Does the New Healthcare Law Affect Fertility Coverage?

Absolutely! Before the new law passed a few years ago, few patients in California had coverage for fertility TREATMENT. But most patients with insurance could get diagnostic TESTING paid for.

In the last 2 years, many plans have dropped coverage for the testing. This is because they are now required to cover many other basic services for patients including preventative services, birth control and nutrition counseling. It is a trade-off: the health of many versus the specialized needs of a few.

What does this mean for you? It is now more important than ever to see a SPECIALIST who knows which tests are most important and how to get those tests done at the LOWEST cost.

We have always been cost conscious at Advanced Fertility Associates. Now more than ever, that benefits our patients as they must pay a bigger part of their care.

Examples of how insurance coverage doesn’t work:

Cystic Fibrosis Testing: This is the most common genetic mutation that Caucasians carry. Traditional insurance covered this test that is usually OVER $300. The new, high deductible health exchange plans “cover” it but if you haven’t met your deductible, the entire cost will be yours to pay – between $350-800 depending on the laboratory.
We can get this test for you for only $99!

Hysterosalpingogram (test to check the fallopian tubes): Most plans no longer cover this. If your primary physician or gynecologist orders it, you may be charged $800-2000! Even if it is covered, you may not have met your deductible and still be responsible for the full fee.

At Advanced Fertility Associates, we can check your tubes for only $400!

Pelvic Ultrasound: Even if your gynecologist codes this as a non-infertility test, you may be responsible for part or all of the cost (depending on your deductible). Again, it can be as much as $1000.

Dr. Ratcliffe will perform a more specific and complete ultrasound at the new patient visit – for FREE!

Avoid Unnecessary Tests and Save Money!

The Science of Medicine changes quickly. We are still discovering new and novel treatments for old diseases and new diseases continue to emerge. This can make it hard for Doctors and Patients to keep up with the latest developments
Consequently, there are many doctors who still performing TESTS and PROCEDURES that have limited if ANY benefit for patients. These tests and procedures can cost the patient’s time and money and in some cases may even have the potential to harm a patient.

The CHOOSE WISELY campaign is sponsored by the American Board of Internal Medicine (ABIM), one of the leading medical societies in the United States. It is meant to educate Doctors and Patients to avoid harm and unnecessary spending.

The following document was produced by the ABIM and the American Society of Reproductive Medicine. It outlines tests typically done in the past for patients having a hard time getting pregnant. We now know that these tests and procedures DO NOT improve a woman’s CHANCE OF PREGNANCY, are COSTLY and can HARM a patient.

Click here for the CHOOSE WISELY document.

Protecting our Patients from Fertility Insurance?

95% of Californians do NOT have coverage for FERTILITY treatment
BUT they think they do. Why?

When a patient calls her insurance company to ask about fertility benefits she is told “yes, you have coverage for diagnosis and treatment for the underlying cause of infertility.”

Happy, she hangs up and finds a doctor that contracts with her insurance company.
But this is where the problem begins:

What this ACTUALLY means is that she is covered for the 2-3 blood tests that help to predict egg quality, the dye test to check that your tubes are open (hysterosalpingogram) and that’s it!

So what do they mean by “treatment of underlying causes”? This means surgery to remove polyps or fibroids in your uterus or a swollen fallopian tube. That’s it.

ACTUAL fertility treatment (ovulation induction with clomid or injections, intrauterine inseminations and IVF) are all SPECIFICALLY EXCLUDED in 95% of health plans in California!

By the time most patients figure this out, they have already wracked up multiple bills (because insurance is slow to process and deny claims) and suddenly can have THOUSANDS of dollars in bills that weren’t expected!

This is why we DON’T contract with the insurance plans and DON’T put off billing our patients. We want you to know EXACTLY how much treatment will cost BEFORE you start.

Don’t get caught in this common trap.
Call us: we’ll get an exact explanation of what is covered and not covered under your plan

BEFORE you spend any money.

Fertile Foods?

Can you eat your way to better fertility?

Yes and no. Mostly the answer is no. Diet changes can’t change your partner’s sperm count, the patency and function of your tubes (i.e. are they open and picking up eggs) or improve the quality of your eggs (since you were born with them).
This means that giving up alcohol, caffeine and other indulgences won’t necessarily improve your fertility!
But of course, too much of anything can be harmful, so limit the amount that you consume daily.

Speaking of too much: too much food WILL hamper your fertility. If you are very overweight (over a Body Mass Index of 30) or are GAINING weight while trying to get pregnant, you most likely ARE compromising your fertility.

In one study, fertility declined by 4% for every BMI point over 28! Weight can also cause some birth defects and lead to more problems with the birth that can harm the baby.

So if you are OVER WEIGHT, losing weight BEFORE conceiving is a really good idea. You will be more likely to get pregnant AND have a healthier pregnancy and baby. All Good!

How do you do that? Well the real truth is that exercise only helps a little. In women, limiting what you eat has a much bigger effect on weight loss. The best way to do this for fertility is a low carbohydrate diet such as the South Beach Diet or the Paleo Diet. Even small amounts of weight loss can have positive effects, so start today!