A blog about babies: the babies I lost, the babies I never had, the baby who made me a Mama.

Friday, December 3, 2010

Money, Money, Money; or, What Would You Do?

Lawyer Guy and I are facing one of the no doubt many practical conundrums we'll encounter as we move forward with ART. I could use some advice from those of you with more experience in these sorts of things.

So, to set the stage first for where we are right now, LG and I are doing a natural (i.e. break) cycle for the month of December. I'm on CD5 and unmedicated will ovulate anywhere between days 18 and 27, though it's usually more in the range of CD 21-24. I will most likely, then ovulate the week before Christmas (though earlier or later are always possible) and won't get my period until the first week of the new year.

In January, we begin our last Clomid+IUI. If that fails, we'll be meeting with Dr. W. in early February to discuss next steps.

Our options, as she laid them out to me briefly, are either to move to injections+IUI (which has an increased risk of triplets that worries her) or straight to IVF.

All of this is very hypothetical at the moment, and there's no reason to spend tons of time stressing or evaluating or deciding what we'll decide to do in Feb/March, when there are cycles to get through right now and conversations waiting to be had (and test results--from the RPL panel--that still haven't come in).

But there is a complicating factor at play. While our current course of treatment is covered by our insurance, we have zero coverage for IVF or injectible meds (the IUI procedure and all monitoring/testing/doctors' visits would still be covered). We have enough saved to handle the both routes for at least a few months and parents who we could turn to for help in a pinch (though that's a last resort scenario) but would obviously like to do whatever we can to keep costs down (and I don't believe our clinic offers any shared risk or other incentive programs).

LG does have a flex spending account for medical expenses. And his benefits coordinator just let everyone know that they need to specify the amount they want to put in it by December 20th. And, of course, whatever is unused in the flex account at the end of the year is lost.

So, how do you think we should handle this? As of now, there's still a chance that Clomid+IUI could work and we wouldn't need to go out of pocket for fertility expenses at all. But it's highly likely that we will be paying for medications at the very least in 2011. We don't know anything about the pricing of IVF at Cor.nell, since we haven't officially had a chat with Dr. W about that yet, but I'm thinking $12,000-$15,000 is pretty standard. And maybe $2,000-$4,000 for the meds, a little less if we're just doing an IUI? (Hard data on these figures would be appreciated.) If we knew for a fact we would be going the IVF route, I'd want to put in enough to cover one whole cycle, but since we don't know anything yet, it may be too big a risk to lose that money at the end of 2011.

Advice needed!

26 comments:

  1. Hmmm...I'm not sure if I'm answering what you're specifically asking about, but I'd keep the money out. If you can lose it if you don't use it, well, that's a huge issue.

    ReplyDelete
  2. Ugh. Don't you hate that you have to think about money when you are trying to have a baby? It royally sucks!

    I think that the cost of IUI + injects varies depending on what specific medication you are on. Did your doctor mention what the exact protocol would be? If not, could you call your clinic and find out what their normal protocol is, and how much it usually costs? (You could even take it a step further and look up different pharmacies to see how much they charge for the drugs. I used Freedom several times, but I know that different pharmacies get better deals depending on which drugs you order...)

    I wish I had more to offer, but that's about the only thing I can think of.

    ReplyDelete
  3. I can't really help because I've been having a similar stressful time deciding basically the same thing!

    ReplyDelete
  4. check your email soon. i'm sending you a long email!

    ReplyDelete
  5. I agree, I would call Freedom or Village and ask them to give you costs. I am fortunate to be covered but for my last cycle which was IVF and included Gonal F, Cetrotide, Estrace, Endometrin and Ovidril the cost would have been about 8K for meds alone. I am a big believer in FSA accounts. I currently put about 2K per year in ours just to cover copays, acupuncture, contact lenses etc. See how much you can utilize that way so you could still use it up if you don't allocate it to fertility drugs. I hope this is helpful!

    ReplyDelete
  6. I'm doing IUI w/injects right now. Luckily (like you) my insurance covers monitoring and the IUI itself. It also cover meds. If I had to pay for meds out of pocket they would be roughly $600-$900 per cycle. I respond really well and use a pretty low dosage. I'd probably try an IUI cycle or two w/injects and then consider IVF.

