Understanding the cost of infertility care and navigating insurance benefits can be confusing for first-time infertility patients doing an IUI cycle as well as for experienced patients on their second IVF cycle. We sat down with Katrina Hammons, Finance Manager from Conceptions Reproductive Associates of Colorado to talk fertility financials including a new program offered at Conceptions in partnership with Future Family.
Katrina, how long you’ve been with Conceptions and working within medical billing?
I have been at Conceptions for 15 years, I’ve been in the medical industry my whole life, even since I was a teenager. My grandfather was an anesthesiologist here in the Denver area. That experience showed me that patients need as much clarity and compassion as you can give them – especially when neither one of us can get a straight answer from the insurance company.
As an outsider, medical billing and finance seems to be a pretty tough job, is it?
Yes, and it gets harder every year. Often new laws and plan designs are meant to help patients often confuse them. I would say the last four years have been the hardest with changes to medical billing and insurance. About four years ago, insurance companies stopped giving you a representative – a real person to direct questions and relations through. So, when you’re fighting for a patient’s services for them, it’s absolutely, incredibly difficult to try and get past the insurance carrier to get these things completed.
And when you do get a live person, they are not particularly educated on infertility benefit design. They’re sort of general customer service people, is that correct?
Correct. When we used to have a provider relations person, at least you can contact them and say, “Hey, shouldn’t it be covered based on their plan? And they would send a claim right back through, make sure it gets paid. We don’t have that anymore. They have eliminated that management position in the insurance world. You’re consistently fighting for your patients.
Do you see yourself and your team at Conceptions as advocates for patients on the financial side?
Absolutely. We have about nine total people in the Conceptions billing office dealing with over 2,000 patients a year. We have counselors that can walk patients through their treatment cycle costs based on their insurance plan.
Often, we may exchange 20 emails and make 20 calls trying to make sure a patient doesn’t get stuck with an unexpected bill and that our center is compensated by the insurance company accurately. We fight for our patients just as the clinical team does but I think we get more complaints. That hurts sometimes as all the team considers themselves patient advocates.
Colorado has a new infertility insurance mandate that will go into effect on January 1, 2023, can you tell us about it?
Yes, the Colorado Building Families Act (HB20-1158) sponsored by Representative Kerry Tipper, is set to go into effect on January 1, 2023. It requires that health benefits issued or renewed in Colorado cover the diagnosis of infertility, treatment for infertility, and fertility preservation services.But just because Colorado has an infertility insurance mandate does not mean that everyone is covered.
If your company has less than 100 employees, it may NOT be required to follow the new infertility mandate. Also, self-insured companies are not bound to follow the Colorado Building Families Act as we currently understand the bill. If your insurance plan is based in another state and NOT Colorado, you likely will not be able to take advantage of the new mandate. So, if you work for a company in Florida, you have benefits out of Florida, doesn’t mean you’ll have benefits in Colorado just because you live and work here.
How can patients educate or prepare themselves for this issue?
They’re going to have to start with their HR department to really dig into what their specific company policy says. And big companies might have different divisions that have different policies. We’re all a little in the dark right now until the mandate rolls out. I have groups out here that I can’t get a hold of to tell me which direction they’re going to go.
We contact every carrier for every new patient, and I would say about 75% of the time we get good information for the patient. Next year, it might be more like 50%. It’s twice as much work to get accurate information.
Let’s switch gears, can you tell me a little about your partnership with Future Family?
Yes, we have a partnership with Future Family who offers treatment financing options. We do have other options on the website, of course, as you know like CapeEx. Future Family seems a lot like Care Credit. We’ve received “a million calls” in the last few years about whether or not we take Care Credit, and they will not entertain IVF at all.
Our partnership with Future Family is a great way for patients if they qualify for treatment financing. We also introduced the buy now pay later option; the website will basically guide them into seeing what their monthly payments will look like.
What percentage would you say of patients are paying completely out of pocket for care? No insurance, no nothing?
Not very many. I would say 10%. And for those patients, we offer a wide range of cash-pay programs that can help them access care.
And what percent of your patients are entirely covered by insurance?
Not very many, again. Maybe 20% of patients are fully covered from consultation to IVF. Those patients are your seasoned patients who have been through this a couple of times already. Most of our patients have coverage for testing, consultations, and maybe IUI’s. Most patients still don’t have coverage for IVF unfortunately. We hope over time that the new mandate can be better designed to help more Colorado infertility patients.
Conceptions works with all of the major carriers in Colorado including, Aetna, United, Cigna, and Progyny.
If you had a few tips for a new patient just starting this process and researching fertility financials, what advice would you give somebody?
If they were just starting to research, I would say number one check what doctors are covered with your plan. Patients mostly don’t know which doctors are or aren’t covered. Having contracts with them is another big deal. Second, I would say talk to the clinic’s business office, they can walk a patient or soon-to-be patient through what their finances will look like. And finally, take notes. Plenty of notes. Who did you talk to and when? What numbers did they quote and for what?
I know our conversation has been about fertility treatment cost and insurance but patients should also consider success rates. So, centers seem to be advertising “low cost” IVF but that often also means less effective. You might have to do more cycles in that setting to get pregnant. Sometimes, the price reflects value.
To learn more about Future Family and all of our fertility financial programs visit https://www.conceptionsrepro.com/conceptions-self-pay-packages/