 |
 |
 |
 |
 |
 |
 |
 |
 |
 |
 | |  | |  | |  |
The journey to conception is a long, difficult road...
Baby or Bust
Joan Caplin
Money; May2006, Vol. 35 Issue 5, p126-130
It's the day before Jennifer Witt is scheduled to start treatment for in vitro fertilization, and she's in a
panic. It's not only the prospect of the medical procedure that's worrying her, or even the possibility
that the treatment won't work and there'll be no baby. "Oh, my God," she says, "I don't know how
we're going to pay for this." That's $11,650 she's talking about--$11,650 that the hospital requires be
paid up front and in full; $11,650 that Jen, a preschool teacher, and her husband Ryan, a group
operations leader at Target, simply don't have.
It's not as if the Witts haven't been trying for months to come up with the money for infertility
treatment. They have. They've investigated a slew of loan options, including financing deals and
borrowing against their retirement accounts, only to reject them all as too expensive. With less than 24
hours to go before their appointment, the Colorado Springs couple finally go ahead and charge the
procedure on a credit card Ryan has with a 1.9% rate. But here's the catch: That rate is only good for
six more months. "If we can't pay off what we owe by then, we'll ask to renegotiate," says Ryan. "If
that doesn't work, we'll try to transfer the balance to another low-rate card."
The decision probably isn't a financially wise one--the interest rate on the card will likely jump to
double digits before the end of the year, and there's no guarantee the Witts will be able to qualify for
another low-rate card. Although they earn a comfortable combined income of $112,500, the couple
already carry a lot of debt--between their two car loans, an outstanding hospital bill, credit-card
balances and student loans, they owe more than $50,000, even without the IVF. But after five years of
unsuccessful attempts to have a baby, Jen, 32, and Ryan, 30, will do almost anything and pay almost
any amount to help them conceive.
Like the Witts, approximately 7 million Americans are infertile--that is, they have been actively trying
to conceive for at least a year without getting pregnant. Less than half of those who are infertile seek
treatment, though, and experts say the high cost is a big reason why. Since most insurance companies
don't cover in vitro, embryonic transfer and other advanced fertility treatments, couples are forced to
come up with the money themselves. That's $10,000 to $20,000 for IVF--and sometimes double or
triple that price if, as often happens, pregnancy doesn't result the first time and the procedure is
repeated. "For infertile couples, we're a country of haves and have-nots," says Pamela Madsen,
executive director of the American Fertility Association. "If you're wealthy enough to pay out of
pocket, you get treatment. But if you're middle class, you often can't get in the door."
Money certainly played a role in the Witts' decision to wait almost three years before seeking medical
treatment. "I always thought in vitro was a fashion trend for rich people," says Jen, "kind of like
buying a third car."
While the Witts are dedicated savers, most of the money they set aside goes into retirement accounts
that they're reluctant to raid--even for the worthiest of causes. They haven't built a big emergency
fund that they could tap to pay for infertility treatment (they have about $8,500 in their savings
account), and then there are those debts to pay. "People never prepare for this financially," says
Jennifer Fritschler, practice manager at the Advance Reproductive Medicine division of the University
of Colorado Hospital. "You just don't plan on being infertile."
Even before they were married, Jen and Ryan talked about their desire to have kids--ideally, two.
"We've been trying since our wedding night," says Ryan. That was five years ago, but until 2003, they
resisted the idea that infertility could be the reason for their failure to conceive. "I think it was a pride
thing," says Ryan. Adds Jen: "It was hard to accept that we needed help."
Because of the circumstances of her own birth, though, Jen has always understood that the path to
parenthood can be difficult. Ten and a half weeks premature, she weighed only two pounds, 12
ounces when she was born. "My mom was constantly told I might not make it," she says. As a result
of her prematurity, Jen has had multiple operations to fix developmental abnormalities, two for
deformities of her intestines. She was 16 when she had the first surgery. "When I woke up from the
anesthesia," she recalls, "the first thing I asked was, 'Can I still have children?'"
Painful reminders of her inability to conceive seem to be everywhere these days. Jen has nine friends
who are pregnant or have delivered in the past two months--three were bridesmaids at her wedding.
She can sense their awkwardness around her, and that's more difficult than any discomfort she feels
about her situation. "For a split second, I feel bad," she confides. "Then I think maybe I'll be next."
