Patient Relations

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Expanding IVF Access: Initiatives to Make Fertility Treatments More Accessible

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US CLINICS INNOVATE TO BREAK FINANCIAL, GEOGRAPHICAL, AND EDUCATIONAL BARRIERS

This News Digest Story is paid featured content. The advertiser has had editorial input and control over its creation. However, the views and opinions expressed in this article do not necessarily represent the views of Inside Reproductive Health. The sponsorship of this content does not imply an endorsement by Inside Reproductive Health.

By Lisa Munger

As demand for fertility treatments surges and barriers persist, several leading fertility clinics and organizations in the U.S. are implementing innovative measures to make in-vitro fertilization (IVF) more accessible to a broader population. By working to address financial, geographical, and educational barriers, these organizations seek to ensure that more people can access the resources they need to expand their families.

CNY Fertility: Affordable and Accessible Care

William Kiltz, vice president of marketing and business development at CNY Fertility, said the company has emerged as a leader in making fertility treatments affordable and accessible.

Kiltz highlighted three primary mechanisms for expanding access: eliminating financial barriers, removing restrictive cutoffs based on age or health metrics and addressing geographical challenges.

ORGANON IS COMMITTED TO HELPING ASPIRING PARENTS ON THEIR FERTILITY JOURNEY

Organon is proud to collaborate with the fertility community in championing care equity around the world and is committed to:

  • Elevating fertility education and awareness

  • Expanding resources and access to care

  • Investing in innovative fertility solutions

Every journey to parenthood is unique, and Organon is here to empower aspiring parents every step of the way.

 
 

He said CNY Fertility's pricing stands out in the industry, with treatments costing one-third of the national average.

“Where standard IVF treatments typically cost around $20,000, CNY Fertility offers similar services for $6,764,” Kiltz said. “This affordability and flexible financing options allow more families to access fertility care. The average household income of CNY’s patients is around $80,000, significantly lower than the typical $180,000 for IVF patients nationwide.”

CNY Fertility has developed a patient-friendly travel program that leverages telehealth and local medical facilities to address geographical barriers.

"Patients can receive treatment remotely for most of the process, only needing to visit our clinics for two days," Kiltz said. "We believe that access to the care needed to grow one’s family is a fundamental human right."

Inception Fertility: Advocating for Improved Insurance Coverage

Under the leadership of CEO TJ Farnsworth, Inception Fertility is also at the forefront of expanding IVF access. Inception focuses on increasing insurance coverage and educating insurance companies about comprehensive fertility care.

"Our top priority is to remove capacity constraints and advocate for expanded coverage," Farnsworth said. "We are dedicated to adapting to changes in the insurance landscape and increasing the number of employers offering fertility care benefits."

Inception Fertility offers solutions for patients facing financial barriers. Through BUNDL Fertility, patients can bundle multiple cycles at a discount, reducing the overall cost and increasing success rates. Additionally, the Wyatt Fertility Foundation provides financial assistance and funds research in infertility.

"We are excited to award five $15,000 grants for IVF, demonstrating our commitment to the future of fertility care," Farnsworth said.

Kindbody: Training and Expanding Access

Kindbody is tackling the issue of limited access through innovative training programs. Angie Beltsos, M.D., chief executive physician, emphasized the importance of increasing the number of qualified fertility specialists.

"Kindbody was founded to create health equity and make family-building more affordable," Beltsos said. "Our new KindInstitute will train board-certified OB/GYNs in reproductive endocrinology and infertility, significantly increasing the number of professionals available to provide care.

This training program, set to graduate its first cohort in 2024, seeks to address the shortage of fertility specialists and improve access for underserved communities. By equipping OB/GYNs to perform fertility-related procedures, Beltsos hopes to increase the monthly cases treated by 50% or more. Additionally, Kindbody is expanding its online offerings to provide convenient, remote patient consultations.

Organon: Cost-Saving Programs for Medications

Organon, a company with a portfolio that has a long history in fertility medications, focuses on reducing patients' costs, said Mike Pohleven, U.S. Fertility Business Unit lead, regarding the effect of Organon’s partnership with ReUnite Rx on expanding access to fertility care

“Our two most popular and utilized programs are the ReUnite Discount Program, which offers point-of-sale discounts for cash-paying customers without insurance benefits, and ReUnite Assist, which provides additional savings for uninsured, income-eligible patients.”

