Pennsylvania have passed some legislation that helps patients working in those states. Currently, the best situation for patients is in New Jersey. In 2001, New Jersey passed legislation requiring most large companies to provide infertility coverage for their employees. This includes payment for infertility medications and up to three cycles of IVF when less extensive appropriate therapies have failed.
Infertility Solutions, P.C. participates in many insurance plans.

Although we can not know your insurance company as well as you can, we will try to share our experience in working with your company with you as much as possible to try to determine what costs are covered. Over time our participation in insurance plans changes. We may stop or start participating in a plan.  Even when we participate in your plan, the exact infertility coverage that your plan will pay for will depend on your insurance company and the plan that your employer purchased.  If we don't participate in your insurance plan, it may be possible for you to submit your bills directly to your insurance company and receive partial reimbursement from them directly.

Some of the major plans that we currently participate with are:

Aetna plans, Amerihealth, Capital Blue Cross, Cigna, Eastern Pennsylvania Health Network (EPHN), First Priority Health (FPH), First Priority Life, Health America, Health Assurance, Health One, Keystone East (KHP East), Keystone Central (KHP Central), Cigna, Oxford Health Plans, Personal Choice, Physician's Care, United Healthcare, and US Healthcare. We also participate with a number of smaller plans. Feel free to call us with any questions.

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Given the poor insurance coverage for many patients and the need to self-pay for at least some of their care, several finance companies have developed plans to help patients pay for their care. We have used several financing companies for this. They enable patients to pay for large non-covered medical therapies such as IVF over a period of one year to 7 years. Some loans are for a fixed amount ans some are for a line of credit. Conditions and eligibility vary with the company and with economic conditions. In general, loans are easy to apply for and are generally unsecured. The most important issues are your state of employment and your credit score. Program features vary significantly. The companies which which we presently have agreements are listed on our Financing page. 

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We offer a prepaid discount to our self-pay patients on the ovulation induction for IVF and other types of ovulation induction cycles. The ovulation induction always takes place over a variable time period depending on your response to the medications. For example, for IVF, it may take place over 10 to 16 days. The variable length of time required makes it difficult to budget for the cost of an IVF or other type of ovulation induction cycle. We offer patients the option of prepaying for the care that would normally be given in the average length cycle. This enables patients to estimate a ceiling cost for the cycle they plan to undertake. Even if the cycle requires a longer time period with more evaluations needing to be performed, there are no additional charges for the ovulation induction. If fewer than average services are required, then the left-over part of the prepaid fee will be refunded. This prepaid discount is not available to patients with insurance coverage (even partial).

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This plan provides for up to three to six fresh cycles of IVF and associated cryo/defrost cycle for a set fee. If you don't take home a baby with this therapy, the entry fee is completely refunded. This refund program guarantees a refund if pregnancy is not achieved or if an achieved pregnancy is lost for ANY reason. Some patients will be able to try IVF (assuming coverage for medications and monitoring), get financing for this program, and not have to re-pay any of the financing unless they leave with a baby! This program is not available to those with insurance coverage for IVF. Other programs may offer a "shared risk/IVF refund program", but few have terms as liberal as ours. If you are also looking at other programs, compare their entry rules for the program, the circumstances for getting a refund (does it cover through delivery?), and the amount of the entry fee refunded to conditions in our program. Detailed information about this program can be found on this web site.

This plan is especially great for those patients with coverage for medication and or the ovulation induction charges. In these cases you can take out a loan (interest free for one year) to participate in this program. If you get pregnant, then you continue to pay off the loan. If you don't get pregnant, you are refunded the entry fee and can then pay off the loan.

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This plan is also for patients without insurance coverage for IVF. A patient pre-pays for (less than) two cycles of IVF. If she needs a third cycle, it is provided without charge. If she achieves a good pregnancy in the first cycle, half of the pre-paid amount is refunded to her yielding a several thousand dollar discount. Some commonly billed separate charges (such as ICSI) are also included. Please see further details for this program elsewhere on our web site.



For patients who come to us with infertility, our focus is on helping them get pregnant rather than just gathering medical information about them.  Much of the testing done for a traditional infertility work-up provides information about the patient but often does not modify the approach that the physician takes to enable that patient to achieve pregnancy.  Based of reviewing charts of patients from many other programs, we generally do less testing on patients than other programs routinely do.

In December of 2009, we reviewed all of our ovulation induction cycles (e.g., for clomid, IUI, gonadotropin, and IVF) to see if we could reduce the number of tests we performed on patients during their ovulation induction without losing information that would impair quality for the patients.  Compared to many programs, we already ordered much less than many of programs.  We succeeded in reducing our total testing by about 10%.  This resulted in a "behind the scenes" reduction in costs for the patients undergoing any pregnancy acceleration technique in our program of up to 10%. 


Many of our patients have a good prognosis for getting pregnant with IVF, but simply can't afford it.  For some it is not a question of their making relative value choices, but of not having or even expecting to have in the near future adequate resources which would enable them to proceed with needed therapy.  The problem has recently been exacerbated by the difficulty that many patients have in obtaining credit.

A solution to this is difficult to come by since IVF is expensive in terms of the technology required to support it, the personnel required to undertake it and even the very specialized supplies that are required to obtain good results.  We are have to now have available a partial solution to this problem.  IVM, in vitro maturation, is a variation of IVF which, by eliminating some components of IVF, will cost the patient about half of what an IVF cycle will cost.  We use a number or variations of IVM, some of which use lower dose fertility medications and all of which (by eliminated medications and monitoring) cost less than routine IVF.  Not everyone can do IVM or its variations and expect good results.  Generally younger patients and patients with ovulatory or male factor problems will do the best.  This is a new program for us and for a limited time, we are providing good prognosis patients the opportunity to undertake IVM for about 1/3 the cost of an IVF cycle.  More comprehensive information may be found on our sister website www.IVMandIVF.com.