As a preschool teacher, she's surrounded by kids all day. But that doesn't bother her. "I don't associate
the two at all," she says. "The kids are a distraction and a joy." She is adored by her students, and
their parents constantly ask when she's going to have children. So does her own family and Ryan's.
Jen usually shrugs off the question with a broad grin and a quick "We're trying, we're trying." But
lately she's been dropping the lighthearted response. "I'm more honest now," she says. "I don't want
to hide what we're going through anymore."
Jen was the first to be tested to find a cause for her failure to get pregnant, then Ryan. Their doctor
found nothing and told them to just keep trying. Jen laughs at the Jell-O she tried for months to make
Ryan eat because her aunt, a mother of four, insisted that's what worked for her. "We tried
everything," says Jen, "taking my temperature, keeping charts, ovulation kits." Nothing worked.
In February 2005, the Witts consulted Dr. William Schlaff, chief of reproductive endocrinology at the
University of Colorado Hospital. Both went on fertility drugs. Nothing happened. They tried artificial
insemination--twice. Still, no baby. "I was completely lost," Jen says. "I couldn't think straight, I
couldn't sleep, I couldn't think about anything else."
The only part of the process that wasn't stressful at the time was paying for treatment. Jen's health
insurance covered just over half the roughly $6,000 cost of the tests, medications and procedures.
With the bills spread out over a couple of years, the Witts easily handled the rest of the payments
themselves.
All that changed last fall, ironically, when Schlaff finally delivered some good news: The Witts, he'd
decided, were good candidates for IVF. By that time, he thought he'd pinpointed the problem: Jen's
multiple surgeries had left her with major internal scarring that was probably preventing conception.
IVF would bypass the trouble spot--Jen's eggs would be removed from her ovaries and fertilized with
Ryan's sperm, and the resulting embryo(s) would be transferred to her uterus. Schlaff put her
chances of getting pregnant through IVF at about 50%, in line with the national average.
For the Witts, it was a thrilling prediction. But the encouraging prognosis also presented a major
financial problem: Unlike their previous treatments, IVF isn't covered by Jen's insurance.
The dilemma is a common one for infertile couples. "A lot of insurance companies will cover
diagnostic tests to find out what's wrong with you, but won't cover treatment," says Fritschler. Adds
Sean Tipton, spokesman for the American Society for Reproductive Medicine: "It strikes me as
unbelievably cruel to say, 'We'll figure out the problem, but we won't pay to fix it.' "
In fact, some 14 states have passed laws requiring insurers to offer some sort of infertility coverage.
But Colorado isn't one of them. Even if it were, the Witts wouldn't be guaranteed their IVF would be
covered since, as Tipton puts it, "the loopholes are large enough to run a truck through." (For more on
the limits of state coverage, see "Financial Aid for Prospective Parents" on page 130.)
This is a big reason the Witts were left scrambling to come up with the cash to pay for their best hope
of having a biological child. And the $11,650 bill for IVF from the University of Colorado Hospital is
only the beginning of what they'll have to pay. Preliminary tests, medications, pregnancy tests and
ultrasound aren't included in that tab, so the actual cost could be closer to $20,000. Then too, couples
often need more than one round of IVF to end up with a viable pregnancy.
As if the cost of the IVF weren't stressful enough, Ryan's new job at Target required that he move to
Tempe, Ariz., 850 miles away, in early March. (Happily, though, the promotion did include a 10%
raise.) Jen, meanwhile, must finish out the school year in Colorado. Although Ryan comes home on
weekends, the burden of selling their $200,000 house falls mostly on her. Worse, Ryan's absence
leaves Jen largely on her own for the medicine she must inject daily for three weeks prior to the egg
retrieval. "I don't know what I'm most stressed about," she says, "the move, selling the house, giving
myself injections, the IVF or being alone."
So while charging treatment on a credit card may not have been the best option, it's understandable
that the Witts made a rash decision about how to pay for the IVF. "We're willing to get more into
debt, we want it so bad," insists Ryan.
Jen wants this child more than anything too. But she's also horribly aware that she and Ryan are
borrowing money "to gamble." If she doesn't become pregnant, she admits, "I'm going to feel so bad
about spending $20,000 on nothing but proof that I can't carry a child."