    ReplyDelete
  7. I'm in the same boat. I just maxed out my FSA account and figured we'd use it one way or another... IVF, Donor egg, therapy. Lots and lots of massages. !!!

    Best of luck. I hope you don't need the $$ for IVF.

    ReplyDelete
  8. My meds, all in all, would have cost about $5k. I would have gotten some of them from Freedom and some from the Apothecary Shops (dunno if you have one near you). I think you're on target thinking that IVF will run you about $12-15k, that's pretty standard in higher cost of living areas. For comparison, my RE's normal rate for IVF in Scottsdale, AZ is $12k - including ICSI, assisted hatching (if necessary), embryo freezing and storage (as if). If you are truly afraid you may not use the money in the FSA, then I wouldn't use it. If your medical costs for 2011 exceed 7.5% of your adjusted gross income, it's all tax-deductible anyway, so it all ends up being tax-free, which is the same benefit of using an FSA.

    Aside from the triplets thing, the other thing to think about with more IUI if you're paying for the meds (the most expensive part) OOP, is if you're going to end up spending the same amount of money that an IVF cycle would have cost on IUI cycles. And hedge your bets on whether or not you think the IUI would be sucessful. I can tell you the engineer's older sister has done numerous IUIs and spent the equivalent of the price of an IVF cycle for IUIs, and is not moving onto IVF. It sucks. It's a betting game that we hardly ever win. THe RE, however....

    ReplyDelete
  9. I wanted to let you know that cornell participates in the NY state grant program which will cover a percentage of up to 2 ivf cycles. It is based on your income and I think you need in to make under $250,000 per year to qualify. Cornell has a grant coodinator who can help you with the process. Please feel free to email me if you have any questions.
    Our cornell ivf cycles have cost (without the grant) between $13,000-$15,000.
    I really, really hope that none of this is needed.
    thinking of you....

    ReplyDelete
  10. If it were me, I think I'd want to try injectable IUIs at least once. I know they are more expensive, and not covered in your case, but I would prefer to hold off on IVF as long as possible b/c of how invasive it is and the cost. Your estimates on price sound right from what I've been told, but I'm not in your area. Good luck in making the right decision!

    ReplyDelete
  11. (Warning I haven't slept much, so this may ramble -- just dumping thoughts. :)

    My Northern California IVF cycles have cost about $16-18k, when I include both the IVF clinic costs and the med costs. I don't qualify for shared risk plans, so that's the basic fee-for-service, with ICSI and assisted hatching, and heavy stims (450IU of Gonal F a day and 150IU of Menopur). My Gonal F alone for an IVF cycle has cost $3800.

    I would price out the meds for IUI cycles and put at least that much in a FSA account.

    This year we maxed out our FSA account because we knew we were doing the IVFs, and while we do have some insurance for that (50% coverage up to 15,000 lifetime max), we had exhausted our medications coverage last year.

    Sucks that money is such a big part of this...

    If you do an injectible IUI cycle, you could start with really low stims, and use the monitoring to see how many follicles develop, and then cancel if you get too many follicles. Cancelling sucks, but at least you'd learn a lot about how your body responds, and then you'd be able to decide if going to IVF and being able to take advantage of all the eggs would be worthwhile.

    Hope some of that is helpful.

    ReplyDelete
  12. I just did this myself! You are only allowed to put so much pre-tax money into the FSA, so check with the benefits co-ordinator to see what your max is.

    I went ahead and maxed out my FSA (at $6500) because I figured I will either be doing IVF (with no insurance coverage) or delivering a baby and either way that money will get used and it reduces my taxable income.

    ReplyDelete
  13. Where you're at right now--trying to navigate the clumsy choreography of insurance coverage, treatment costs, and financing it all--was probably *the* most difficult place for me, SS. At its peak it was a more insane feeling than learning to accept that we would need IVF to build our family. So, I have armfuls of empathy for you, my dear. Yep.

