Insurance Pearls

Summer has come…in a blink it will be early fall and that means…open enrollment!  But before open enrollment, employers re-negotiate their benefits packages with their carriers.  Around the Bay Area, competitive benefits packages are a way of life.  The better the package the more attractive the company is to work for.  As a result, an increasing number of companies are offering fertility benefits that include in vitro fertilization (IVF) coverage.  

Some of the biggest employers for our area are Google and Salesforce, and both offer IVF coverage.  But while both entities cover fertility services to include in vitro fertilization, that’s where the similarities end.  

Through the 2015 year, Google’s healthcare benefits have been administrated by Blue Cross.  Their package offers each employee a lifetime maximum of $20,000.00 to be used for fertility services.  The savvy patient will find a contracted provider and have 2-3 cycles of care available from that amount due to contracted rates which drop the cost of each cycle to somewhere in the $6000-$8000 price range.  At Google, fertility medications are also covered and are NOT part of the $20,000.00 lifetime maximum.  As a result, patients are typically only out of pocket the cost of very specialized optional services such as their embryo biopsy.  

Salesforce, alternatively, chose Aetna for their administrator.  Patients have coverage for 50% of six insemination cycles and 50% of three in vitro fertilization cycles.  But wait, first you have to call the company to register with the Fertility group at Aetna.  Then you have to submit current laboratory test results, two semen analyses and await authorization which can take up to thirty days.  Oh..and this only applies if you have had unprotected intercourse for up to six cycles.  So single women and same sex couples… beware.  Further, once the Aetna fertility nurse agrees with your physician that you need fertility treatment, Aetna (not you or your physician) gets to determine your first step.  They still believe in the concept of lesser before greater (ie.  Insemination before IVF).  That is great if it is in line with what you want to do, but no good if you want to bank embryos (or freeze eggs) for future use.  This is also a problem if you wish to perform embryo biopsy to ensure that a good quality embryo is implanted and avoid complications like miscarriage which typically further delay you by months on end.

Google and Facebook continue to lead the way and have gone a step further.  Last year, these companies report spending over $9 million in expenses related to high order multiples and fertility complications.  Enough! They have carved out the fertility benefits from their respective Blue Cross and Aetna administrators and moved them over to a new PPO called Progyny that only works with fertility benefits.  Therefore, as of January 2016, there were no more silly hoops to jump.  These PPO’s are working with providers to ensure that the packages offered to patients actually make sense.  They are including the technology that has pushed our field forward in 2015 such as embryo biopsy and preventative banking of eggs and embryos.  

Finally, a plan that makes sense!   Kudos to Google and Facebook for seeing the light and here’s to hoping that the other Bay Area corporations catch up in offering plans that truly benefit their employees.

In the rest of this issue, you will find a guideline to preparing for your first fertility appointment, a savory end of summer recipe, some advice of keeping your relationship intact during your fertility journey, and the findings of a recent survey on how patients experience miscarriage.  We hope you will find the answers to some of your questions.  Enjoy!

Author
Dr. Danielle Lane Danielle E Lane, MD, Reproductive Endocrinology and Infertility Specialist

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