The advice
To help the Witts figure out how to pay for their treatment and get the rest of their financial life on
track, MONEY consulted Craig Carnick, a financial planner in Colorado Springs. Here is his advice.
• Use your 401(k) to pay, not plastic. Ryan has about $35,000 in his retirement account. Carnick
points out that he can borrow up to half of the amount that he has vested and use the money to pay
off the IVF charges on his credit card. Ryan won't get hit with taxes or a penalty, notes Carnick, and
the interest he'll pay will go back into his account. And unlike charging a large amount, the 401(k) loan
won't adversely affect his credit score.
But when Ryan looked into a 401(k) loan, he rejected the 8.9% rate as too high. The couple also
considered working with a private firm that offers infertility financing, called ARC, and they qualified
for an 18-month loan at 1.9%. That sounded attractive until the Witts learned that ARC's package rate
for the IVF was 19% higher than the hospital's fees. They rejected that option as well. (ARC
subsequently dropped its rates.)
Carnick, though, is hoping the Witts will reconsider the 401(k) loan down the road--particularly if they
aren't able to pay off the credit card before their low rate expires, and they can't transfer the balance
to another low-rate card.
• Beef up your emergency fund. Carnick also worries that, with only $8,500 in liquid savings, the
Witts don't have a financial cushion to tide them over if Jennifer does become pregnant and has to
stop working. He suggests they put off buying a new house in Tempe and invest the $20,000 or so
they expect to make on selling their Colorado Springs home in short-term CDs, to serve as an
emergency fund. "That's all that separates them from financial disaster," he says. He's also concerned
about them buying a new house since Ryan's job requires frequent relocation--they've lived in three
cities in five years--and the real estate market in Tempe has cooled off lately.
But the Witts balked at this suggestion too, noting that they've bought and sold three houses and
haven't lost money yet. Carnick retorts: "You're living on the edge." To reduce their financial risk, the
planner urges them to pay off their debts at a faster pace, even if it means saving a little less for
retirement. Their long-term focus is good, he says, but not if it comes at the expense of their short-
term needs.
• Go for maximum insurance. Ryan's new job and home means he gets to make a new decision about
his health insurance. Since Jen doesn't know whether she'll be working next fall, Ryan will add her on
to his policy at work. Like Jen's, it doesn't offer coverage for IVF. Carnick suggests that, given Jen's
medical history, they opt for the most comprehensive plan available instead of the cheapest. "If they
run into a $100,000 delivery," he says, "what's a few hundred extra in premiums compared with tens
of thousands in medical costs?"
The Witts are waiting anxiously to find out if they'll need that advice: May is when they should learn
whether or not Jen is pregnant. "If the IVF doesn't work and I have to start all over," she says, "I
don't think we'll try again right away." Ryan says they'll need time to rebound emotionally before they
can figure out their next move--maybe they'll adopt first and try again for a biological child in a few
years. "Bottom line," he says, "one way or another, we will have kids."
FINANCIAL AID for Prospective Parents
Less than half of couples who are infertile seek medical help, largely because treatment is so expensive
and insurance often doesn't cover it. If you're struggling to pay infertility bills, these strategies may
provide some relief.
1. Check your insurance for exclusions.
If your policy doesn't mention your treatment by name and your claim is denied, you have strong
grounds for an appeal. "If it's not specifically excluded, it's an implied inclusion," says Pat Ferguson,
an infertility medical billing expert.
2. Know what you're entitled to.
Insurers often cover diagnostics. If you're not reimbursed for tests, fight back. Infertility is the
symptom of a medical problem, so you can make a compelling argument that testing for, say,
endometriosis or fibroid tumors should be covered.
3. Carefully compare financing options.
Many infertility centers offer payment plans through third parties. Make sure you know exactly what's
covered and what's not. Medications and pregnancy testing, for instance, are often excluded. "Shared
risk" programs offer up to 100% refunds to qualified women if pregnancy is not achieved, but you
may be charged twice as much for that money-back guarantee.
4. Check state laws.
Fourteen states require health insurers to cover infertility treatment (for the list, go to resolve .org,
click on "Learn" and then click on "Insurance Coverage"). But there are caveats aplenty. For example,
the laws don't necessarily require employers to pay for the coverage, and all exempt self-insured
plans. Before you forge ahead medically on the strength of state laws, read your policy's fine print.
