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I. Background

II. Program eligibility

III. Coverage

IV. Refund criteria

V. Other details

Appendix A

Appendix B


Home : Contents : IVF Program : IVF Risk Sharing/100% Refund Program

Risk Sharing—IVF Refund Program

I. Background

  1. IVF is an expensive procedure that is wonderful when it works and painful to all involved when it does not work.
  2. Most charges for the IVF procedure are poorly supported by insurance coverage in Pennsylvania.
  3. The concept of a "risk sharing" or a "money back guarantee" approach to IVF funding has been used by several programs in the United States for several years. Ethics committees have evaluated this approach and found it suitable for many patients.
  4. Programs offering "risk sharing" opportunities risk losing money if they cannot consistently produce above average IVF success results.
  5. Patients who enter such programs understand that they have an excellent chance of getting pregnant because they are committing to multiple IVF cycles (IVF does not work each time).
  6. If patients are NOT fortunate enough to achieve a pregnancy and deliver a baby during this program, most of their financial resources will be returned to them so they can pursue other options such as adoption.
  7. The source of these funds returned to patients (assuming that this program maintains a high pregnancy rate) is the patient who get pregnant quickly because she ends up paying more for her care than she would have without the money back guarantee. (The AMA ethics committee considers this an insurance product and not a guarantee of success.)
  8. Patients who achieve pregnancy also save money because of the volume discount offered for committing to a series of cycles. Some patients in this program will receive over $60,000 worth of services.
  9. Although all risk sharing or IVF refund programs share a common approach and underlying philosophy, there are many small differences between programs that may be important to some individuals. Some of the differences in our program compared to other programs are listed in Appendix B.

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II. Program Eligibility

  1. To make this program work,, we need to limit the "risk sharing" to our largest and most homogeneous subset of patients. (However, our entry criteria are more liberal than many programs. In addition, we also have a "3 for 2" multicycle discount program that is open to anyone. Some patients who qualify for the "risk sharing" program may even like the "3 for 2" program better. It does not have an insurance component and you will not pay for any services you do not use.)
  2. Patients must be under 35 years of age when they enter this program. (We also have a similar program for patients under age 38. Call our office for more details.)
  3. See Appendix A for other criteria for admission to this program. These criteria may change from time to time.
  4. Depending on the agreement we have with your insurance company, we may require their approval (even if they pay nothing) before your entry into this program. Some insurance contracts (even when there is no cost to the company) do not allow their "customers" to participate in an arrangement like this.
  5. The fee to enter this program is $26,000. The Springstone Financing Program can help you with a payment plan for this fee ( http://www.springstoneplan.com/ ). You may finance this fee over five years. If you have insurance coverage for the ovulation induction and other excluded services, you can finance the entry fee, make payments during the course of this program and if you don't succeed in having a baby, you may use the refund to pay off the loan!