Going forward, Pohleven said the company’s development “will be based on market dynamics and events, so we are always aiming to meet the needs of aspiring parents.. Organon’s mission-critical NorthStar is to be ‘Here for Her Health.’ We continually look for ways to address women's unmet needs.”

Through ReUnite Rx, Organon provides access to several cost-savings programs, benefiting 50,000 eligible patients since 2018, he said.

This News Digest Story is paid featured content. The advertiser has had editorial input and control over its creation. However, the views and opinions expressed in this article do not necessarily represent the views of Inside Reproductive Health. The sponsorship of this content does not imply an endorsement by Inside Reproductive Health.

All external links active as of 7/18/2024

External links are being provided as a convenience and for informational purposes only; they do not constitute an endorsement or an approval by Fertility Bridge or Inside Reproductive Health of any of the products, services or opinions of the corporation or organization or individual. Neither Fertility Bridge nor Inside Reproductive Health bears responsibility for the accuracy, legality or content of the external site or for that of subsequent links. Contact the external site for answers to questions regarding its content.

 
 
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Early Diagnosis, Better Outcomes: The Future of Fertility with Clinical Decision Support Software

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LEVY Health reveals how 96% of women trying to conceive received diagnoses for previously undiagnosed conditions

This article has been authored by our advertiser, and is paid featured content. The advertiser had complete editorial control over its creation. The views and opinions expressed in this article do not necessarily represent the views of Inside Reproductive Health. The sponsorship of this content does not imply an endorsement by Inside Reproductive Health.

This News Digest is paid sponsored content from

 
 

Shockingly, only 16% of women with infertility are properly diagnosed.

New data highlights the potential of clinical decision support software (CDSS) to revolutionize fertility diagnostics and treatment. CDSS can help providers identify conditions earlier and more efficiently, leading to an increase in treatment conversions and improved patient outcomes.

A recently published white paper by LEVY Health with first author Serena Chen, MD, FACOG reveals that including OB-GYNs in diagnostic fertility workups and early diagnostics is essential to improving access to fertility care. However, OB-GYNs also need support. 

"Many women facing challenges with conception have conditions that don't necessarily require in-vitro fertilization," says Chen, the first author of the white paper. "Without increased involvement from OB-GYNs and tools to aid in diagnosis and treatment, infertility rates will continue to climb."

In a study using LEVY Health’s software, 96% of women received diagnoses for previously undiagnosed conditions, including polycystic ovary syndrome, thyroid disorders, or premature ovarian insufficiency - conditions that oftentimes need many years to diagnose. The white paper shows that clinical decision support can empower OB-GYNs, thereby improving patient triage and making fertility clinics more efficient.

This article has been authored by our advertiser, and is paid featured content. The advertiser had complete editorial control over its creation. The views and opinions expressed in this article do not necessarily represent the views of Inside Reproductive Health. The sponsorship of this content does not imply an endorsement by Inside Reproductive Health.

This News Digest is paid sponsored content from

 
 

All external links active as of 5/28/2024

External links are being provided as a convenience and for informational purposes only; they do not constitute an endorsement or an approval by Fertility Bridge or Inside Reproductive Health of any of the products, services or opinions of the corporation or organization or individual. Neither Fertility Bridge nor Inside Reproductive Health bears responsibility for the accuracy, legality or content of the external site or for that of subsequent links. Contact the external site for answers to questions regarding its content.

 
 
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Aetna Will Pay LGBTQ+ Enrollees up to $2 Million to Settle IVF Lawsuit, Law Firm Gets $1.65M

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The litigation accused the health insurer – which is owned by pharmacy chain CVS Health – of having separate IVF coverage policies for same-sex and heterosexual couples.

The content and themes expressed within the article are that of the news. The advertiser does not have editorial control over the content of this article, and Inside Reproductive Health maintains full editorial independence. The views and opinions expressed in this article do not represent the views of the Advertiser or of Inside Reproductive Health.

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BY RON SHINKMAN

A national insurer under criticism for its reproductive health benefits design has agreed to settle a lawsuit and change its policies regarding IVF and other reproductive health coverage for same-sex couples.