Joan Caplin
Money; May2006, Vol. 35 Issue 5, p126-130
It's the day before Jennifer Witt is scheduled to start treatment for in vitro fertilization, and she's in a
panic. It's not only the prospect of the medical procedure that's worrying her, or even the possibility
that the treatment won't work and there'll be no baby. "Oh, my God," she says, "I don't know how
we're going to pay for this." That's $11,650 she's talking about--$11,650 that the hospital requires be
paid up front and in full; $11,650 that Jen, a preschool teacher, and her husband Ryan, a group
operations leader at Target, simply don't have.
It's not as if the Witts haven't been trying for months to come up with the money for infertility
treatment. They have. They've investigated a slew of loan options, including financing deals and
borrowing against their retirement accounts, only to reject them all as too expensive. With less than 24
hours to go before their appointment, the Colorado Springs couple finally go ahead and charge the
procedure on a credit card Ryan has with a 1.9% rate. But here's the catch: That rate is only good for
six more months. "If we can't pay off what we owe by then, we'll ask to renegotiate," says Ryan. "If
that doesn't work, we'll try to transfer the balance to another low-rate card."
The decision probably isn't a financially wise one--the interest rate on the card will likely jump to
double digits before the end of the year, and there's no guarantee the Witts will be able to qualify for
another low-rate card. Although they earn a comfortable combined income of $112,500, the couple
already carry a lot of debt--between their two car loans, an outstanding hospital bill, credit-card
balances and student loans, they owe more than $50,000, even without the IVF. But after five years of
unsuccessful attempts to have a baby, Jen, 32, and Ryan, 30, will do almost anything and pay almost
any amount to help them conceive.
Like the Witts, approximately 7 million Americans are infertile--that is, they have been actively trying
to conceive for at least a year without getting pregnant. Less than half of those who are infertile seek
treatment, though, and experts say the high cost is a big reason why. Since most insurance companies
don't cover in vitro, embryonic transfer and other advanced fertility treatments, couples are forced to
come up with the money themselves. That's $10,000 to $20,000 for IVF--and sometimes double or
triple that price if, as often happens, pregnancy doesn't result the first time and the procedure is
repeated. "For infertile couples, we're a country of haves and have-nots," says Pamela Madsen,
executive director of the American Fertility Association. "If you're wealthy enough to pay out of
pocket, you get treatment. But if you're middle class, you often can't get in the door."
Money certainly played a role in the Witts' decision to wait almost three years before seeking medical
treatment. "I always thought in vitro was a fashion trend for rich people," says Jen, "kind of like
buying a third car."
While the Witts are dedicated savers, most of the money they set aside goes into retirement accounts
that they're reluctant to raid--even for the worthiest of causes. They haven't built a big emergency
fund that they could tap to pay for infertility treatment (they have about $8,500 in their savings
account), and then there are those debts to pay. "People never prepare for this financially," says
Jennifer Fritschler, practice manager at the Advance Reproductive Medicine division of the University
of Colorado Hospital. "You just don't plan on being infertile."
Even before they were married, Jen and Ryan talked about their desire to have kids--ideally, two.
"We've been trying since our wedding night," says Ryan. That was five years ago, but until 2003, they
resisted the idea that infertility could be the reason for their failure to conceive. "I think it was a pride
thing," says Ryan. Adds Jen: "It was hard to accept that we needed help."
Because of the circumstances of her own birth, though, Jen has always understood that the path to
parenthood can be difficult. Ten and a half weeks premature, she weighed only two pounds, 12
ounces when she was born. "My mom was constantly told I might not make it," she says. As a result
of her prematurity, Jen has had multiple operations to fix developmental abnormalities, two for
deformities of her intestines. She was 16 when she had the first surgery. "When I woke up from the
anesthesia," she recalls, "the first thing I asked was, 'Can I still have children?'"
Painful reminders of her inability to conceive seem to be everywhere these days. Jen has nine friends
who are pregnant or have delivered in the past two months--three were bridesmaids at her wedding.
She can sense their awkwardness around her, and that's more difficult than any discomfort she feels
about her situation. "For a split second, I feel bad," she confides. "Then I think maybe I'll be next."
