Question: We hope to have embryos left after transfer and need to consider storage. Can you help us understand what determines your storage fees?

Answer: Many Pacific Fertility Center patients have surplus embryos at the end of their IVF cycle. If you chose to freeze your embryos, you will need to consider how long you plan to store the embryos before being used for a frozen embryo transfer. Patients who are finished building their family, but are not interested in destroying the surplus embryos, may choose to freeze them, offer them for adoption or donate them to research. These options are included on the consent forms, which must be signed prior to transfer.

Once you choose to freeze embryos, you need to factor in the annual storage fee. Pacific Fertility Center strives for lower fees, but must be able cover the underlying costs of services. Storage fees include expenses from the following sources: storage tanks, liquid nitrogen, leased floor space, embryologists and staff hours, equipment maintenance, annual inventory, information dissemination, forms, billing, legal fees and liability.

Let’s begin with the storage tanks themselves. At PFC we have 3 state-of-the-art embryo tanks: two tanks hold a total of 1376 spaces each. Every one of these spaces can hold up to 5 straws of embryos and each straw holds 1 to 3 embryos. These two tanks are full. Recently, we purchased another, larger tank, which holds almost 1500 patient spaces. This tank is already almost half full.

Once these tanks are filled with liquid nitrogen, they are extremely heavy. Because of their weight, they cannot be clustered together in the same room, but must be strategically placed to spread out the weight over the center’s floor. In addition, they must be stored in a secure, locked location. Every time we add a tank, an appropriate new space must be located. With square footage at a premium, this is not an easy task.

Storage tanks must be monitored. Gauges and seals must be functioning and the temperature must be kept at the optimum level with the addition of liquid nitrogen. The tanks are fitted with an alarm, which sounds if there is a problem. This alarm automatically sends an alert to the embryologist on call 24 hour a day, 365 days a year.

All embryo straws are labeled and a file is maintained for every patient who has embryos in storage. This extremely important aspect of storage is taken very seriously. A thorough inventory is completed every year. This is a time-consuming process as every straw must be located and identified. Patient addresses are kept up-to-date and confirmed annually when the invoice is sent or when patients notify the center of an address change.

If patients fail to notify us of a move and/or abandon their embryos, we make every effort to locate them. When they repeatedly fail to pay their invoice, we may be forced to send their billing on to a collections agency. During this process, we continue to store their embryos. As a last resort, we will go before a judge, show proof that we are unable to contact the patient after multiple attempts over a reasonable period of time, and request permission to discard the abandoned embryos.

One of the most frequently asked questions is “When am I going to be billed?” You will be billed based on the month that your storage begins. Patients often forget they have a back-up sample of frozen sperm and are “surprised” when they receive an invoice indicating they must pay their storage fee.

PFC is always available to answer any questions you may have regarding the storing of your embryos and sperm. For disposition questions, please contact Alexis Von Austin, Tissue Bank Manager at (415) 249-3636. For questions regarding an invoice, please contact Rosemarie S. Tagle, Billing Supervisor at (415) 249-3651.

Question: How do I decide which one of your “Shared Risk” plans is best for me?

Answer: It is estimated that there are approximately 2 million infertile patients in the US. Approximately 1.5 million will seek treatment. Of these, about 750 K conceive with standard treatment and 750 K remain infertile. Of the 750 K who remain infertile, 50 K adopt, 50 K undergo IVF, and 650 K drop out of treatment. Only about ¼ to ¹/3 of infertile patients see a Reproductive Endocrinologist; most patients are only treated by gynecologists. The remaining ¹/3 don’t seek treatment because they believe that they can’t afford it, and ¹/3 don’t proceed to adequate treatment secondarily to financial barriers.

Given these daunting statistics, we understand that it is important for IVF clinics to help maximize access to all levels of fertility care, by sharing the financial burden and the risk of an IVF cycle. With these goals in mind, PFC offers two “shared risk” financial plans to our patients. We call our two plans: the Refund Plan and the Option 2 Plan.

