If you’ve been following my blog for sometime, you know that I’m relatively open with what goes on in the Storjohann household in terms of finances. Some may think it’s weird, but I think it adds a level of transparency and ultimately shows that I, like everyone else, have my share of financial roadblocks. The below post is not meant for everybody. It’s a very specific post that I’ve felt compelled to write for some time and targets an issue that many couples today are facing, but that most also will never encounter. So feel free to read on if it applies, if you’re curious, or if you think there’s someone you know who may benefit. Approximately one in eight couples experience some form of infertility issues. My husband, Brian and I contribute to this statistic. When Brian and I first married, he was gung-ho to get on the baby-making-train right away. I however, was hesitant. I wanted to build my career, to travel, to have freedom… you name it. It took a few years for me to come around, but when I was finally ready to start a family,  it… well, it wasn’t happening. After the obligatory year of trying, the “don’t stress” comments, the  “just get drunk” comments and more, we started the round of tests to see if there was an issue. And to our surprise, there was. What proceeded was a yearlong adventure through the world of treatments, prescriptions, roller coaster hormone rides, and an IVF cycle, which ultimately culminated in a pregnancy as I’m now about 28 weeks along. The world of infertility is a scary and complicated place. The word itself is taboo and makes people feel uncomfortable. Add that in with the issues people have in being comfortable with their finances and you typically have an icky situation. Coping with the treatments, terminology and outflow of cash can be a stressful time. Here are the ways we handled it in our household (on the financial front) and what I’d recommend to anyone facing down the same beast.

Step 1: Stop. Breathe. Call Your Insurance Company

Upon receiving the referral or recommendation to consult with an infertility specialist, that is your cue to pick up the phone and find out every detail you can about your coverage. What’s covered and what isn’t? Are diagnostic tests included? Prescriptions? Treatments? The consultation with the specialist itself? You won’t have a lot of details to give your insurance provider at this point (aside from possibly knowing part of the issue behind the referral), but it will help to understand the amount of coverage you may or may not have with treatments. Questions to Ask:

  • Which procedures require preauthorization?
  • Does preauthorization need to be done for each cycle of treatment and how long does it take to get?
  • Are there restrictions on the type of healthcare provider who can perform infertility services?
  • Are there limits to the number of procedures or the maximum dollar limit on benefits?
  • Is there a co-payment for medical services?

Step 2: Schedule and Attend Your Consultation (Bring Your Partner and a Notebook)

I can’t stress enough how important it is to bring a pen and paper and take COPIOUS notes during this meeting. There is going to be a lot thrown at you. Do not attend this meeting without a partner and any appointments or meetings without a buddy, especially in the initial weeks of appointments. You’re going to be overwhelmed with information so it’s important to ensure you have someone else there asking the questions that need to be asked and getting clarification. Brian did a lot of the note-taking while I asked a lot of the questions. This allowed us to ensure we covered and documented everything.

Step 3: Ask (More) Questions

Most fertility clinics have a variety of departments they send you through. The doctors make the medical recommendations, but don’t discuss the finances. The nurses and assistants do scheduling and hold appointments, but also don’t discuss the finances. There’s a distinct department for that and you’ll likely need to hold your questions around the money until you get shuffled into the appropriate office. This is where it’s incredibly important to ask the doctor about the following in regards to your recommended course of treatment:

  • What diagnostic tests are needed?
  • What prescriptions are specifically involved and the quantities?
  • What is the breakdown of steps in the treatment?
  • How many cycles are being recommended in your treatment plan before another course of action may need to be considered?
  • What are the next steps if the recommended course doesn’t work?

Once you have the breakdown of the recommendations, you can then sit down with the financial consultant and begin to review costs. Ask about every line item and detail and ensure you have a dollar figure next to each prescription, treatment and test. Don’t worry about crunching the numbers while you’re there. You can process that when you get home.

Step 4: Call Your Insurance Company (Again) and Do That Question Asking Thing

Once you’re back home and able to process, it’s time again to make the call to your insurance company again and ask more detailed questions about your recommended course of treatment. (I swear I had Tricare on speed dial by the end of this).

  • Is there a co-payment for drug coverage and is prior authorization required for these medications?
  • Does the plan cover self-administered subcutaneous (under the skin) or oral medications?
  • Are there discounts for mail-order medications?
  • Will the treatment/procedure/medication be covered under my current coverage or under my major medical portion?
  • If yes, is there any limit of any kind-dollar amount or number of attempts? If no, are any portions of the charges covered for prescription medication, laboratory tests or ultrasounds leading up to treatment?

