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My husband and I are in the early stages of preparing for IVF treatment. We are doing the tests required by the fertility clinic. I have been searching everywhere for information about the payment process, specifically regarding paying for multiple cycles. When I spoke with the clinic's billing office, they stated that you do not get a refund if you become pregnant on the first cycle, even if you paid for 2-3 cycles. At this particular clinic, it costs $6,900 for the first cycle and about $11,000 if you pay for 2 cycles. So, you save money if it takes you 2 cycles to get pregnant but you lose a big chunk of money if you get pregnant on one. This doesn't include medication costs of course.
Is this standard procedure for most clinics? I understand that you are happy just to get pregnant but it seems like they are taking advantage of desperate people. I can understand if they don't refund you the entire amount but what is the reasoning for not refunding any money at all? Do you know of anyone who has successfully fought back against this policy?
Shared risk is a great plan for those without insurance coverage with the emphasis on the word "shared." You are sharing the risk with the clinic; meaning, if you don't get pregnant, they ate a lot of the cost and if you do get pregnant, you may have eaten an extra portion of the cost. But the risk is shared by both parties.
With a single payment plan, the risk isn't shared at all. It's solely on you. Therefore, if you get pregnant, great--it will cost $6900. And if you don't get pregnant, we're sorry--but it will cost you $6900. And it sounds from the question that you'd like the risk to be solely on them. And it would be nice if they were willing to work with that, but since you have the option to apply for the program or the option to pay per cycle, it isn't really feasible for the person requesting the service to also have the service pay them to use them essentially. In other words, you need them. They don't need you (though they do need customers and they have set up these plans in order to make IVF more accessible to a larger population. Though, "more" is an relative word when you're talking about thousands of dollars).
Here's the thing with shared risk: because the clinic is deciding who qualifies for the plan, they are not taking anyone they see outright as a risk. Because that isn't in their best interests and they are a business and not an altruistic organization. Which sucks to think about because they are doctors, but you can't think of them in the same way you think of your local emergency room staff. It is simply a different kind of medical service. So if you qualify for the plan, it means they think that you have a greater chance of getting pregnant in one IVF cycle than you do taking two or more cycles to get pregnant.
You can do what you wish with that information.
Some people see if they qualify for shared risk and then decide that they'd rather take the gamble and pay per cycle. If they get pregnant on the first try, they saved a lot of money. If they get pregnant on the second try, they lost a little bit of money. But if they get pregnant on the third try, they lost a lot of money.
Here are the pros and cons to a shared risk plan and who should or shouldn't use the plan if they qualify:
- If you are worried about the financial side of things and would rather know a flat end price than pay little bits at a time, never knowing fully how much you'll spend in the end.
- If you have a lot of stress in your relationship about financial matters and want to argue about cost one time.
- If you want to remove some of the stress inherent in a cycle.
- If you want to have options to try different protocols.
- If you have unexplained infertility or no clear diagnosis.
- If you are doing it to save money (because you might or you might not and you'll be right pissed if you lose money and this was your reason for entering into the plan).
- If you think you will get pregnant in one try.
- If you have a clear diagnosis with a clear solution.
And that's the beauty of how these programs work. The plans are not actually for paying for IVF. They are simply insurance for when things don't go according to plan. And you need to decide whether or not you need insurance simply because it is offered.
No really, the beauty of a blog advice column is that you get to weigh in with your two cents too. Let the questioner know if you support the advice, add to the response, or dispute it completely. I would love people to add their feelings if they used (or didn't use) a shared risk plan.
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