Ep 318: Age and Lifestyle: How They Interact

 Fertility Docs Uncensored Today’s episode of Fertility Docs Uncensored is hosted by Dr. Carrie Bedient from the Fertility Center of Las Vegas, Dr. Susan Hudson from Texas Fertility Center, and Dr. Abby Eblen from Nashville Fertility Center. In this episode, titled Age and Lifestyle: How They Interact, the doctors tackle one of the most common and emotionally loaded questions in fertility care: does age matter more than lifestyle when it comes to getting pregnant?
The discussion starts with a clear answer—female age is the single most important predictor of fertility outcomes. While lifestyle choices absolutely matter, age plays the dominant role, especially as women move into their late 30s and early 40s. The doctors explain why maintaining a healthy body weight, avoiding alcohol, cigarettes, and marijuana, eating a Mediterranean-style diet, and exercising regularly are all recommended when trying to conceive. But how much can lifestyle really offset age related fertility decline?
The episode also explores whether lifestyle changes have a bigger impact once pregnancy occurs. Why do heavier patients face higher risks of complications such as preeclampsia, gestational diabetes, and stillbirth? And can weight loss before pregnancy reduce those risks?
The doctors then address what happens in the early to mid-40s, when age often overwhelms lifestyle efforts due to declining egg number and increasing genetic abnormalities. Why do women at 42 or 43 struggle to conceive even when they are otherwise healthy? What role do egg genetics play at that point?
Finally, the episode answers whether chromosomal abnormalities are driven more by age or lifestyle, and why age particularly over 35 has the greatest impact, while lifestyle has minimal influence on egg genetics. This podcast was sponsored by Fertility Centers of Illinois at Milwaukee. 

Transcript

Susan Hudson (00:01)

You're listening to the Fertility Docs Uncensored podcast, featuring insight on all things fertility from some of the top rated doctors around America. Whether you're struggling to conceive or just planning for your future family, we're here to guide you every step of the way.

Carrie Bedient MD (00:22)

Hello everyone and welcome to another episode of Fertility Docs Uncensored. I am joined by my joyful jazzy jubilant co-partners, Dr. Abby Eblen from Nashville Fertility Center and Dr. Susan Hudson from Texas Fertility Center.

Abby Eblen MD (00:33)

Hi everybody.

Susan Hudson MD (00:37)

Hey everyone.

Carrie Bedient MD (00:39)

Okay, I have been diving into random websites and so my random question of today for you is what unpopular opinion do you have about food? So whatever type of food, whatever particular item of food do you have an opinion about that most people would go, uh-uh, don't agree.

Susan Hudson MD (01:02)

Bell peppers ruin the taste of anything they touch.

I'm telling you, that's exactly, there are people out there, you must be one of them, who are like, it's just color, it adds no flavor. ⁓ my goodness, no.

Carrie Bedient MD (01:19)

It's crisp!

Abby Eblen MD (01:20)

It does add flavor, but I usually like it.

Susan Hudson MD (01:25)

My goodness. I can literally say I have hated bell peppers since I was in utero. It was the one thing my mom could not eat when she was pregnant with me. And I do not like them. Literally, if you put a bell pepper next to another food, I will smell it in that other food, I will taste it in that other food. It contaminates everything about everything around it.

Abby Eblen MD (01:52)

Wow. Says the girl that's wearing the green sweater right now. This may not be anything that's weird. I was just thinking about weird things that maybe I like that maybe somebody else, my husband who is from the Midwest has never done this, but when I eat hash browns, I always get ketchup. I always eat ketchup with those. I don't know that's really unpopular or not, but. And then the other thing that he often will eat, is apple pie with cheddar cheese. And I'm like, why would you put the two of those together? But he seems to think they taste pretty well, pretty good together.

It's not bad, I would say. I would require cheddar cheese to eat apple pie, but that's his thing. ⁓

Carrie Bedient MD (02:38)

So my unpopular opinion, at least in the people that I see, sushi is huge around here. And I think sushi is so incredibly overrated for the lack of anything that goes into it. I will completely give credit that they are artists because sushi looks very pretty.

And it takes effort to roll it and to get it. No arguments there but as a food source like yeah… It's not all that. I would go and I would eat sushi if I had to. But if you give me any form of a choice, I'll try just about anything. But I don't see the point. I don't see it's worth the money. I understand why it's expensive because those fish are expensive. But I don't understand why it's such a big thing. I could go...shoot a rabbit outside and put it on a plate and say, here's sushi. And to me, it's the same thing. Also, I would have no idea how to find or shoot a rabbit just so we're clear.