Note: Creating spreadsheets to track all of the numbers is totally fine and recommended. We especially did this when it came to shopping around for the best prices on our prescriptions for IVF. We’re talking hundreds of dollars saved by making a few phone calls.

Step 5: Have a Glass of Wine, Cup of Tea or Take a Walk

At this point you’re probably so worked up and boggled down by numbers, recommendations and unknown vocabulary terms that you need to unwind. Take some time to yourself to get away and clear your mind. Everything will be there when you get back and it’s best to de-stress in the midst of all this so you can think clearly as to what’s best for you and your family. Girls’ nights, date nights, letting the tears (and hormones) flow and late night calls with my best friend helped me immensely through this process as did building Workable Wealth and working with couples across the country to help them meet their goals. Determine what will help you cope on the road ahead and allow yourself time to process.

Step 6: Review Your Financial Situation

Now that you have a general idea of what the treatments will cost you with and without insurance, it’s time to look at your own personal financial situation. Specifically, you’ll want to review:

Determine where you currently stand in these areas. If you’re not the kind of couple that has a budget in place, now is certainly the time to take action in that category. It’s going to be incredibly important to understand where your money is going in the months ahead.

Step 6: Prioritize

There isn’t a price that can be put on building or starting your family. Each couple and situation is unique and you have to determine where this phase and step falls on your list of priorities. If you are currently saving up for a home down payment or a big trip, is that money that you’ll reallocate towards the medical payments for treatment? Perhaps you’ll cease making contributions and reallocate any future savings amounts towards your family planning goal. What are you willing to trim back on in order to go down this course and make room for the expenses? Only you can decide that.

Step 7: Create a Plan

Now that you’ve reviewed and prioritized, it’s time to put together a plan and determine:

  • How much do you currently have in savings that you can allocate towards payments without wiping out your emergency fund? Remember, this isn’t an emergency (as much as it feels like one).
  • What areas will you be cutting back on in order to save more for treatments?
  • Will you open up a separate savings account to handle all expenses and treatments?
  • If you don’t have the funds on hand to currently cover the costs, will you continue to save and build up your cushion or will you finance the expenses?
  • Should you obtain a second opinion and perhaps shop around for more affordable (but still quality) care?

Step 8: Review the Fine Print on Lending

Should you choose to go the financing route, consider if loans from parents or a family member may be feasible or affordable first. Your doctor’s office will likely have a recommended lender, but be weary of high interest rates and any kickbacks your provider may receive for recommending them. Shop around for better loan terms on your credit cards, personal lines of credit from the bank and consider other creative ways to fund the treatments if you’re insistent on borrowing. Remember the higher the interest rate, the higher the amount you’re tacking on to what is likely already a four or five-digit number. Do your research here!

Step 9: Get Creative, Start Saving & Make Adjustments

Fertility treatments are by no means a walk in the park, but if you’re being forced to spend money and it is money that you may already have set aside, take advantage of the costs by using a credit card that will earn you points towards travel or cash back. We would put all of our medical bills on our credit card and then immediately transfer the money from our savings to make a payment. This allowed us to stock up on travel points that we’ve cashed in for trips over the past few months. Now is the time to open up a separate savings account for this goal and set up your automatic monthly transfers. If you’re not using mint.com already, you should have your accounts synced up and be closely monitoring the areas you’re cutting back in.

Step 10: Stay Flexible, but Know Your Limit

There’s no straight path or guarantees when it comes to what will work. Our path lead us from the DIY route, to some prescriptions, to IUIs, to more prescriptions and giving myself shots, to IVF. (Imagine the dollar amount climbing exponentially here.) We were flexible, but we had a limit and one round of IVF was it for me – physically, emotionally and financially. If it didn’t work after one round, adoption was our route and we were okay with that. As mentioned previously, you can’t put a price on building a family – but it is important to know your limit. How much is too much money and/or too much time spent in these areas? If a treatment is not working, it may be best to take a physical and financial break and circle back when you have the funds built up again. It’s hard to keep the numbers in mind with such an emotional issue, but as it goes with many things with your finances, you shouldn’t put all of your eggs in one basket. While you may want to throw everything you can at this goal (which could work for a period of time), you can’t let it wreck financial havoc on your life. Remember to simultaneously continue saving for retirement, work back into stashing away in your travel fund and take time to dream and plan for other goals you have as a couple as well.