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Even when IVF is covered by insurance, high bills and hassles abound

Phil Galewitz, Kaiser Health News on

Published in Health & Fitness

Kaminski said the surgery center told her that it was likely to be added to the Blue Cross network soon, and she appealed to the insurer for a waiver to have the center’s care considered in-network. She was told by customer service agents for the insurer that she’d get the waiver, but she didn’t get that confirmed in writing. Still, she went through with the procedure.

It took place in 2021, and Kaminski again expected to pay about $2,700 out-of-pocket for the care from the IVF specialist in Winter Park. She knew she would face separate out-of-pocket costs for the medications used in IVF.

But because her care was deemed out-of-network by Blue Cross, Kaminski said, she was billed more than $6,000 by the clinic and its surgery center. That was in addition to nearly $4,000 in out-of-pocket drug costs.

Kaminski has spent nearly a year trying to get Blue Cross to treat her second round of IVF as in-network. She said it’s unfair for Blue Cross to have listed the Winter Park fertility clinic in its provider network if its doctors performed the actual IVF procedure in an out-of-network surgery center. The surgery center is owned by some of the clinic’s doctors.

In a statement to KHN, the Center for Reproductive Medicine’s executive director, Stephen Brown, wouldn’t address Kaminski’s case specifically even though she had given permission for him to discuss it. In an email, Brown wrote that the clinic was transparent with all its patients that its surgery center was not in Blue Cross’ network.

Brown said low reimbursement rates aren’t what has kept the surgery center out of the Blue Cross network. Instead, he said, the insurer didn’t act quickly, taking more than four years to add the surgery center to its provider network. “The reason for not initially being in-network with BCBS was based solely on the lack of response from BCBS,” Brown said.

 

Before any treatment is done, Brown said, the clinic gives its patients estimates of the costs of their procedures based on their insurance. Kaminski received an estimate that said she could expect to pay $3,000 to $4,000 just for the transfer of the embryos grown in the lab into her uterus.

In March 2021 — about a month after Kaminski completed her treatment — the Winter Park surgery center was added to Blue Cross’ provider network.

In February 2022, KHN reached out to the provider and insurer. Within two weeks, Blue Cross told the couple it would consider all the services they received at the surgery center in-network, and it paid all its bills in full. Kaminski and Pritt no longer owed anything to the center. Blue Cross had initially said it would pay a nominal portion of disputed bills that totaled $21,450 for care in 2020 and 2021 because the surgery center was out of its network.

Blue Cross also confirmed to the couple that in January 2021 it had granted them a waiver so all the surgery center’s bills could be considered in-network. Mistakenly, the waiver hadn’t been applied, so they faced the high out-of-network charges.

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©2022 Kaiser Health News. Distributed by Tribune Content Agency, LLC.
 

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