Susan Hudson MD (03:49)

The fact that we're combining Rabbit with a sushi conversation is actually the oddest part of the entire thing.

Carrie Bedient MD (03:58)

I mean, it's not like in Vegas I could go out and find a a fish to shoot. Barrel or otherwise.

Abby Eblen MD (04:02)

Well, maybe you could if you like went to the Parisian hotel or to the Venice hotel and they had fish. Yeah. Bellagio fountains. Yeah.

Carrie Bedient MD (04:06)

Those fish are probably drunk. Okay, Susan, do we have a question for today?

Susan Hudson MD (04:18)

We do. Hello, I have a question for the podcast that I'd love to hear your feedback on. In 2017, I was diagnosed with cervical cancer stage 1B1 and had a fertility saving surgery called a radical trachelectomy. Now we've reached the period where I'm confident in moving forward with trying to conceive and my husband and I have been trying for nearly a year unsuccessfully. I'm 41, my FSH is 10.3, AMH 0.87, progesterone 17.5.

During the surgery, a permanent cerclage was put in and my cervix is 1.4 centimeters. We are meeting with a fertility specialist in less than a week and I am hoping for good news to proceed in trying IVF. My question is, have any of you performed IVF with someone who has had the surgery and if so, what should I be aware of? Thank you so much.

Carrie Bedient MD (05:09)

So I have not done IVF on someone specifically who's had a radical trachelectomy. For the most part, my cervical cancer patients have either been in a position where it's a LEEP or a cone or a full hysterectomy, or they still have it because it was advanced stage and surgery wasn't gonna help anyway. And in those cases, usually what we're talking about is multiple cycles of IVF oftentimes not because the ovaries have been impacted by the cancer itself, but because chemotherapy or radiation in that area was used. Now, the unfortunate thing about cervical cancer in particular is that it's very common for someone to have radiation as a form of treatment. And unfortunately, that radiation hits the ovaries and has a markedly negative impact on it with terms of egg quantity and quality.

And it also has a very marked impact on the uterus itself. I would say the vast majority of the time, we don't transfer embryos into the uterus of someone who's had more severe cervical cancer. I'm not talking about like the LGISL, the HGISL, the things that are dealt with with just a simple cone. We're not talking about that here. But when someone's had that big time radiation, they can't carry a pregnancy. Their lining doesn't get thick.

They don't have the blood flow to support the growth that is required during that. Those are more of the experiences that I've had with it. What about you ladies?

Abby Eblen MD (06:41)

Yeah, I haven't really had a patient that's had radical trachealectomy. I was thinking though, something similar, I was just thinking about the transfer procedure itself and obviously, you mentioned that you have a cerclage and my assumption is it's an abdominal cerclage. I do have some experience transferring patients with abdominal cerclages and generally with those, the cervix should be wide enough that you can transfer an embryo and also wide enough so that if you have a miscarriage, you could have a D&C or something like that. That would be certainly something to check out.

The length of your cervix, I think, is reasonable, but the other thing you start to worry a little bit about is with not much cervix there, in addition to the risks and things that Carrie talked about, which I fully agree with as well as far as the radiation impact on the uterus and the lining and all that, even if you implant a pregnancy, we worry a little bit more about a higher risk of things like stillborn babies. We also worry about a higher risk of the cervix dilating because cerclages are really effective, but they're not effective for everybody. And so if you actually go into labor where you're contracting, cerclage doesn't help that. It only helps if the cervix is thin and the baby's heavy and the heaviness of the baby causes the cervix to dilate on its own. If you go into labor and start contracting, however, that cerclage has to be removed before your cervix dilates around it and tears.

Certainly, in addition to seeing a reproductive endocrinologist, I'm betting that if you have not already seen a high-risk OB doctor, that will be your next stop because really they're probably the ones to really say that it's okay for you to get pregnant or not.

Susan Hudson MD (08:11)

I agree with all of you.

Susan Hudson MD (08:12)

There's something about spring that feels like possibility. The days are brighter, everything feels a little lighter, and for many of you, this may be the season you're thinking about the next steps in your fertility journey. If IVF has been on your mind, we want you to feel hopeful, but also informed. At Fertility Docs Uncensored, we spent years answering your questions and helping patients navigate IVF with clarity and confidence. And we took everything we've learned, plus the thoughtful questions you've sent us and created one comprehensive, easy to understand guide, the IVF Blueprint that walks you step by 

step through the IVF process in the same straightforward down to earth style you know from us. We explain what to expect, how decisions are made, and what really matters so you can move forward feeling steady and supported. Whether you're just starting to explore treatment this spring or already in the middle of it, the IVF Blueprint is designed to help you feel empowered every step of the way.