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III. Coverage

  1. Entry into this program will provide for up to six attempts at pregnancy through fresh IVF and additional attempts using any cryopreserved embryos produced in those attempts. All of these attempts must be completed within 24 months of entry into the program.
  2. Prior to the start of the program, you will have the opportunity of choosing a minimum of three to a maximum of six fresh IVF cycle attempts at pregnancy. There is no difference in cost if you sign up for three or six fresh cycles. We recommend six since the expected pregnancy rate is significantly higher, but some patients prefer fewer cycles (especially if they do not have insurance coverage for the components of a cycle not included in this program like medications). Once you select the maximum number of tries and the program begins, you cannot change your mind.
  3. There are costs associated with IVF pregnancies that are not covered by this program. In addition to the IVF cycles themselves, there is preparation and evaluation prior to an IVF cycle, potential treatment for complications of IVF, and evaluation of and treatment for complications of pregnancy. Prior to the IVF part of the cycle, many medications are used and there are office visits, ultrasounds, and hormonal testing to evaluate the effects of these medications. This program is intended to only pay for the expensive procedures specific for IVF. Routine medical insurance may pay for many or even all of the other costs associated with this extensive process.
  4. If you choose the program with six cycles, some of those cycles may be IVM or Mini-stim IVF if you and your physician wish to utilize those technologies.  For more information, contact the office.
  5. The specifically included components are:
    1. Oocyte aspiration and ultrasound guidance
    2. Oocyte identification
    3. Oocyte cleaning
    4. Routine sperm preparation
    5. Oocyte insemination
    6. Embryo culture
    7. Prolonged embryo culture if indicated
    8. Embryo transfer including ultrasound guidance
    9. ICSI if indicated
    10. Assisted hatching if indicated
    11. Embryo freezing as recommended by the program
    12. Cryo-embryo storage until pregnancy is achieved
    13. Embryo defrost and culture of cryo-preserved embryos
    14. Embryo transfer of cryo-preserved embryos
    15. All facility charges at Infertility Solutions' office
  6. The following components are NOT included:
    1. Evaluation and preparation for an IVF cycle
    2. Ovulation induction (ultrasound studies, blood tests/draws, and office visits) [It is possible to include this in the shared risk component of this program, but there is an additional fee. Contact the office for more information.]
    3. All medications including, for example, gonadotropins, lupron, progesterone, antibiotics, anesthetic agents, IV solutions/infusions
    4. All anesthesia charges
    5. Genetic studies including embryo biopsy (PGD) if desired
    6. Donor sperm or donor eggs
    7. Sex selection techniques
    8. Management of any complications
    9. Pregnancy evaluation (ultrasounds, etc.)
    10. Procedures or lab tests performed by other health care providers or at other places
    11. Surgeries other than oocyte aspiration
    12. Costs directly associated with TESE
  7. Patients must agree to not use medical insurance for any included components. Insurance may be used for excluded components including medications and the ovulation induction. If we participate in your insurance and the company allows it, the ovulation inductions is commonly covered.
  8. If patients do not have insurance coverage for the ovulation induction, costs can be controlled by purchasing ovulation induction as a package. These costs are not included in the refund.
  9. If patients do not have medication coverage, our staff can direct you to places to purchase medications at costs lower than most pharmacies. These costs are not included in the refund.

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IV. Refund Criteria

  1. The patient will be refunded her full entry fee ($26,000) if she has not achieved a pregnancy and left the hospital with a baby after completing the agreed upon maximal number of fresh IVF cycles and associated cryo-transfer back cycles within the 24 month period of the program.
  2. If the patient has not completed the agreed upon number of IVF cycles and all associated cryo transfer back cycles within 24 months of entry into the program and has not achieved pregnancy, then she will be charged for those services that she used and any money left over from her entry fee will be returned to her (assuming her account is otherwise settled). Similarly, the patient may withdraw from this program at anytime before egg aspiration or after a negative pregnancy test and obtain a refund equal to her entry fee less charges for any services already delivered.
  3. It is the patient's responsibility to undertake IVF and cryo replacement cycles in an expeditious fashion in order to optimize her opportunity to achieve pregnancy during the 24 months she is in the program. (We provide opportunities to do IVF about ten times each year.) If the patient is pregnant or if her baby is in the hospital at the end of the 24 months, we will have earned our fee.
  4. Although we cannot control for pregnancy losses unrelated to our care, we still provide additional services or give a refund (provided you have completed the program within the 24-month time period should you experience such a loss.
  5. We may choose to drop you from the program at any time for any reason. If we do so, we will refund your full entry fee unless you have acted in a way to prevent pregnancy from occurring (for example, not taking HCG at the time directed, or not showing up for the egg retrieval). In that event, we will refund your entry fee less our routine charges for the services that you have already used. We will not reimburse you for any other expenses you incurred (such as the ovulation induction or medications).
  6. If a patient chooses to have a pregnancy termination (i.e., a D&C while she has a baby with a heart beat), we have the option of dropping her from the program and assessing her routine charges for all services previously rendered. Money left over from her entry fee will be returned to her.