    I wrote a post not terribly long ago about how we financed our treatment. We, too, had zero coverage for ART, and we footed nearly the entire cost OOP. (Admittedly, it was a little less than your approximate expected expense...) Anyway, here's the link: http://andtherewerethreeinthefamily.blogspot.com/2010/09/race-for-familyfunding-if-treatment.html

    I say go for the flex account--this is how I purchased the bulk of my medications. My max out for the flex account was a piddly $3300, so I ended up requesting only half of that because that seemed like a good middle ground--something I knew we could get through without risking losing any of it at the end of the year.

    My clinic gave me some donated drugs, too, since they knew I had no script coverage. And there were three different bloggers who gave me some of their unused meds as well. One thing I have learned is that there is humongous depth when it comes to the generosity of ART peeps.

    You WILL figure this all out, as overwhelming and unpredictable as it may seem. You will commit your heart to the money piece of this--whatever that may come out to be--and you will just move past it. I have never once missed the money I've spent on my IVF cycle. Never once looked at the depletion of my savings with any measure of question or regret. Best money I've ever fucking spent.

    ReplyDelete
  14. I put less than I thought I would use for a few iui's. I figured if I got pg fast I could use it for birth expenses, if not then the iui's. I didn't do ivf amount because we would have had to borrow that. Hope that helps a bit.

    ReplyDelete
  15. I know my company has a max we can put in FSA accounts ($2K!) so check that out before you get too deep into this. Another thing to consider is that FSA rules are changing drastically in 2011 due to the health care bill. For example, things like OTC meds (aspirin, an ice pack, etc) are no longer covered without a doctor's Rx (which is insane). This won't effect the pricing of IVF, it just means that it's harder to use up extra funds than ever before.

    We got all of our meds at Freedom pharmacy and they are awesome about giving price quotes with insurance factored in if you give them a day or two to crunch numbers (and have an idea of how many ius of meds you're going to need). I also discussed pricing of IVF with the financial coordinator at Dr. Awesome's office before we even had our IVF consult (and asked about cost of add-ons like PGD and ISCI and freezing embies)...a good RE office like yours will be more than happy to give you some insight on what this might cost you should you have to do IVF (and I pray that you do not!).

    Also, just my two cents, but if you MUST do another cycle after Clomid in Jan (and I'm really positive about your conceiving a healthy baby this month or on that cycle!!), I would consider a round of injects before moving directly to IVF. I think about HOW MUCH all of my REs learned about my body and my response during my three injects cycles and think that if we'd had to go to IVF it would've been a much better stimming experience than if we'd gone directly from Clomid to IVF....you know?

    I know this is a total mind f-. You WILL figure it out and it will feel like a weight has been lifted. It sucks you have to cross this bridge before you're ready (thanks to the FSA deadline), but you'll hit the ground running come 2011 having made some big decisions on your "break" month (during which you WILL ovulate and we will all be rooting for your miracle baby!!!). xoxo

    ReplyDelete
  16. I actually read this yesterday and thought about it overnight. My first inclination was to say not to max out the FSA. That if you got pregnant on the next IUI cycle then you can't get all that money out. But I actually came to the same conclusion as Slackie O. It seems like you have pretty good insurance but out of pocket medical costs for pregnancy, labor and delivery can be pretty serious too. Plus if you get pregnant in January, you can also spend FSA funds on the baby. There will be three of you to help use it up! So I say max it out.

    ReplyDelete
  17. This is such a difficult issue. It really sucks that money is has to be a factor in having a baby for some. I'm not sure if anyone else brought this up, but something our clinic talked to us about was the fact that several OOP IUI + inject cycles would end up costing about the same as one IVF cycle (which had greater chances of working).

    My greatest fear was going through several unsuccessful IUIs and then not having enough money left over for IVF. So this pushed us into skipping the IUI phase and jumping straight to IVF, which did work for us. Sorry again that this is so hard :( I really hope you find success this month and don't even have to think about this stuff!