Aetna – which is owned by pharmacy chain giant CVS Health – will set aside $2 million to reimburse same sex couples who had previously been denied coverage under its prior policies.

The insurer was sued in September 2021 by playwright Emma Goidel, who obtained her Aetna coverage through Columbia University.

Goidel’s lawsuit, a class-action filed in federal court in New York City, argued that Aetna’s policy of requiring same-sex couples to undergo a dozen rounds of intrauterine insemination at their own expense before it would provide IVF coverage was discriminatory. By contrast, heterosexual couples only had to claim 12 consecutive months of trying to get pregnant before IVF coverage would kick in.

Under the terms of the settlement, Aetna has agreed to change its coverage policy. “Aetna will apply and administer its clinical policies such that individuals with a uterus in an eligible LGBTQ+ relationship at the time of seeking IVF are not required to undergo any greater number of IUI cycles to qualify for IVF than individuals with a uterus in a heterosexual relationship,” the settlement stated.

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Aetna has also agreed to reimburse same sex couples who had IVF coverage from the insurer but previously had to pay for IUI treatments out of their own pocket. Each enrollee would be eligible to a default payment of $2,300, although they may apply for additional compensation if they spent money on procedures exceeding that sum. 

“We celebrate this significant stride toward achieving justice for LGBTQ+ people who have faced obstacle after obstacle trying to access the health care services that they need to build their families,” said Alison Tanner, an attorney with the National Women’s Law Center, which represented Goidel in the litigation

Court records indicate 5,621 individuals belong in the various classes of plaintiffs, although only 850 are currently confirmed as qualifying for reimbursement, according to the settlement. The other individuals would have to prove they were in a same-sex relationship and denied fertility benefits in order to qualify. Any money left over from the $2 million fund will be donated to a charity of choice decided by the plaintiffs and Aetna.

The attorneys who represented Goidel and the other class members will receive $1.65 million in legal fees separate from the $2 million settlement fund. Aetna will also pay $130,000 to administer the settlement, which is comprised primarily of notifying class members that they may be due compensation.

“We are committed to providing quality care to all individuals regardless of their sexual orientation or gender identity and pleased to reach a resolution to this matter,” Aetna said in a statement provided to Inside Reproductive Health. A spokesperson for the health insurer declined to answer specific questions.

Meanwhile, Aetna was sued again in federal earlier this month, this time in Los Angeles. The plaintiff in that case, Amelia Rynkowska, claims Aetna has ambiguous language in its group employer coverage that appears to exclude coverage of many reproductive services completely.

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External links are being provided as a convenience and for informational purposes only; they do not constitute an endorsement or an approval by Fertility Bridge or Inside Reproductive Health of any of the products, services or opinions of the corporation or organization or individual. Neither Fertility Bridge nor Inside Reproductive Health bears responsibility for the accuracy, legality or content of the external site or for that of subsequent links. Contact the external site for answers to questions regarding its content.

 
 

Thousands of IVF Payments Frozen After Change Healthcare Cyber Attack

Other clearinghouses, cash-pay patients, insulate reproductive medicine sector from severe financial crunch.

The content and themes expressed within the article are that of the news. The advertiser does not have editorial control over the content of this article, and Inside Reproductive Health maintains full editorial independence. The views and opinions expressed in this article do not represent the views of the Advertiser or of Inside Reproductive Health.

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BY RON SHINKMAN

A ransomware breach of one of the nation’s largest clearinghouses for health insurance claims has likely caused some consternation to reproductive medicine practices, an expert familiar with the situation says.

The breach of Change Healthcare – a subsidiary of UnitedHealth Group, the nation’s largest medical insurer – occurred in late February. Change reportedly paid a $22 million ransom in bitcoin to regain control of its data and networks, but the company said it will not be able to start processing healthcare claims against until at least March 18. Change handles about 15 billion healthcare transactions a year, according to the U.S. Department of Health and Human Services.

“The hack affected not only (our customers), but the entire healthcare industry,” said Nimesh Shah, chief executive officer of eIVF, which provides services to about 140 fertility practices, although not all of them use its billing service. The company relies on Change Healthcare to process and pay claims to its clients. Shah said about 30 to 40% of the claims its processes for clinics are billable to insurance companies, and the company typically handles “thousands” of such claims each day.