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V. Other Details

  1. If a cycle is cancelled prior to retrieval (for example due to over or under response), it will not count against the fresh cycles to which a patient in this program is entitled.  Any transfer cycle utilizing only cryo-preserved embryos does not count toward the fresh cycles to which a patient in this program is entitled.
  2. Patients need to be willing to undergo procedures essential to success of this program such as:
    1. Willingness to transfer at least two embryos. (The exact number to transfer is a joint decision by her doctor and the patients.)
    2. Willingness to use ICSI or assisted hatching if the physician thinks it beneficial.
    3. Willingness to cryo-preserve embryos as recommended by the physician and generally to use them prior to starting another fresh cycle.
    4. Willingness to accept the risks associated with an IVF procedure.
    5. Agreement not to smoke starting one month prior to a cycle and in early pregnancy. We may drop you from the program (to routine self-pay IVF) if we find significant nicotine products in your bloodstream.
    6. Agreement to keep all appointments and follow directions to the best of your ability.

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Appendix A (July 1, 2014)

To qualify for this program, a patient must meet all of the following criteria:

General

  1. Patient must be under 35 years old when she enters the program.
  2. She must have no chronic health problems that may impair her ability to carry a healthy pregnancy.
  3. If she has more than one failed prior IVF cycle, lab records of the embryos produced must be available for review and embryo quality must be adequate for good chance at pregnancy.
  4. The patient must be a non-smoker or must be willing to stop at least one month prior to cycles and be willing to have blood and urine tests to confirm lack of exposure to smoke.
  5. The patient cannot be severely obese. Her BMW must be less than 40. (This is a measure of obesity equal to weight in kilograms divided by height in meters squared. To exceed this measurement, a 5-foot tall woman would have to weigh more than 205 pounds. A 5 foot 6 inch tall woman would have to weigh more than 250 pounds.)

Sperm

Semen analysis in our lab must confirm at least 500 motile sperm in two specimens.  If the sperm specimen contains less than 3M motile sperm in a specimen, then the couple must have a sperm specimen cryo-preserved in the laboratory to be used as a back-up specimen.

Ovarian function

  1. The patient must have an AMH level > 1.2.
  2. The patient must have two accessible ovaries on ultrasound and at least 12 antral follicles in her ovaries.

Uterine condition-

  1. Any fibroid must be less than 2.5 cm in maximal diameter.
  2. The uterine cavity must be free of submucous fibroids, polyps, and adhesions.
  3. Any intramural fibroids cannot alter the endometrial line.
  4. There can be no significant impediments to transcervical embryo transfer.

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Appendix B

Although different "risk sharing" IVF programs have common characteristics, they also differ in ways that may be important to some patients. Some of the ways that our program differs from some of the other programs are:

  1. Our program covers up to six fresh IVF cycles. Assuming that we maintain a pregnancy rate at least as great as the national average, at least 90% of the patients in this program will leave with a baby. If a maximum of three cycles are undertaken, we would expect at least 70% of that group to have a baby.
  2. If you don't achieve a pregnancy and leave the hospital with a baby, we will return 100% of the program fee ($26,000). Many programs return a percentage of the entry fee or charge an additional non-refundable deposit to cover the "insurance" aspect of their program. Few programs provide refunds for losses outside of their control (like delivery problems).
  3. Our program fee does not cover the cost of the ovulation induction. We do this instead of charging a non-refundable deposit or keeping a portion of the entry fee. We feel this is fairer to the patient and also enables her to use her medical insurance that commonly pays for at least part of the ovulation induction. However, if you do not have insurance that covers ovulation inductions and wish to have the ovulation inductions included in a shared risk setting, there is an add-on program that you may participate in.
  4. Our program lasts for 24 months. Most programs have a 12-month duration. We do this because we have about 10 cycle series each year and this time period makes it more convenient for patients to undergo all included cycles, especially if a cycle results in pregnancy complications (for example, miscarriage or ectopic pregnancy). Our program also provides "coverage" until the baby leaves the hospital after delivery.
  5. This program does not guarantee that you will have a baby. It does guarantee that you will get a refund if you do not deliver a baby after you have fully completed the program. In this way, it covers you financially for a large array of tragic obstetrical events which result in death including, umbilical cord accidents, delivery problems, lethal chromosomal abnormalities, automobile accidents, blood clots, and infections.