When engaged with you in a shared risk plan, we are indicating that if you meet the appropriate medical criteria, we feel confident that we have a reasonable chance to help you achieve your goal of parenthood, and we are therefore willing to share in the financial risk associated with IVF. Sharing in the financial risk of treatment is a statement of confidence in our ability to help you overcome infertility.

As physicians, we are often asked by our patients to recommend a financial plan. Each patient’s case is different, and choosing the best plan for you has to do with your own comfort level in taking financial risk, dovetailed with your emotional comfort and commitment to treatment. These levels of comfort can only be addressed on a personal and individual level.

Some general questions to consider in analyzing the plans are the following:

• • What are your estimated chances of success with your fresh embryo transfer?
• • What are the chances of having any frozen embryos?
• • What are your estimated chances of success with your frozen embryos?
• • If you are not pregnant with this IVF cycle, would you want to proceed to another IVF cycle?
• • If you do not become pregnant after a treatment cycle, would you rather receive a refund and then decide on the next steps for treatment?

Depending on the answers to these questions, you can begin to define which financial plan may make the most sense. For patients who want some financial buffer if their cycle is not successful, the Refund Plan may be the best choice. It allows you to receive a refund and then decide if the next steps will be to do nothing more, to continue treatment, or to use the refund for other options such as adoption. For those who are ready to commit to a second IVF cycle attempt if the first cycle is not successful, the Option 2 Plan may be the preferred choice. This plan provides the option of 2 cycles for only a little more cost than a single cycle. In general, the Option 2 Plan is for those whose chances of having frozen embryos is less—making the probability of needing a second fresh IVF cycle greater. At PFC, we have two financial coordinators dedicated to providing all the information about costs which can then help you to make these important decisions.

As in any financial decision, there is no right or wrong answer, but only an answer which best fits your particular situation. This decision is then matched with your personal comfort level in sharing risk. For some patients, neither of these plans may seem appealing, and the Single Cycle Plan (pay for services as provided) will be most appropriate. For patients with insurance coverage for IVF, the Single Cycle plan is the only option.

While Pacific Fertility Center can not choose a financial plan for you, if you need more information about your specific fertility situation before deciding on a “shared risk” plan, please do not hesitate to discuss this with your physician or your financial coordinator.

– Dr. Isabelle Ryan

Question:
Which insurance company has the most favorable coverage for infertility treatment?

Answer:
The package of insurance coverage for infertility treatment is not up to the insurance company, per se. It is typically up to an employer to determine the scope of coverage that is offered by its insurance company, and whether that package includes compensation simply for diagnosis of infertility, or whether it also covers treatment.

Moreover, one cannot assume that coverage will be the same from one employer to another even if that company uses the same insurer. For instance, an employee of Bank of America with Kaiser coverage might have a completely different insurance package for infertility as compared to an employee of Wells Fargo who also has Kaiser insurance. Through negotiation, an employer may choose an insurance plan with more or less infertility coverage than the average plan.

Another caveat has to do with state regulations. A total of 12 states in the United States have passed laws mandating infertility insurance coverage. However much of this regulation is considered a “soft mandate” meaning the insurers only have to offer it to employers who can choose to take it or leave it. California has a soft mandate so companies here are not legally obligated to purchase coverage for its employees.

A more forceful “hard mandate” requires a company to actually provide it, not just offer it. Massachusetts and Illinois are two states that have this hard mandate.

An exception to this is when a company is self-insured and is not legally required to follow state mandates. Because the majority of people with employer-sponsored health insurance policies are “self-insured”, the mandates do not apply to the majority of people, even in states with mandates.

Obviously, people who are self-employed and therefore pay for their own insurance might have a greater motivation to research those insurance companies that might have more comprehensive infertility coverage. Watch for subsequent articles in Fertility Flash that address this question for people who purchase insurance directly from insurance companies. In addition, the financial consultants at Pacific Fertility Center are available to work with our patients so they receive the benefits their insurance company provides. Click here for more Insurance Information.

– PFC Financial Consultants