The issue has become so serious that last Sunday, Health and Human Services (HHS) issued a letter urging UnitedHealth to “take responsibility to ensure no provider is compromised by their cash flow challenges stemming from this cyberattack” and “ensure expedited delivery of funds to impacted providers.” 

How the breach is impacting individual reproductive medicine clinics and their networks remains unclear. Executives and spokespersons with some of the largest fertility clinics in the U.S. – including Boston IVF, Shady Grove, the Prelude Network, Progyny and the University of California at San Francisco Center for Reproductive Health – have either declined to comment or did not immediately respond to requests seeking comment.

Taylor Stein, co-CEO of EngagedMD, which provides support services to clinics but does not handle their claims, suggested that fertility centers’ finances may not be as crimped as other medical practices, because of the number of self-pay IVF patients.

“Unless they’re operating in states (with mandated insurance coverage for IVF), most clinics have a lot of cash coming in the door,” Stein said.

Workarounds through other clearing houses

Meanwhile, other clearinghouses have been offering workarounds to providers who contract with Change Healthcare. Availity, another claims clearinghouse, is offering to process claims for Change clients, Shah said.

“Once a clinic registers with Availity and creates a relationship, we’re automating that into our (electronic medical records) or billing solution, so that they can do things in an automated fashion as opposed to a manual process (for submitting claims),” Shah said. He added that about half of eIVF’s clients – fewer than 100 in total – have signed onto the program, which is known as Availity Lifeline.

According to Availity spokesperson Matt Schlossberg, the company has "provided free digital connectivity to more than 300,000 providers—and that number continues to grow,” Schlossberg said in an email, adding that about $5 billion worth of claims had been processed through the program as of early this week. He was unable to immediately provide a breakdown on the number of reproductive medicine providers participating in the program.

Remaining concerns

Although Shah observed that his company wants “to create choice whenever possible,” he would not say directly whether eIVF would seek another clearinghouse for its clients.

“When this happens, nobody is claiming victory,” he said. "If you’re Availity or (other clearinghouses), you are not excited by what just happened. Probably their number one reaction is ‘thank God that wasn’t us.’”

However, the likelihood of clearinghouses and other players in the healthcare industry dodging such breaches appears to be diminishing, said Stein, whose expertise is in cybersecurity.

“They’re going to keep on happening,” he said. “It’s the new normal.”

The content and themes expressed within the article are that of the news. The advertiser does not have editorial control over the content of this article, and Inside Reproductive Health maintains full editorial independence. The views and opinions expressed in this article do not represent the views of the Advertiser or of Inside Reproductive Health.

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We Surveyed Thousands of Patients So You Don’t Have To - Here’s What They Said

Unlock the key to exceptional patient satisfaction and clinic growth with BUNDL Fertility's exclusive survey report. Dive into comprehensive data analyzed from over 2,500 patient reviews and discover how to enhance every aspect of your clinic's services. 

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All external links active as of 3/14/2024

External links are being provided as a convenience and for informational purposes only; they do not constitute an endorsement or an approval by Fertility Bridge or Inside Reproductive Health of any of the products, services or opinions of the corporation or organization or individual. Neither Fertility Bridge nor Inside Reproductive Health bears responsibility for the accuracy, legality or content of the external site or for that of subsequent links. Contact the external site for answers to questions regarding its content.

Medications Finally Included with Price of IVF

Program Expands to Remove Variable from Patients and Clinics

This News Digest Is Paid Sponsored Content From
BUNDL

 
 

BY: ERIN FLYNN JAY

Historically, IVF medications have almost never been included with the price of an IVF cycle. That was, until very recently.

The popular fertility financing program BUNDL has launched BUNDL with Medications℠, a new partnership with InspireRx to finally include patient medications with the price of IVF.

Separate Medication Costs Negatively Impact Patients, Providers

When patients can’t plan for medication costs, they may not be able to start their cycle when they’d like…or they may not be able to start their cycle at all. They may need more of a certain drug or a different protocol and they can’t afford it. 

