IVF Insurance Coverage questions, shared risk

[CT_Michele]

I know that my girls on my current cycle buddy thread are not going to be happy I am even thinking this way right now, but with beta so close and not much hope at this point, I really need to start thinking about my next step.

We live in CT and had 2 fresh cycles covered under the mandate, but this FET was out of pocket. We have no coverage left and I now have loans and debts from this FET that doesn't appear to have worked.

Does anyone know of any private pay insurance companies that offer ivf coverage?

What about shared risk programs? I hate thinking about leaving my clinic who helped me have success with my DD, but I really just don't see a way to afford it. If I am going to take out an equity loan, I need to find a program.

Any help, info, or ideas on what I can do will be very helpful. Thanks.

[washingtonda]

CT - Sorry things don't seem to look too good. Just hang in there until you get your beta on Monday.

As far as shared risk, you know that's what DH and I did. We paid 22K which was $20K for the shared risk and an additional 2K for ICSI because of my husband low morthology. In addition to that be spent about another 2K on our meds. Our insurance covered a good portion of the meds and that 2K was our out of pocket expense.

We did get pregnant on the first try with Michaela and were happy and felt it was money well spent. However we are thinking of trying one more time and since I just turned 40 we can't be in the program anymore because the age limit is 38 to be considered. If it weren't for my age I would have probably already paid the money and started my next cycle but I too am afraid to sink alot of money in and there is no guarantee. We had no embryos left to freeze so we know our first fresh cycle will cost us $11,500 for the procedure and 2K for meds with no guarantee. I also know I would be like you and not want to stop and we would end up baby poor and than I'll think of all of the things that money could have been spent on for Michaela. This IVF stuff is surely a gamble. I want to but I'm scared to give up that kind of money with no guarantee.

We took a home equity loan to pay for our first one and this time it will probably be out of pocket unless I can convince my DH otherwise. With today's market he's probably wanting to save all the equity in the home that we have. We have lots but I know his plan wasn't to use it this way. He hasn't ever said a word about not using it and he would probably never tell me no but I know him. We both work and have very good stable jobs so I might talk him into doing it and telling him that I'll repay the 2nd mortgage loan.

We go for a consult on the 13th to just see what our RE thinks and we'll decide what we will do from there.

Does your clinic not offer Shared Risk? I live in MD which is not that far from Connecticut. I'm about an hour and a half away from my clinic but we took the drive. If you are interested in coming to MD to have the procedure, you DH and Ella can bunk with us at anytime at no cost if that will help. We have a nice home with plenty of room and I know that you will be comfortable. Ella and Michaela could become BF's (smile). Keep me posted or you can PM me if you want more info.

By the way I have three other adult children and am only not able to get pregnant because I had my tubes tied. So my insurance offers coverage but not if your not able to get pregnant because youi had your tubes tied. I am remarried and my DH didn't have kids so that's why we're here. My youngest daughter prior to Michaela just turned 18, I have a another whose 19 and a 21 year old son. And a 4 month old grandson that my son and his girlfriend just had. Girls are in college and my son works in Real Estate. That's alot huh....lol

Much Luv,

Doreen

[moorebaby]

hi there! i'm so sorry things aren't looking too good for you, but you have to have faith & keep going with whatever it is you decide to do. i have a breakdown of the standard ivf fee schedule from uconn's center for advanced reproductive services (cars):

-1a appoitnment-evening session (informational session): free (no charge)

-1b appointment-ivf consultation & exam: $330

-nursing visit (not sure if this is part of the 1b apointment or what): $65

-cycle management fee for stimulated cycle: $500

-follicular ultrasouns @ $220 each (estimate of 5): $1,100

-ultrasound egg retrieval: $2,520

-ultrasound guidance: $130

-Hartford Anesthesiology Associates, Inc.: $682.50 (separate check to them)

-IVF laboratory fee: $3,685

-transfer: $1,260

-ultrasound guidance transfer: $220

-bloodwork (has to be done at the center) (PER DRAW):
-estradiol: $115
-FSH: $95
-LH: $95
-progesterone: $85
-prolactin: $90
-TSH: $75
-pregnancy test quantitative: $80
-venipuncture: $15

-extra costs:
-cost of patient's medications
-initial screening
-semen analysis

-additional lab charges:
-cryopreservation of sperm: $220 with a quarterly maintenance fee of $100
-cryopreservation of embryos (procedure with 12 months of storage): $1,000 with a quarterly maintenance fee of $150
-ICSI (micromanipulation of oocyte, greater than 10 oocytes): $2,520
-ICSI (micromanipulation of oocyte, equal to or less than 10 oocytes): $2,205
-biopsy, oocyte polar body or embryo blastomere (for PGD) (greater than 5 embryos): $2,625
-biopsy, oocyte polar body or embryo blastomere (for PGD) (equal to or less than 5 embryos): $1,575
-assisted hatching: $660
-sperm identification from aspiration (MESA): $265
-sperm identification from tissue (TESA): $550
-maternal serum collection & processing: $220


you should go their website & check out their financial plans:http://www.uconnfertility.com/programs_patient.htm
http://www.uconnfertility.com/programs_share.htm

[CT_Michele]

Thank you both so much for the info!

