IVF Treatments - does insurance cover the cost?
My wife and I are moving to the United States to the SF Bay Area in the next month.
We are currently doing egg donation overseas and would need to do ultrasounds and blood tests leading up to appointment. Does anyone know where this can be done and approximately how much it would cost?
We are planning on going with Kaiser for insurance, is there something particular that we need to ask for or make sure to tell them we need on our insurance that would cover future egg donation/IVF treatments? Is there a better option than Kaiser if we would like better coverage on things like this?
Additionally, what is the approximate cost of the medications required for egg donation/IVF treatments and is there a way to get the medical insurance to help cover the costs?
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Congratulations on your upcoming move to the Bay Area! We have gone through several IVF procedures with Kaiser. Our insurance policy did not cover IVF but it did cover all the other procedures that were part of our overall fertility treatments. We used an egg donor and paid Kaiser $15,000 which covered all the medical costs for both the donor and myself. Kaiser doesn't provide egg donors; we went to an outside agency and paid them directly for the donation.
When we tried again later using the frozen embryos that we already had, the cost was only $4500 for my needs. I don't know the specific costs for the medications since we paid a lump sum. I would advise that when you get insurance through Kaiser, that you specifically what the difference in the annual cost is with and without IVF coverage - it could be that you are better off paying out of pocket for the implantation rather than paying super high annual premiums.
I can't speak to the insurance portion of your question, except to say that many policies do not cover fertility treatment. My understanding with Kaiser is that if one's policy does not cover fertility treatment, the only benefit is that most of your lab work may be covered, which is minimal in the scheme of fertility treatment costs.
I would recommend choosing a clinic based on reviews of REs and proximity to work/home. I've had a positive experience of Reproductive Science Center, which is in San Ramon but has several satellite clinics for scans and routine blood work.
I can't speak to the cost precisely, but the egg retrieval (including meds) is the most expensive part of treatment, so if you already have the eggs you'll be in good shape financially. I think transfers cost approximately $300 per cycle and meds for transfer cost less than $100 per month, but those are both ballpark figures. I paid for a package, so have no idea how much scans cost.
We took 13 months to conceive our son so around month 11 I started digging in. I had a really good Kaiser plan at the time and they only covered 6 rounds of IUI and 50% coinsurance on the meds/labs. Your Kaiser plan may be better, but after looking around... I think that was one of the better infertility treatments offered by many insurers (Anthem, Blue Shield, UHC, Cigna, etc) at the time.
I don't have all your answers, but I can point you to another place to get answers: Resolve, the National Fertility Association, has a forum where there are lots of people who can share their experiences and there are often questions about these things and many people in the bay area who can give specific recommendations and experiences.
I have Kaiser and went there for testing, but have not gone on for IVF. My husband has good insurance that pays for 50% co-insurance for testing and treatment, excluding IVF. The doctor told us that no Kaiser plan covers IVF, but it is possible for companies to buy a specific IVF policy in addition to a regular plan. It won't be included in your regular plan, and you'll have to talk to your HR department and ask if they have IVF. I'm not sure if meds and monitoring would be covered with our fertility coverage, but I think it's likely since IUI is covered, I think it's just the IVF itself that is not covered. So I'd ask what their fertility coverage is (it's rare to have any coverage for it at all- both the financial office and the RE's office we're suprised we had coverage). Alternately, the fertility centers in the area probably offer monitoring and meds. I knows I've seen this question asked and answered recently on the Resolve forums with someone doing out of state IVF, see definitely check out that forum. Good luck and best wishes for success!
In terms of pricing (I feel money sick all over again looking at my IVF spreadsheets;)- my clinic charged about $300 for an initial consultation and then $490 per monitoring visit- that included the ultrasound, and blood work for estrogen and progesterone levels. The embryo transfer ran about $5,300 but it would have been closer to $3,700 had it been a frozen transfer which yours likely will with donor eggs (unless you're leaving the country for that part). Then there were two blood draws to test for hcg levels (pregnancy hormones) at $65 a pop and a mandatory 7 week sonogram to confirm the pregnancy that ran about $270. If you already have the egg retrieval taken care of your medication costs will probably be quite low in comparison to the $3-6k for a full retrieval cycle (but I'm just guessing here) you may only be on the hook for lupron ($200-300 for a 14 day course) and progesterone which is about $120 for a 10 day supply of injectables (this is from memory, may be wrong) plus about $100 a week for progesterone suppositories if your doctor likes to double up. I was on the progesterone until I was 11 weeks pregnant so that cost adds up but I've heard people have good luck ordering from Europe (ivfmeds.com or the like) where the cost is about 75% less.