“It puts an extra stressor on patients--maybe they finally have an IVF plan and finally have their treatment scheduled. But then they have to figure out what's going to happen with the meds?,” said Cheryl Campbell, Director of Operations for BUNDL. “It continues to grind at them and halt their process. They’re left alone to research where they’re going to get the best and most inexpensive meds.”

When patients face financial strain because of medication costs, it puts their treatment in jeopardy and may end up canceling their IVF cycle, which negatively impacts the fertility center’s scheduling.

BUNDL with Medications℠ allows fertility clinics and patients to consolidate treatment and medication costs into one plan with the backing of a financial guarantee. 

Campbell said it's hard for fertility physicians to see patients struggle with medication costs.

“As an ex-fertility patient myself, time is of the essence, right? When a patient can’t move forward with their provider’s treatment plan because they are hindered by medication costs, that's very daunting for physicians. They want those patients to move forward.”

How to Reduce Stress of Medication Costs for Patients

BUNDL with Medications℠ is a multi-cycle program. “Patients’ financial barriers are being removed because we are discounting their treatment. We’re going from top to bottom for the patient; all they have to do is focus on their IVF cycle.” Campbell added.

“It works as a layer onto our existing discount program. When a patient buys a two-cycle program from us, for an extra X amount of dollars, they can choose to add the costs of their medications and we'll handle that back and forth with their clinic.”  

BUNDL with Medications℠ covers everything a patient might need. “If a patient needs more but we didn't realize it, they're going to get it,” said Campbell. “If they're a poor responder and they need more, we're going to give it to them. Our patients will get what they need when they need it. The only exception drug is omnitrope, an off-label drug; other than that, patients will be able to access what they need.”

Which Fertility Clinics Can Benefit

BUNDL with Medications℠ is open to any clinic who has partnered with BUNDL.

Karol E. Bonilla, Strategic Account Manager for InspireRx, said there are many patients who don't have any coverage for either treatment or medications. “It's not difficult to actually combine great providers and great pharmacies to provide brand name medications,” she said.

Patients go with the provider of their choice. “Through InspireRx, they have less medication pricing for their fertility drugs since they don't have any coverage,” she said. “You're going to get multiple cycles so there are savings on the treatment and then also savings on the medication. It's a win-win for our patients.”

This News Digest Story is paid featured sponsor content, where the Advertiser has editorial control. They do not reflect the views of Inside Reproductive Health.

How to Finally Streamline Medication Costs for Your Patients

Medication costs are a huge stressor for patients working through IVF and IUI treatments. They can be costly, and the variability of when they’re needed means an even more difficult process. But it doesn’t have to be this way, and that’s why BUNDL has streamlined the process with their new BUNDL with Medications℠ program.

BUNDL with Medications℠ is a multi-cycle offering that includes all the patient’s medications, for one up-front cost. Contact BUNDL today to learn about their exclusive virtual pharmacy program, and how this can optimize treatments for your practice and patients.

 
 

This News Digest Is Paid Sponsored Content From
BUNDL

 
 

All external links active as of 8/10/23.

External links are being provided as a convenience and for informational purposes only; they do not constitute an endorsement or an approval by Fertility Bridge or Inside Reproductive Health of any of the products, services or opinions of the corporation or organization or individual. Neither Fertility Bridge nor Inside Reproductive Health bears responsibility for the accuracy, legality or content of the external site or for that of subsequent links. Contact the external site for answers to questions regarding its content.

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Compared: Progyny, Kindbody, Carrot, and Maven as fertility benefit coverage increases 33% in two years

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BY: RON SHINKMAN

According to a recently released survey by the International Foundation of Employee Benefit Plans, 40% of U.S. employers offered some form of fertility coverage last year. That’s up dramatically from 2020, when only 30% offered fertility benefits – a 33% jump in just two years. More employers now offer fertility benefits than financial assistance or paid leave for an adoption.

“We’ve been seeing family-friendly benefits like fertility coverage continue to grow as part of the larger trend of expanding work-life integration policies to be more inclusive of all employees,” said IFEBP Vice President of Content Julie Stich.  “Fertility benefits hold a high value by talent no matter their gender identity or relationship status. Providing these benefits helps nurture overall happiness and well-being.”

