With limited insurance coverage, many couples pay thousands of dollars for IVF treatments (whether or not they’re successful).
Only 15 states in the U.S. currently require health insurance to cover in vitro fertilization (IVF) for parents looking to have a baby and having trouble getting pregnant naturally. Brenna Kaminski and her husband, Joshua Pritt, of Florida, know the process all too well.
The couple decided to give IVF a try in 2020. However, their insurance, provided by Pritt’s employer, would only cover so much and for just one round of treatment, they discovered they’d be responsible for $2,700, the out-of-pocket maximum under his policy. They would also have to pay $500 to use an out-of-network lab. Over time, the couple would end up paying more than $15,000 for two rounds of IVF, including all medications that came along with treatment. Both times, the IVF was unsuccessful.
“This whole thing has been a nightmare,” said Kaminski, 37. “The stress has been unbelievable.”
According to Mercer, a consulting firm, approximately “1 in 5 women” have trouble getting pregnant, and IVF, while providing hope, is rarely covered 100%. In fact, just over a quarter (27%) of companies with “500 or more employees covered IVF in 2020, up from about 24% in 2015.”
“Infertility is a disease and should be treated as such, and insurance coverage should reflect that,” said Dr. Kara Goldman, associate professor of obstetrics and gynecology at Northwestern University. “Coverage is often incomplete because people too often don’t see infertility as equal to other diseases.”
Kaminski’s insurance company, Blue Cross and Blue Shield (BCBS) of Illinois, gave the couple a list of in-network IVF providers close to their home in Melbourne. For in-network care, the couple was told they’d be responsible for 20% and for out-of-network treatment, they would pay 40%. The first in-network specialist they tried had an office close by. However, after an initial consultation, they learned they’d need to travel over three hours to Miami to receive IVF on three separate occasions.
In fall 2020, they decided to try to get pregnant again using another in-network fertility clinic about an hour away from their home – the Center for Reproductive Medicine. The group scheduled Kaminski to begin treatment ity. However, the Orlando Avenue Surgery Center (in the same building and affiliated with the clinic), was not considered in-network.
Because her care was deemed out of network by Blue Cross, Kaminski said she was billed more than $6,000 in addition to close to $4,000 in out-of-pocket drug costs.
“Before any treatment is done,” the Center for Reproductive Medicine’s executive director, Stephen Brown said, “the clinic gives its patients estimates of the costs of their procedures based on their insurance. Kaminski received an estimate that said she could expect to pay $3,000 to $4,000 just for the transfer of the embryos grown in the lab into her uterus.”
In March 2021, the surgery center ended up getting added to BCBS’s provider network and, finally, in February 2022, the insurance company told the couple it would consider all the services they received in-network, and it would pay their bills in full. This was after BCBS initially said it would pay only a small portion of disputed bills totaling $21,450 for care in 2020 and 2021. It’s difficult to tell whether increased insurance coverage for services, in general, has to do with recent changes to women’s wellness coverage.
“It’s finally making logical sense,” Pritt said. “It’s good to know we won’t be getting any more bills.”