As a preschool teacher, she's surrounded by kids all day. But that doesn't bother her. "I don't associate
the two at all," she says. "The kids are a distraction and a joy." She is adored by her students, and
their parents constantly ask when she's going to have children. So does her own family and Ryan's.
Jen usually shrugs off the question with a broad grin and a quick "We're trying, we're trying." But
lately she's been dropping the lighthearted response. "I'm more honest now," she says. "I don't want
to hide what we're going through anymore."
Jen was the first to be tested to find a cause for her failure to get pregnant, then Ryan. Their doctor
found nothing and told them to just keep trying. Jen laughs at the Jell-O she tried for months to make
Ryan eat because her aunt, a mother of four, insisted that's what worked for her. "We tried
everything," says Jen, "taking my temperature, keeping charts, ovulation kits." Nothing worked.
In February 2005, the Witts consulted Dr. William Schlaff, chief of reproductive endocrinology at the
University of Colorado Hospital. Both went on fertility drugs. Nothing happened. They tried artificial
insemination--twice. Still, no baby. "I was completely lost," Jen says. "I couldn't think straight, I
couldn't sleep, I couldn't think about anything else."
The only part of the process that wasn't stressful at the time was paying for treatment. Jen's health
insurance covered just over half the roughly $6,000 cost of the tests, medications and procedures.
With the bills spread out over a couple of years, the Witts easily handled the rest of the payments
themselves.
All that changed last fall, ironically, when Schlaff finally delivered some good news: The Witts, he'd
decided, were good candidates for IVF. By that time, he thought he'd pinpointed the problem: Jen's
multiple surgeries had left her with major internal scarring that was probably preventing conception.
IVF would bypass the trouble spot--Jen's eggs would be removed from her ovaries and fertilized with
Ryan's sperm, and the resulting embryo(s) would be transferred to her uterus. Schlaff put her
chances of getting pregnant through IVF at about 50%, in line with the national average.
For the Witts, it was a thrilling prediction. But the encouraging prognosis also presented a major
financial problem: Unlike their previous treatments, IVF isn't covered by Jen's insurance.
The dilemma is a common one for infertile couples. "A lot of insurance companies will cover
diagnostic tests to find out what's wrong with you, but won't cover treatment," says Fritschler. Adds
Sean Tipton, spokesman for the American Society for Reproductive Medicine: "It strikes me as
unbelievably cruel to say, 'We'll figure out the problem, but we won't pay to fix it.' "
In fact, some 14 states have passed laws requiring insurers to offer some sort of infertility coverage.
But Colorado isn't one of them. Even if it were, the Witts wouldn't be guaranteed their IVF would be
covered since, as Tipton puts it, "the loopholes are large enough to run a truck through." (For more on
the limits of state coverage, see "Financial Aid for Prospective Parents" on page 130.)
This is a big reason the Witts were left scrambling to come up with the cash to pay for their best hope
of having a biological child. And the $11,650 bill for IVF from the University of Colorado Hospital is
only the beginning of what they'll have to pay. Preliminary tests, medications, pregnancy tests and
ultrasound aren't included in that tab, so the actual cost could be closer to $20,000. Then too, couples
often need more than one round of IVF to end up with a viable pregnancy.
As if the cost of the IVF weren't stressful enough, Ryan's new job at Target required that he move to
Tempe, Ariz., 850 miles away, in early March. (Happily, though, the promotion did include a 10%
raise.) Jen, meanwhile, must finish out the school year in Colorado. Although Ryan comes home on
weekends, the burden of selling their $200,000 house falls mostly on her. Worse, Ryan's absence
leaves Jen largely on her own for the medicine she must inject daily for three weeks prior to the egg
retrieval. "I don't know what I'm most stressed about," she says, "the move, selling the house, giving
myself injections, the IVF or being alone."
So while charging treatment on a credit card may not have been the best option, it's understandable
that the Witts made a rash decision about how to pay for the IVF. "We're willing to get more into
debt, we want it so bad," insists Ryan.
Jen wants this child more than anything too. But she's also horribly aware that she and Ryan are
borrowing money "to gamble." If she doesn't become pregnant, she admits, "I'm going to feel so bad
about spending $20,000 on nothing but proof that I can't carry a child."