However, coverage can differ dramatically between employers. For example, among companies that offer fertility benefits, less than 35% cover egg harvesting or freezing services, and less than 45% cover fertility services that are not related to in vitro fertilization (IVF). There are numerous other variations along those lines.

Larger employers – those with more than a few hundred workers – often self-fund their employee medical costs and use a third-party administrator to handle claims (typically a subsidiary of a large health insurer). They may also outsource their benefits to major fertility platforms such as Progyny, Carrot or others in what are known as benefit “carveouts.” In those cases, the fertility firms usually act as a one-stop shop, offering benefits in line with the limits of coverage set by the employer, managing claims and collecting payments. Here is a breakdown of the four largest platforms:

Kindbody
Founded: 2018
Headquarters: New York City
Valuation: $1.8 billion
Locations: 27 Clinics in 21 cities in 15 states and the District of Columbia, Including New York City, Los Angeles, Atlanta and Houston
Senior Management: Gina Bartasi, Founder and Chairwoman; Angeline Beltsos, M.D., CEO, clinical operations; Annbeth Eschbach, CEO, corporate operations; Greg Poulos, President; Taryn Branca, Chief Revenue Officer
Major Employer Clients: Walmart, Lyft, Activision

Walmart, the nation’s largest company with more than 2.3 million employees, entered into a fertility benefits carveout with Kindbody last September.

“Our partnership with Walmart signals that fertility benefits have joined medical, dental, and vision as standard workplace benefits for leading employers,” said Bartasi when the deal was announced.

The pact with Walmart is an indication of how all-in-one fertility companies have grown in just a few years. Kindbody was founded only five years ago. That it was able to raise more than $281 million, according to Crunchbase, helped turbocharge its growth.

Although Kindbody does not post specifics regarding its benefits packages for employers, a recent webinar conducted by its senior management indicated that companies should curate a benefit that takes into account projected utilization by employees, medical and drug costs per cycle, and sources of direct and indirect savings.

Progyny
Founded: 2008
Headquarters: New York City
Enterprise Value: $2.7 billion
Coverage: It networks with 650 clinics and 950 physicians and clinicians
Leadership: David Schlanger, Executive Chairman; Peter Anevski, CEO; Michael Sturmer, President; Mark Livingston, Chief Financial Officer; Jennifer Bealer, General Counsel
Major Employer Clients: Detroit Pistons (NBA Team and its employees); Children’s Hospital Association

Progyny is the elder statesman of the group with its founding in 2008. Its 2022 revenue of nearly $787 million was 57% higher than 2021’s. It works with 370 corporate clients nationwide representing some 5.4 million employees, although the company has been mostly tight-lipped about its clientele. Unlike the other companies, it does not post the names and logos of its major corporate clients on its website. And the employer pacts it has announced – with an NBA team and a healthcare trade association – likely only cover a few hundred employees apiece.

Progyny and Maven were the only companies to respond to a request seeking comment for this article prior to publication. According to Progyny spokesperson Alexis Ford, the company assigns each patient an advocate “to better understand their Progyny benefit, their deductible, co-insurance, etc., since this is dependent on each employer’s health plan. The patient care advocate also provides unlimited education and is the patient’s go-to resource during the entire journey.”

Ford provided a single detail regarding Progyny’s carveouts: 90% of employers working with the company also offer their workers ProgynyRX, which includes medication coverage, next-day deliveries and access to support from pharmacists and other medication clinicians.

According to Holly Hutchison, co-owner of Reproductive Health Center in Tucson, Ariz, a carveout firm such as Progyny offers a “smart cycle.” That is specifically an egg retrieval and transfer along with anesthesia, laboratory and monitoring services. “Employers choose how many cycles they want to include in coverage, from one to five cycles,” she said.

According to Progyny’s website, an IVF procedure where one embryo is implanted and rest are tested and/or frozen represents three-quarters of a cycle. An intrauterine insemination represents one-quarter of a cycle. Egg freezing is half a cycle. A reciprocal IVF procedure involving a same-sex couple is 1.25 cycles, while a surrogacy IVF is 1.5 cycles.

