Paying for IVF: Shared Risk Programs

May 16, 2010Carole 4 Comments »

Because many patients do not have insurance coverage for IVF procedures, various forms of creative financing have popped up to fill the gap. Some patients have enrolled in Shared Risk Programs which are a sort of financial insurance policy against IVF failure.

It works like this. The IVF program charges you a much higher initial fee for IVF. This fee does not usually include your drug costs or screening costs, which you still pay in addition to the up-front fee. Some programs have added the option (for an even higher upfront fee) to include medications. In return, you get a certain number of attempts at IVF until you get pregnant or until you have exhausted all your pre-paid attempts. If your IVF is successful on the first or second try, you have paid more than you needed to get pregnant. If you don’t get pregnant, you get most or all  of your pre-paid money back, depending on the program.

It is no surprise that this is appealing to patients who like the idea of getting money back if the ART treatments don’t work, money they could use for adoption.  The American Society for Reproductive Medicine has published an ethical opinion regarding these programs.  They conclude that these programs can be offered ethically if programs are very clear about patient eligibility criteria to enter the program, what fees are not included in the up-front fee, and crystal clear in defining “success” endpoints.

If you meet eligibility criteria for the program, that means that you are pretty likely to get pregnant before exhausting your pre-paid tries so the program stands to make money. Many programs limit eligibility to the under 35 year age group, which have a statistically better chance of conceiving than older women, everything else being equal. This is exactly like insurance companies offering the best medical insurance rates to the youngest healthiest people who are least likely to need healthcare in the first place.

Also, some programs define success as being pregnant for a certain period of time, not necessarily giving birth and bringing a baby home. Defining success as being pregnant for a certain period of time is just not good enough because the take home baby rate is the only rate that matters to you. Programs justify this approach because at some point it’s not the programs fault if the pregnancy does not go to term. But that’s exactly why gambling on the outcome should not enter into the fees paid for IVF.

Your IVF program should clearly explain in writing what is included and what isn’t. Fees associated with screening such as blood tests, ultrasound tests, semen analysis and your ovarian stimulation medications which can easily amount to a third of your costs typically are not included in the pre-paid price.

In addition to ethical concerns related to transparency, ASRM reviewed the question of whether providers may be motivated to push the boundaries of safe medical practice to increase the odds of success. For instance, would providers be tempted to stimulate women to produce more eggs or transfer more embryos than is safe so they get pregnant as early as possible? ASRM concluded in their 2006 revised publication, that they have not seen “any evidence that either danger has materialized”. Frankly, it might be hard to tell since many ART programs are justifiably criticized for still having unacceptably high multiple pregnancy rates even for patients not enrolled in a shared risk program.

My gut feeling is that I don’t like these programs. But then I am particularly risk adverse and don’t enjoy gambling and hate paying on credit. I like the straight forward fee for service approach. Here are the services you will receive for this payment. You can’t be guaranteed a healthy pregnancy, no matter how much upfront money you can afford to pay.  However, your medical staff should be able to guarantee you that every patient gets their best effort every day.  Our only incentive should be to give you the best medical care we can give you and charge you an honest price, based on actual costs to provide care and not on a statistical probability that you will get pregnant (or not) in X number of tries.

© 2010, Carole. All rights reserved.

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