The advice
To help the Witts figure out how to pay for their treatment and get the rest of their financial life on
track, MONEY consulted Craig Carnick, a financial planner in Colorado Springs. Here is his advice.
• Use your 401(k) to pay, not plastic. Ryan has about $35,000 in his retirement account. Carnick
points out that he can borrow up to half of the amount that he has vested and use the money to pay
off the IVF charges on his credit card. Ryan won't get hit with taxes or a penalty, notes Carnick, and
the interest he'll pay will go back into his account. And unlike charging a large amount, the 401(k) loan
won't adversely affect his credit score.
But when Ryan looked into a 401(k) loan, he rejected the 8.9% rate as too high. The couple also
considered working with a private firm that offers infertility financing, called ARC, and they qualified
for an 18-month loan at 1.9%. That sounded attractive until the Witts learned that ARC's package rate
for the IVF was 19% higher than the hospital's fees. They rejected that option as well. (ARC
subsequently dropped its rates.)
Carnick, though, is hoping the Witts will reconsider the 401(k) loan down the road--particularly if they
aren't able to pay off the credit card before their low rate expires, and they can't transfer the balance
to another low-rate card.
• Beef up your emergency fund. Carnick also worries that, with only $8,500 in liquid savings, the
Witts don't have a financial cushion to tide them over if Jennifer does become pregnant and has to
stop working. He suggests they put off buying a new house in Tempe and invest the $20,000 or so
they expect to make on selling their Colorado Springs home in short-term CDs, to serve as an
emergency fund. "That's all that separates them from financial disaster," he says. He's also concerned
about them buying a new house since Ryan's job requires frequent relocation--they've lived in three
cities in five years--and the real estate market in Tempe has cooled off lately.
But the Witts balked at this suggestion too, noting that they've bought and sold three houses and
haven't lost money yet. Carnick retorts: "You're living on the edge." To reduce their financial risk, the
planner urges them to pay off their debts at a faster pace, even if it means saving a little less for
retirement. Their long-term focus is good, he says, but not if it comes at the expense of their short-
term needs.
• Go for maximum insurance. Ryan's new job and home means he gets to make a new decision about
his health insurance. Since Jen doesn't know whether she'll be working next fall, Ryan will add her on
to his policy at work. Like Jen's, it doesn't offer coverage for IVF. Carnick suggests that, given Jen's
medical history, they opt for the most comprehensive plan available instead of the cheapest. "If they
run into a $100,000 delivery," he says, "what's a few hundred extra in premiums compared with tens
of thousands in medical costs?"
The Witts are waiting anxiously to find out if they'll need that advice: May is when they should learn
whether or not Jen is pregnant. "If the IVF doesn't work and I have to start all over," she says, "I
don't think we'll try again right away." Ryan says they'll need time to rebound emotionally before they
can figure out their next move--maybe they'll adopt first and try again for a biological child in a few
years. "Bottom line," he says, "one way or another, we will have kids."
FINANCIAL AID for Prospective Parents
Less than half of couples who are infertile seek medical help, largely because treatment is so expensive
and insurance often doesn't cover it. If you're struggling to pay infertility bills, these strategies may
provide some relief.
1. Check your insurance for exclusions.
If your policy doesn't mention your treatment by name and your claim is denied, you have strong
grounds for an appeal. "If it's not specifically excluded, it's an implied inclusion," says Pat Ferguson,
an infertility medical billing expert.
2. Know what you're entitled to.
Insurers often cover diagnostics. If you're not reimbursed for tests, fight back. Infertility is the
symptom of a medical problem, so you can make a compelling argument that testing for, say,
endometriosis or fibroid tumors should be covered.
3. Carefully compare financing options.
Many infertility centers offer payment plans through third parties. Make sure you know exactly what's
covered and what's not. Medications and pregnancy testing, for instance, are often excluded. "Shared
risk" programs offer up to 100% refunds to qualified women if pregnancy is not achieved, but you
may be charged twice as much for that money-back guarantee.
4. Check state laws.
Fourteen states require health insurers to cover infertility treatment (for the list, go to resolve .org,
click on "Learn" and then click on "Insurance Coverage"). But there are caveats aplenty. For example,
the laws don't necessarily require employers to pay for the coverage, and all exempt self-insured
plans. Before you forge ahead medically on the strength of state laws, read your policy's fine print.