You can find it in print, ebook, and audiobook with a special conversation from the three of us at the end, wherever books are sold, and at FertilityDocsUncensored.com. If this season feels like a fresh start, let it be the one where you move forward with clarity, confidence, and real hope.

Carrie Bedient MD (09:30)

All right, so our topic today is insurance and fertility care and navigating some of the financial stuff about all of this. And I am going to say this right up front, insurance is a four letter F word for me. That maybe doesn't start with F because we...we struggle so much with getting the care that we need for our patients. And I have a feeling that all three of us probably have a million and a half stories of things that have made our blood pressure go absolutely through the roof. So this is not an insurance bashing episode, but I'm going to get off that soap box right now. So what we're going to do is talk about some of the different types of insurance plans that are out there, ways that you can approach it, and how you think about this as you're going through it. First of all, what is the general difference between an HMO, a PPO, and concierge medicine?

Abby Eblen MD (10:26)

So Concierge Medicine is basically where you pay a fee to see your doctor. And there's different types of concierge service, but essentially you're paying a monthly fee to basically have a doctor that really is at your beck and call. I've talked to different concierge doctors and they handle it differently, but like if you go to the emergency room, they go with you. Sometimes they don't. They do all the testing that you need in their office. I've even had, at one point I had concierge physician who actually came to my practice with this new infertility couple that I had. Basically he was there and it was great because I said, have you had a tube test? And he was like, yes, here it is right here. Have you had an AMH? Yes, here it is right here. He was actually incredibly helpful. It was great because patients were like, I don't know what we've had. And he was able to give me all that information. So it was very helpful to have him there. But I will tell you, those patients are probably far and few between because that's a pretty expensive thing for you to sign up for. But some people certainly have that.

Susan Hudson MD (11:25)

And when it comes to things like HMOs or PPOs, generally, both of them are going to be you have physicians to choose from. If you have an HMO, it's probably a much smaller circle of physicians to choose from. And PPOs, you tend to have more choice. You tend to have a little bit better coverage with PPOs. There's a lot of clinics that only accept PPOs that they don't accept HMO coverage because HMOs tend not to pay physicians and clinics well. That can make a difference. Just because you have traditional insurance in the form of an HMO or PPO, it's important for you to find out from your fertility clinic, which plans and providers do they accept insurance from. So Some of the big names out there, Blue Cross Blue Shield, Humana, Cigna, Aetna, there's others out there, but those are a few to give you an example. Not every clinic is going to accept all of those or even subtypes of those plans. So like at our clinic, we accept Blue Cross Blue Shield, but Blue Cross Blue Shield HMO,

They don't have a contract with us. It's a different platform.

Abby Eblen MD (12:46)

And physician's offices have to to negotiate those contracts separately.

Carrie Bedient MD (12:49)

What does it mean when someone is in network versus out of network?

Abby Eblen MD (12:54)

So you pay less if you're in network versus if you're out of network. So ideally you would like for your physician to be in network.

Carrie Bedient MD (13:00)

How do you figure out what kind of coverage you have?

Susan Hudson MD (13:04)

So on your insurance card, there is a phone number and you can call that phone number. There's oftentimes websites. I think they may not be quite as intuitive as a lot of websites are. They're not necessarily well written. So sometimes making that phone call, but it's important when you're looking at fertility care and you're speaking to someone that you understand that there's two sets of fertility care coverage. So you can have diagnostic coverage, which is all the testing and things that lead up to the diagnosis. And then you can have treatment coverage, which are things like inseminations or IVF coverage, that type of thing.

Abby Eblen MD (13:52)

Or you could have insurance and you come to your doctor's office and we say, gee, I'm sorry, you have no fertility coverage. And you say, well, I have insurance. You may have insurance, but they carve out fertility and don't cover that specifically. So it's really helpful for you to know that. And a lot of times with the doctor's offices, I know our office does this, we give you a preliminary idea of kind of what your coverage is so that you won't be shocked and have a really expensive bill when you come in if you come in thinking that you have coverage when you really don't for fertility.