    ReplyDelete
  18. Hey Sloper,
    Man, we're in the same boat! We just maxed out DH's FSA at $5K for next year knowing we'll obviously need it for IVF. But for you, my friend, here's what I would consider first:

    -Say IUI #3 works (yippee! b/c it CAN and WILL work!) find out how much your insurance covers for labor and delivery. Maybe you'll need to pay like $1,000 to have your baby so then AT LEAST you know you can put $1,000 in FSA and know you'll use it.

    -Find out if your RE can get you injects meds for free. My RE gave me samples of Gonal-F for all 4 IUIs I used injects for (IUI #3.5 was obv canceled). If they can't, start shopping around. Freedom Pharmacy is definitely cheaper BUT it's not the cheapes out there. Your nurse/RE will know best. For example, my nurse can get my IVF meds cheaper at this pharmacy in Charlotte than at Freedom Pharmacy. You just gotta ask. That way you can better gauge how much the meds will cost you for IUI/injects. Also, find out what does. My last 2 IUIs I was on 37.5IU so I didn't even use a whole pen--at that amount I could use one pen for 2 IUIs.

    -Sadly, you don't know if you'll need IVF (I'm confident you won't need it at all!) so that means it's a huge risk to put that $$ in FSA if you don't need it. It's a huge gamble and since I'm not much of a gambler, I wouldn't put in any for IVF at all if I were you. I'd just look into the two points above only. I know I'm no doctor, but I truly believe that IUI is it for you. Maybe w/injects, but that's it. I know my hopes and dreams for you mean nothing when it comes down to cold, hard cash, but I just wouldn't put $$ in for IVF. Too risky. Place your bets on IUIs working for you :).

    Whew! That was A LOT! I hope it was helpful! Gimme a shout if you need more help especially since we JUST did this on Thursday :).
    xo

    ReplyDelete
  19. I say find out what your FSA max is and check with the federal publication about what is covered. Acupuncture is covered, as well as travel to your doctors appointments, as well as over the counter drugs, if your doc will give you a prescription for them. We are flying to New Jersey for our FET in the Spring and our flights will be reimbursed from our account, as well as the costs of our transfer, since we do not have ART insurance.
    Of course it is always best to check with your own company to double check what they will reimburse for.

    ReplyDelete
  20. Here's hoping that whatever money you put in the FSA is spent on co-pays for your pregnancy visits to the ob/gyn and trips to the pediatrician! XOXO.

    ReplyDelete
  21. This is a tough one. Not sure what to advise though I think I lean to maxing it out. And there's also the grant program that CGD mentioned, which might be able to help somewhat.

    ReplyDelete
  22. I agree with everything Egg said re: the FSA. The rules are changing, so just make sure you won't be stuck with a bunch of money in an account that you can't use. I would check to see if any pregnancy/baby items can be purchased from the FSA if the (fingers crossed) Clomid/IUI works.

    Also, I concur with Egg about trying an inject/IUI cycle before moving to IVF. Ask your RE about the possibility of switching to IVF if you have a better-than-expected response to the injects. The inject/IUI cycles are WAY cheaper and like Egg said, you will learn a lot about how your body responds to the meds. I think the risk of high multiples (triplets or more) is pretty slim unless you have a crazy amount of eggs.

    Anyway, hopefully this is all a pointless discussion and Clomid is your ticket. xoxo

    ReplyDelete
  23. My only advice from personal experience is that we bought $1600 in plane tickets before I got pregnant, and then we decided not to go because I didn't want to spend more money and didn't feel up to traipsing around Europe.... I am trying to get the money back from travel insurance, but there is a good chance that I won't, and you know what, I don't give a shit. When you get pregnant for keeps, you won't care what money you might lose in the process. Not that I'm saying that you should definitely max out your account or anything (I don't know what you should do), but I'm just saying that whatever you decide, you will NOT regret losing any unspent funds (oh, I hope they ALL go unspent!!!!).

    ReplyDelete
  24. This sounds so complicated, and I'm sorry you have to deal with it now because of a deadline, as opposed to when you're ready to discuss the issue. Here's hope that you'll use the money for pregnancy and delivery co-pays!

    ReplyDelete
  25. Very nice post. Infertility clinic in Nigeria is a hope for infertile people Nigeria.

    ReplyDelete