Carrot Fertility
Founded: 2016
Headquarters: Menlo, Park, Calif.
Valuation: $500 million (estimated)
Locations: NA
Leadership: Tammy Sun, Founder and CEO; Ashima Ahmad, M.D., Co-Founder and Chief Medical Officer; Tim Kelly, Chief Commercial Officer; Brooke Quinn, Chief Customer Officer
Major Employer Clients: Zoom; Clif Bar; Lucid Motors (luxury electric automaker)

Carrot Fertility has raised more than $114 million since its founding, according to Crunchbase. Its $500 million valuation is an estimate made by Inside Reproductive Health based on available revenue data and multipliers for the healthcare industry.

Carrot Fertility did not respond to a request seeking comment about their company’s differentiation in the fertility space.

Maven Clinic
Headquarters: New York City
Founded: 2014
Valuation: $1.35 billion
Locations: NA
Leadership: Katherine Ryder, Founder and CEO; Kalliope White, Chief of Staff
Major Employer Clients: Snap, Bumble, Sanofi, Booz Allen Hamilton

A Maven spokesperson said the company offers “typical” carveouts, but did not provide specifics. 

Maven has raised more than $292 million since its founding, according to Crunchbase.


Carveouts Provide More Guidance Than Traditional Insurance Companies

Despite the dramatic increase in fertility benefits from employers, there are still no standardized guidelines mandated by nationwide governmental bodies such as the U.S. Department of Health and Human Services. As a result, fertility benefits and carveout structures vary from company to company.

“The coverage will vary depending on the employer and which fertility benefit management group they choose,” said Hutchison. State mandates on fertility benefits also play a role, she added. Hutchison estimated that about 45% of its patients currently have some form of insurance coverage. “They all have co-payments and deductibles and out of pocket amounts that apply prior to the coverage kicking in,” she added.

David Stern, the chief executive officer of Boston IVF – which operates 18 fertility clinics in six states – observed that most employees receive minimal guidance regarding their fertility benefits.

“You might have fertility coverage and IVF coverage, but the employee is told by their insurer ‘you’ve got to figure out yourself,’” he said. That puts enrollees at risk of using up their benefits on unneeded testing and procedures before they even start IVF, Stern added.

By contrast, carveouts can provide direction to health plan enrollees. According to Stern, one of the most important parts of a carveout is that fertility platform companies can provide care managers “who will talk to you about what the process is and what it looks like.” Boston IVF is a network provider for several major fertility benefits companies , including Progyny, Maven, Carrot and Stork Club Fertility, according to Stern.
 

Controlling Unexpected Costs

Stern noted that many platforms also emphasize “centers of excellence” models where they only refer patients to clinics with the highest standards and outcomes. This not only helps with success rates, but can also protect the employer, which may rely on rigorous standards to avoid multiple births. A triplet birth, even if all are healthy, can cost a self-insured company more than seven times the cost of a single birth, Stern said. As a result, he observed that many carveout arrangements specify only one embryo transfer at a time may be attempted for an IVF or similar procedure. Currently, about 95% of Boston IVF’s procedures are comprised of only a single transfer, according to Stern.

Whether employers offer carveouts or not, most coverage Stern sees from companies is minimal.

“You can go to a doctor and you can be seen by a specialist, but they don’t pay for medication or treatment,” he said.

The themes reported in this publication are those of the news. They do not reflect the views of Inside Reproductive Health, nor of the Advertiser

 
 

All external links active as of 4/20/23.

External links are being provided as a convenience and for informational purposes only; they do not constitute an endorsement or an approval by Fertility Bridge or Inside Reproductive Health of any of the products, services or opinions of the corporation or organization or individual. Neither Fertility Bridge nor Inside Reproductive Health bears responsibility for the accuracy, legality or content of the external site or for that of subsequent links. Contact the external site for answers to questions regarding its content.

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Fight for Families: RESOLVE’s 2023 Initiatives in a post Roe world

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This News Digest Is Donated Sponsored Content From RESOLVE

 
 
 

BY: MELANIE KALMAR

When the Supreme Court overturned Roe v. Wade last year, one organization renewed its focus on access to care for patients battling infertility.

Since 1974, RESOLVE: The National Infertility Association  has provided education, advocacy and emotional support to people nationwide who are trying to build families. The 501c3 is funded by individuals, corporations, fertility clinics, and individual professionals/experts in the field. 