Doreen- That is sooooo nice of you to offer me/us to stay with you. Maryland will not be out of the question when making future decision. My brother in law and a very good friend recently moved to maryland, so I have have 3 options of where I could stay. Is your clinic shady grove? I came across their website when looking for shared risk options, and their program looks fantastic. I will most likely be calling them if my beta does not go well. What city do you live in? I would love for Michaela and Ella to meet. I read on shady groves website that many times they can coordinate so non-essential appts are local and I would just have to go for the big stuff.

moorebaby- Thanks for the uconn info. I planned on calling them too. I know someone who went through their shared risk program. It is good to see their prices, my clinic is so much more expensive than they are. I wonder if most of my early screening stuff would still be covered. My clinic told me I have full infertility coverage, for everything leading up to IVF, but I just maxed out on my actual cycles, so it is the actual ER/ET and stimulation that is not covered.

All things I will be looking into. Thanks girls.

[dys24]

Hi Michele!

I hope things turn out better today for you and that you will get your BFP! When is your beta? maybe you are testing too early.I'm praying for you.

As you know i went to Uconn and had the shared risk program, I'm not sure if any of the costs went up but this is what I paid for everything. The whole thing cost me 29k which included: 3 fresh cycles and 4 frozen, ICSI, hartford anesthesiology fee, and freezing for 1 yr. If you are not successfull after the 7 tries they refund 70% off of the ivf fee and icsi only. Freezing fee and anesthesiology is not refundable. Also if you'r not successfull the first try you have to pay the anestesia fee of i think 680$ for each fresh cycle same goes with freezing everytime you freeze you must pay the 1k and if you have nothing to freeze they sent you back the check within 2 weeks.

All these fees do not include any blood work and medicine.

Also if you do get pregnant first try you get nothing back.

Also FYI they dont freeze anything on day 3 unless the embryo is perfect 8 cell grade 1 anything else they grow until day 5 and if it makes it to blast then they freeze.

I know they have some rules where you have to attend info class, and injection class as well as doc visits none of these pre-ivf are included in the fee.

As far as regular ivf it costs around 14k

I hope that helps!!!

You can always pm or call me if you have any Q

[CT_Michele]

Edith- I am so glad you posted, I am thinking about you all the time girl! I see you are at 28 weeks, that is awesome! Are you on bedrest? I am hoping you make it many many more weeks.

Thanks for the info on uconn shared risk. I was going to pm you to get that info. That is pricey, but at least they are somewhat local. I will be looking into a lot of options.

I saw one place in online, that is in Hamden, and they had their shared risk eligibility form online. I would not have qualified because my bmi is too high and because I have had 2 failed ivf (if FET's count in that number), and it is extreme male factor. I wonder if those requirements are everywhere. I wonder how it will all work with dh needing TESE. We have one frozen vial of sperm at our clinic, but who knows how much sperm is in there, so he would probably need to do TESE again.

[dys24]

Oh Michele I'm having a crazy pregnancy so many trips to L&D its insane but I'm still hanging on! I wanted to call you yesterday but I switched my phones and lost your number. My # is stil the same so if you want you can call anytime.

I know uconn has the bmi restriction too. Anything over 39 i think they wont do ivf at all. Mine was a little above what the norm is and i had to go for anesthsia consult, which thankfully went fine but it was an added stress!

I know there is one place in shelton that does shared risk but dont remember the name I'll try to look it up for you.


Also the shared risk program at uconn i know they have some restrictions on failed ivfs too but dont remember how many you can have. I know its actually a different company that does the program because they had to fax them all my and husbands medical records to them and you get an answer within a week.

[esperanza]

Michele--I promised I would come back, and here I am! how are you doing? tomorrow is beta time, right? I'm thinking of you and still keeping a positive mind about you and the outcome of this FET.

Washington DA!!!! how's your little Michaela? Asha is doing great, she has come to change my life upside down...and it's all good. Miss ya dear.

[washingtonda]

Michele I did use Shady Grove in Annapolis, MD. I actually live in Dameron, MD which is about 1 and 1/2 hours away from the clinic. If you decide to proceed and use them, PM me so I can give you the name of the RE that I used there.

Wishing you much luck tomorrow and I'll let you know how things go with my consult.

Also the 20K is fully refunded 100% if you don't have a baby after 6 tries and you can decided to quit at any time if you don't get pregnant and still get a 100% refund. My health insurance had for all of my monitoring so I didn't have any added expenses for my visits. It was just the procedure and the 2K cost towards my meds.

Keep us posted.

Esperanza -- Good to hear from you girly. I talk to DH about you all the time. Glad Asha is great. Michaela is great. She's walking and talking and you can't tell her anything. She just had her 1st Birthday a few weeks ago and it was great. Around 20 kids and a Cha-Cha the Clown...lol. We had a blast. I'll try to post new pictures to her website later this week for you to see.

As you can see we are considering one more. This IVF stuff is an expensive gamble.

Love you girls.