FertileCare Physician Service Agreement:
In general, there are three reasons why some couples fail to have a baby even with the help of a fertility specialist. Those reasons are: 1) The patient’s medical problems exceed the ability of current medical technology to effect a cure, 2) The patient and/or husband grow tired of the emotional distress and hassle involved with infertility treatments, and 3) The couple cannot afford the costs associated with infertility treatments. While there may be little that can be done for the first reason, the other two are easy to fix. We can keep patients from growing tired of treatments by quickly and comprehensively finding and treating the causes of their problems. In other words, do a complete evaluation within one to two months and then give the necessary treatments immediately. Finally, the cost issues can be addressed by making these tests and treatments affordable and within the budget of most working people. To deal with this cost issue, which directly impacts on your ability to obtain quick and comprehensive care, we have put together the following unique physician service contract.
As you may know, infertility as a diagnosis is not covered at all by the majority of insurance plans in the Midwest, while other insurance plans have only very limited coverage. If you look in your insurance manual under the section labeled Exclusions, you will probably find that infertility, artificial insemination, and medically unnecessary procedures are excluded from your coverage. Many of the causes of infertility come from common female disorders and, because of this, we are able to file an insurance claim for you and expect your carrier to pay a portion of your expenses. There are many services, however, that are uniquely infertility related and therefore difficult, if not impossible, to get your carrier to pay for.
An example of such a case would be the case of Jane Doe, our sample infertility patient, who recently had a diagnostic laparoscopy because of pelvic pain and infertility. (A laparoscopy is a telescope put in below the belly button to view the female reproductive organs). The laparoscopy showed that Jane’s tubes are severely damaged, causing her both pelvic pain (a legitimate diagnosis with her carrier) and infertility (a not too acceptable diagnosis). Subsequent to her surgery, we called her insurance company to pre-authorize Jane for some tubal reconstructive surgery. The insurance company wanted to know why the surgery needed to be done. We told them that the purpose of the proposed surgery was to repair the damage to her tubes and to help get rid of her pain. Some insurance companies would approve this surgery for those reasons. Others, however, would say that to repair the tubes would only be for the purpose of improving her fertility status and they will not pay for this procedure. They go on to say that they would pay to remove her tubes and the scar tissue or even pay for a hysterectomy, but not to repair her tubes. This decision by her insurance company not to pay could then easily cost Jane in the neighborhood of $12,000 to have the needed surgery.
Without insurance coverage, or with inadequate insurance coverage, the diagnosis and treatment of an infertility problem could cost you anywhere from a few hundred dollars to $20,000 or more during the first year of care. In order to avoid such a situation for our patients, we have come up with an alternative which will lock you into a fixed cost situation, with a fixed ceiling that should be affordable to most infertile couples. The cost of the Preferred Plan is comparable to the cost of an average dinner, 2-3 packs of cigarettes a day or the cost of a six-pack of beer a day. Most couples desiring a family can almost certainly afford such an expense to help them get all of the tests and treatments they will need to have a baby. Remember, one of the most common reasons couples fail to have a child is that they cannot afford to continue the necessary treatments. Now, you will not have to worry about quitting prior to getting the treatments you need. Ask yourself, "what cost am I willing to pay, to be able to have a family?" FertileCare is a way of helping you to realize that dream. Two of our five plans are listed below.
Gold Plan: This is our most all-inclusive physician service plan. It is a two year plan in which our office will perform any and all infertility related services that we provide to the general infertility population, as often as they are indicated, for a fixed price. That is to say, if you need 24 months of artificial inseminations, 3 laparoscopies, 2 major tubal reconstructive surgical procedures, and 50 office visits, it would happen for the one fixed price .... no added costs, no deductibles, no co-pays.
Preferred Plan: This plan is similar to our Gold Plan, however it lasts for only one year rather than two. In this plan, our office will perform any and all infertility related services that we provide to the general infertility population, as often as they are indicated, for a fixed price.
These plans provide the widest coverage to you and therefore hopefully enable you to have the highest possible chances of conceiving. The cost of these plans are the same for all patients and, unlike conventional insurance, do not depend on pre-existing conditions, how long you have had your insurance, your age or your state of health. Our service contract is not meant to offset, replace, or supersede any agreement that we have with any insurance company, only to act as a supplement to cover any infertility services which may not be covered under your existing policy, if you have health insurance.
We believe our service agreements are extremely cost effective plans that can potentially save you virtually tens of thousands of dollars. The most important aspect of this agreement is that it safeguards your budget and guarantees you that your maximum physician cost is fixed at the service agreement price. If you do not currently have the funds to initiate this agreement, financing is available through Jewish Hospital, in conjunction with a local bank with repayment over one to five years. If you are not interested in this service agreement, you can pay as you go, in the usual fashion and take your chances with your insurance. However, if you are interested and have any questions regarding our service plans, please feel free to discuss them either with Dr. Levin or Venica in our office.