A majority of the work RESOLVE does involves ensuring patients have access to emotional support and all family building options, no matter their zip code. This work includes, —support groups, federal and state advocacy, a program to encourage employers to include IVF coverage in benefits packages, public awareness campaigns and patient education, explained Barbara Collura, CEO of RESOLVE.

In FY 2022, RESOLVE helped 1.4 million people gain new or improved family building benefits through its access to care initiatives. According to Collura, the non-profit’s three big initiatives for 2023 include: protecting access to IVF services, opening access to it in California, Minnesota, Oregon and Washington State (four states that don’t have IVF insurance mandates) and increasing emotional support by returning to in-person support groups. RESOLVE offers peer-led support groups in 30 states and Washington, D.C. (42 in-person; 78 virtual; and 31 professionally led).

Protecting access

In response to the Supreme Court overturning Roe v. Wade, a move that could restrict access to IVF and people’s rights over their embryos, RESOLVE launched a new campaign: Fight for Families. Its goal is to amplify the non-profit’s existing state advocacy work and protect access to care.  

“What’s different now is the stakes are so much higher,” Collura said. “We felt we needed a louder voice and brought in PR support.” RESOLVE recently hired New York-based Fenton Communications to work with IVF patients on how to succinctly tell their stories to the media, to change minds and influence public policy.

Increasing access

Sharing stories of people who face barriers to building their family is so important in RESOLVE’s work, especially the Fight For Families campaign and when it comes to increasing access to IVF insurance through state laws,, Collura said. RESOLVE sees even more of an opportunity to increase access to care in California, Minnesota, Oregon and Washington State because after Roe v. Wade was overturned, legislators from those four states announced reproductive rights of women are protected in their regions, yet  those states don’t have an insurance mandate for IVF to back it up, Collura explained. She went on to say that this state advocacy work largely happens because of a strong coalition of other non-profits and corporate partners that work together. 

She said a robust insurance mandate would include coverage of at least two cycles of IVF, medication, unlimited frozen embryo transfers and fertility preservations (insurance coverage to preserve sperm, egg or embryo of patients experiencing Iatrogenic Infertility; infertility caused by medical interventions like chemotherapy, surgery or other medications someone facing Cancer treatments may undergo).

It’s critically important for people in those states to know what’s going on and speak with legislators,” Collura explained. “RESOLVE can show up and advocate but if constituents, the people that vote these lawmakers into office, don’t show up it doesn’t move our issues forward. “If legislators are hearing from their constituents about how important it is, it changes their mind and gets them to support our issues.”

She said RESOLVE has put coalitions to work made up of doctors, patient advocates, attorneys, grassroots influencers and bill sponsors and hired a team of paid lobbyists to help advance legislation they introduced in those state capitols.

Mental health matters

The third initiative is restarting and reinvigorating in-person support groups across the country that were virtual during the pandemic. “We believe your mental health and ability to take care of yourself enhances and directly correlates to your ability to stay in medical treatment,” Collura said. “Connecting with others, finding a sense of community and taking care of yourself is vitally important to everyone as they go through this journey.”

Introducing federal legislation

With the overturning of Roe v. Wade, access to IVF was not federally protected. RESOLVE is hopeful that the Right to Build Families act that was introduced at the end of last year will be reintroduced this year. It aims to reintroduce to Congress the Right to Build Families Act that was introduced at the end of last year. “It would create a new law at the federal level that says people have a right to access IVF, medical professionals have a right to offer that service and people have a right over their embryos,” Collura said. “We’d love to see it in federal law, then states wouldn’t need to pass their own laws restricting access.”

On April 25, RESOLVE and the American Society for Reproductive Medicine (ASRM) will host a federal advocacy day, an opportunity for people to join RESOLVE and ASRM to advocate on a federal level. Participation is free.

“We provide training and an opportunity to tell you what to say, what the issues are, why these issues are important,” Collure explained. “We help people develop their own story and make it very bite size and succinct so that it will hit on the really important points members of congress need to hear.”

Meetings between participants, senators and state representatives are virtual and last 15 to 20 minutes. Most conversations actually take place with legislators’ staff who relay the messages.

“So many members of congress don’t know about all these issues,” Collura said. “This is our chance to tell them what’s important to us.”

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