Even when IVF is included, the high bills and challenges abound: Shots

Oona Tempest / Kaiser Health News

a woman with a medical account

Oona Tempest / Kaiser Health News

Brenna Kaminski and her husband, Joshua Pritt, have tried unsuccessfully to have children for many years and have tried in vitro fertilization.

Only 15 states require maternity insurance, and Florida, where Kaminsky and Pritt live, is not one of them. However, the couple’s insurance, from Pritt’s job at an energy company, put them in a happy minority of Americans whose insurance plan included an expensive birth procedure. Kaminsky and Pritt determined the cost of one round of IVF: $ 2,700, out of pocket for their policy.

Instead, after many twists and turns with two specialty internships, they paid more than $ 15,000 for two rounds of IVF, including all medications. As with most national procedures (success rates vary from 12% to 49% depending on the patient’s age), neither cycle resulted in a viable pregnancy. “It was all a nightmare,” said Kaminski, a 37-year-old freelancer who specializes in marketing and writing. “The stress was amazing.”

Approximately 1 in 5 women have difficulty conceiving, and IVF has become a common way for many to become parents. However, as demand grows, insurance coverage remains limited. According to the consulting firm Mercer, in 2020, 27% of companies with 500 or more employees covered IVF, which is 24% more than in 2015.

“Infertility is a disease and should be treated well and insurance coverage should reflect this,” the doctor said. Kara Goldman, Associate Professor of Obstetrics and Gynecology, Northwestern University. “The coverage is often incomplete because people often don’t see infertility on an equal footing with other diseases.”

Kaminski’s insurers, Blue Cross in Illinois and Blue Shield, offered a list of network IVF providers in the area near the couple’s home in Melbourne, Fla. For in-network care, the couple would be responsible for 20% of the costs. They had to pay 40% for off-site maintenance.

The office of the first industry professionals they tried was located in the spring of 2020 in Viera, Florida. However, after seeing the doctor, they learned that he had to travel to Miami for 3 hours, where the doctor performed IVF procedures three times.

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The couple paid $ 2,700 for medicine alone. They also paid an additional $ 500 because the maternity clinic required them to use an off-site laboratory for blood tests.

In November 2020, the couple decided to try again, they have another maternity medical team listed in the Blue Cross provider network. It was in Winter Park, Florida, about an hour’s drive from their home.

Kaminsky met with doctors at the Center for Reproductive Medicine, who planned to start the procedure at his office in the same building. However, this facility was not in the Blue Cross network of Orlando Avenue surgical center.

According to Kaminsky, the surgery center told him that he could soon join the Blue Cross network, and he asked the insurer to refuse to consider the center’s care network. He was told by the insurer’s customer service agents that he would receive a waiver, but this was not confirmed in writing. However, he underwent the procedure.

This happened in 2021 and Kaminski again expected to pay about $ 2,700 to take care of an IVF specialist in Winter Park. He knew that there would be separate costs for the drugs used in IVF.

But because Blue Cross considered his care to be out of the network, he was billed more than $ 6,000 by the Kaminsky Clinic and its surgery center. The cost of this out-of-pocket medicine was about $ 4,000.

Kaminsky spent nearly a year treating Blue Cross as his second-round IVF round network. He said it would be unfair for Blue Cross to add a Winter Park maternity clinic to its provider network if its doctors performed the current IVF procedure at an outpatient surgery center. The surgical center is owned by some of the clinic’s doctors.

In a statement to KHN, Stephen Brown, executive director of the Center for Reproductive Medicine, said he would not address Kaminsky’s case, despite allowing him to discuss it. In an email, Brown wrote that the clinic is open to all patients and that his surgery center is not in the Blue Cross network.

According to Brown, the low rates of compensation are not something that has taken the surgical center out of the Blue Cross network. Instead, he said, the insurer did not act quickly, and it took more than four years to connect the surgical center to the provider’s network. “The reason we weren’t in the network with BCBS in the beginning was simply because BCBS didn’t respond,” Brown said.

Before undergoing any treatment, Brown said, the clinic provides patients with an insurance-based evaluation of their procedures. Kaminski estimated that he could pay between $ 3,000 and $ 4,000 for the transfer of embryos grown in the laboratory.

In March 2021 – a month after completing Kaminski’s treatment – the Winter Park Surgery Center joined the Blue Cross provider network.

In February 2022, KHN contacted suppliers and insurers. Within two weeks, Blue Cross told the couple that they would review all services received at the surgery center within the network and paid all of their bills in full. Kaminsky and Pritt no longer owe anything to the capital. Blue Cross initially said it would pay a nominal portion of the disputed bills of $ 21,450 for care in 2020 and 2021 because the surgery center was out of network.

Blue Cross also confirmed that in January 2021, the couple was allowed to opt out of all of the surgical center’s accounts to be considered online. The mistake that can easily get your claim denied is to fail.

“It finally made sense,” Pritt said after learning that their settlement dispute had been resolved. “It’s good to know we’re not getting bills anymore.”

After Blue Cross decided to close the IVF in Winter Park, the couple recovered $ 1,600 from Orlando Avenue Surgery Center.

John Simley, a spokesman for Blue Cross and Blue Shield in Illinois, said: “There can be errors with non-routine rejections. The good news is that they can be fixed quickly.”

In this case, however, almost a year has passed.

Experts say Kaminsky’s case suggests that even when people have coverage for IVF, they may be left with large payments. Also, the lists of network insurers are not always accurate. Sabrina Corlett, a research professor and co-director of the Center for Health Insurance Reform at Georgetown University, said: “It feels like a bait and substitute.”

The new federal insurance law, the No Surprise Act, went into effect in January 2022. It states that patients should not pay more than the distribution of costs within the network if the catalog of the insurer provider provides incorrect information.

It is unclear whether the law will apply in cases such as Kaminski and Pritt. In any case, the law came into force late for them.

Betsy Campbell, Resolve: National Infertility Association, Patient Protection Organization, Kaminsky’s case shows that insurance coverage is not always developed around the patient. “Infertility treatment is a series of very complex procedures, including laboratory work, surgery, and anesthesia, and it must be provided in a way that is not always respected by the insurance system,” he said.

According to Campbell, insurance often surrounds a couple to get the care they need. “Everyone should have the right to get married, and it doesn’t matter what employer you work for, or what state you live in, or how big a check you can make,” Campbell said.

Kaminsky and Pritt do not refuse to have children. So far, they are using other methods of treatment of childbirth, not IVF.

KHN (Kaiser Health News) is a national news section that publishes in-depth journalism on health issues. This is an editorial independent operating program KFF (Kaiser Family Foundation).

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