With 2023 quickly unfolding, there are new healthcare insurance laws here in Colorado covering infertility treatments like IUI and IVF that many patients may be able to access. We took a minute to sit down with Katrina Hammons, Manager of Patient Finance here at Conceptions to talk about the new insurance mandate in Colorado and how patients can maximize the insurance resources they may already have.
What percentage of patients in Colorado have some level of insurance benefit for infertility treatment?
I would say close to 50% of patients have insurance coverage for some kind of infertility treatment. That means some might only have coverage for diagnostic testing and maybe IUI’s. Others might have all that plus coverage for one IVF cycle or more. Our patients are very savvy and started looking for new jobs last year where they were likely to get access to the new mandate. Not every employer is required to offer infertility benefits under the new law.
Many patients have been here in the past and now have an opportunity to change jobs with infertility benefits. We’ve seen some Starbucks employees with benefits, that’s encouraging. Not everyone wants to be a barista I know, but we’ve had some very smart people go and work for Starbucks just for the infertility benefits.
It’s early January often a time when insurance plans change. Are there common questions that you get faced with from an insurance standpoint this time of year?
I spoke to a new patient this morning. She has the new insurance according to the law, but the insurance system hasn’t caught up yet. It’s going to take as much as 90 days I think for there to be clarity on the insurance side. We’re finding right now that a lot of the plans do not have the updated policies uploaded into their database. For those members, what they’re telling us is it’s going to take several weeks.
So, everybody’s kind of stuck in a little bit of limbo until they load all their members and their lives into their database. That’s a big deal. It’s an issue that everybody has in every part of the country. If you talk to two people at an insurance company, you’ll get two different answers often. I’ve been around this field a while and I still can’t figure out why.
It’s really important that both our team at Conceptions and our patients when calling get every piece of information we can from the person were talking to. It’s especially important to get the names and ID numbers of the people you’re talking to. Confirm policy numbers and take exacting notes.
Let’s talk a little bit about the new Colorado mandate, how does it work?
Basically, the new law will cover up to three (3) IVF retrievals and unlimited embryo transfers, which is great. But it’s really important to speak to your employer and human resources department to see if your company will fall under the new infertility insurance mandate in Colorado. If your company has 100 or more employees, you’re likely to be covered under the new mandate. Unfortunately, self-insured companies are not bound to follow the Colorado Building Families Act (HB20-1158) as we currently understand the bill.
If your insurance plan is an out-of-state plan, you likely will not be able to take advantage of the new mandate. We encourage you to speak with your employer for more specific information.
And just so people are aware, we have had several carriers leave the Colorado market due to the new law. Not great. We received notice from them that they were leaving the market at the end of last year. But when all is said and done, the mandate is awesome. Patients that didn’t have a chance before might have a chance now to have treatment. So that is a great thing!
Patients have to be well connected with their HR and benefits administrators to understand the opportunities that they have now, right?
Exactly. At Conceptions, we accept plans from Aetna, Cigna, Blue Cross Blue Shield to United Healthcare, and Progeny. We see a lot of patients with the Progeny benefit. Kaiser is a big one too.
If a patient asked you if they could get any one of those plans, is there one that’s more supportive of infertility treatment?
Well, I can’t directly make any recommendations but most of the plans but with the new law patients should have better access to infertility care. Again, we’ve seen many patients switch jobs just so they could get some infertility benefit. Employers would be wise to use infertility benefits as a way to attract and retain employees.
One unique insurance provider I’d like to highlight is Progyny, how do they work with you?
They work directly with employers to offer a network of high-performing infertility centers like Conceptions. In order to be part of their network you have to have success rates that exceed US averages and commit to single embryo transfer which cuts down on delivery and maternity costs for the employer in the long run.
So, if I’m a patient and I’ve got Progeny, I want to maximize my benefits, right?
Absolutely. What happens is they call Progeny and get assigned a patient care advocate through their service. That patient care advocate will let the office know (Conceptions) if they need an appointment or just start sending referral information and authorization information. So, it’s already rolling by the time that the patient is here, and everything is very transparent with them. Yeah. So as far as that goes, it’s super easy.
Any closing thoughts for patients who are eager to use their new mandated infertility benefits in Colorado?
You know, just hang in there for the first month, I would say mid-February the plans should be up to speed. For our office, January through March is the biggest benefit-checking season for us. Benefits Checking Season, funny maybe that’s a thing?
For patients with new plans, with treatment, and they know they have treatment coverage, do your research on your plan for both medications and treatments. Make sure you understand it as best as you can. Make sure you understand what deductibles and co-insurance are, out-of-pocket, and out-of-pocket maximums. And make sure you review the published success rates for your age group from the center you are considering for fertility care. No matter the cost or level of insurance you have, success rates matter most.
With success rates that exceed U.S. benchmarks and four Denver-area locations, patients are supported by success at Conceptions Reproductive Associates of Colorado.