In terms of your insurance- very few insurance plans in the US cover IVF. If you're lucky enough to work for a major tech company you might get hooked up but most others will be out of luck. Ours covered 50% of infertility (dignostics, IUIs, any procedures necessary to help your fertility like HSG or laproscopy) but nothing for IVF (or egg donation). If your insurance covers any of the IVF costs, I'd stick with them though I had an awful experience at the Kaiser IVF center in Fremont and later switched to Reproductive Science Center Orinda which was wonderful- had my insurance paid for anything I would have sucked it up and stayed at Kaiser.
In terms of where your monitoring can be done- any place that offers full IVF will be set up for it. Kaiser used to do IVF satellite monitoring out of a number of offices, including Oakland but stopped allowing patients to go to Oakland while I was there in June so you had to drive all the way to Fremont and wait an hour (first come first served) for a two minute ultrasound and then drive to a separate lab wait and wait in a huge line to get blood drawn every two days. RSC was a very quick, one stop shop where you got blood and ultrasound done at the same time and with very little wait.
All the figures above are pulled from a cycle where I used my own eggs though so please know that it's just what it cost in my case- I'm not an expert in treatments with egg donations.
Good luck to you- it's a stressful and insanely expensive ride but totally worth it if it all works out (the kid just better get a scholarship to college because we're fresh out of money;P)
I'm sorry to hear you have to go through IVF -- we are in the process ourselves and it is very stressful for us! The good news is that there is very good fertility care in the bay area. The bad news is that it can be quite expensive and both treatments and medication are frequently not covered by insurance. Our fertility doctor told us about 20% of his patients have some kind of fertility insurance. A lot of people actually go abroad for a cycle to get lower cost treatment! Even with missed work it can be a more affordable option.
In terms of the insurance question, it really depends on what is offered by you or your wife's employer. Fertility treatments are so expensive it really is worth making your health insurance decision around which plan, if any, covers fertility. Check carefully through the plans, and talk with the HR people at you or your wife's work, and call the plans themselves. I think if you are getting coverage through a big tech company like google you are more likely to find fertility coverage. If you are going through Covered California (ObamaCare/ the semi public health plan), you probably will not be able to get any kind of coverage (at least when I had it there were no plans). I once had an employer sponsored plan that covered fertility evaluation, but not treatment. My friend has a Kaiser plan that covers 50% of the costs, although she hasn't been particularly happy with her care (but I'm sure there are a variety of doctors there). Also worth knowing that Kaiser's main fertility centers are in Fremont and Sacramento, although there are some smaller offices. https://www.kpivf.com/
The costs to you will really depend on what kind of coverage you have. I am looking at my paperwork, and if you have to pay the full costs yourself at my clinic (like I do), the ultrasounds are $280 per visit. I'm not sure which hormones they will be looking at for donor egg transfer (we are doing egg retrieval), but labs for progesterone, estradiol, and HCG are $120 each (although insurance should cover HCG and progesterone tests if you are already pregnant). The stim meds for egg retrieval are really expensive $5000 per cycle), but it sounds like you won't be doing that if you already have a donor egg lined up. I don't know what meds are involved for a donor egg transfer cycle, but meds for our frozen embryo transfer were around $300. Most clinics offer a bundle package for all the treatment and testing needed for one cycle. I don't know about donor eggs, but a traditional IVF cycle runs from $15000 to $20,000 per cycle.
Best of luck! It so tough to be struggling not only with fertility, but figuring out how to navigate the medical system side of things as well.
In terms of where you can get your testing done, we love our doctor, Dr. Herndon, at AltaBates IVF in Berkeley, although the doctors do their surgical procedures in another clinic. You can also check out Pacific Fertility Center or Spring Fertility Center in SF. In Marin there is Marin Fertility Center.