Carrie Bedient MD (14:22)

If your friend who works across town at a different place and you both have the same insurance company, let's say you both have Aetna, you both have Blue Cross Blue Shield, whatever, and maybe you both even have the PPOs and she's got amazing fertility coverage, does that mean that you have amazing fertility coverage?

Susan Hudson MD (14:45)

Absolutely not. It is all determined by your employer. So your employer contracts with that insurance company and decides what level of coverage they are going to pay for. So as an employer, understand that the employer chooses certain things when they're figuring out what insurance they want for their company. And having fertility coverage is actually something that costs more for an employer when they're looking at how much they are paying in. And so that's a big reason why in a lot of states that aren't mandated that there's still a good number of employers that don't include fertility coverage with their corporate policies.

Abby Eblen MD (15:36)

And I would say too, the other factor is a deductible. And most people know this, but if you're younger and this is your first job and you haven't had, it's hard to understand how this works, when you pay for your insurance, you pay to start having coverage at a certain level, meaning after you've spent so much money, the insurance provider will kick in and start paying for it. And leading up to that, the part that's not covered is called your deductible.

And over the past several years, it's more more popular for people to get higher deductible plans, meaning your insurance coverage doesn't kick in until you've already spent a certain amount of money. And that could be $5,000, that could be $10,000. And so it's not too uncommon in January or February of the year, early in the year, I'll see people who come in and they're like, oh, I've got fertility coverage. And they do, but it doesn't kick in until they've already put in a significant amount of money, like $5,000 or $10,000.

So essentially you're paying everything out of pocket until you meet that deductible, meaning you get to that point where you've spent a certain amount of money, then the insurance will kick in at that point.

Carrie Bedient MD (16:40)

So how do you go about getting a plan that actually covers fertility? So for example, I have a lot of patients who they're self-employed and they say, I'm about to re-up my plan anyway, just which plan should I get?

Susan Hudson MD (16:57)

So if you're self-employed, it's a different issue than if you're not self-employed. If you're self-employed, you usually have some sort of insurance broker that you're working with that's going to help you figure out, what are the different plans out there? How much do they cost? If I have a fertility rider, this is how much is going to add on to the monthly payment and that type of thing. If you're an employee in a business, your number one thing to do is go talk to your HR and let them know that this is something that the employees need and want. But unfortunately, outside of that, other than finding a different job, there's often not a lot you can do. Now, if you are a couple and your partner has fertility coverage on their plan, realize you may not have access to it, even though it takes two to tango, it doesn't work that way. So in a lot of those situations, you may have your insurance through your employer, he may have his insurance through his employer, his insurance may have fertility coverage, but that insurance, unless you're actually under that plan, is not going to cover your IVF in a lot of situations, not all, but in a lot of situations.

Carrie Bedient MD (18:17)

So if you need to get into that plan when open enrollment rolls around, you need to make sure that you make that switch at that time. Usually open enrollment, at least I feel like it's always around November, December-ish, although I think that can differ from company to company. So know what the open enrollment plan time period is for the specific plan you're looking for.

Susan Hudson MD (18:31)

There's different companies. Yeah.

Abby Eblen MD (18:39)

And the other thing I would say is if you're looking for a new job or you're thinking about or new to town or whatever, say, and particularly nurses are great example. We have four major different hospital systems in Nashville, and they all have different levels of coverage. One covers multiple cycles of IVF. One covers a certain amount of money, like they'll pay $25,000 towards your IVF cycle.

Another one has absolutely no coverage because philosophically they don't think IVF is a good thing. If you work for them, you have zero coverage for IVF. If you're in a job like that and you're looking at some different options, talk to HR before you accept the job because that might be your tipping point.

Susan Hudson (19:18)

Finding the right fertility care starts with feeling supported and informed. At Fertility Centers of Illinois, you have access to advanced fertility treatments, IVF refund options, and flexible payment plans, making high quality care more accessible across Chicagoland and now Milwaukee. Take the next step toward parenthood with our expert team. Visit fcionline.com to schedule your consultation because your miracle is FCI's mission.

Carrie Bedient MD (19:47)

So everybody's used to the traditional insurance companies. What are the new kids on the block for insurance coverage that are relatively new over the past couple of years that haven't existed for forever and ever on men like the traditional insurance companies do?

Susan Hudson MD (20:02)

So there are some new, what I would call intermediaries called Progyny, Maven, Carrot, to name a few. And the way that they work is they contract with the actual employer and they have their own cutout for fertility coverage. They tend to have very good coverages for both diagnosis and treatment. But again, it all depends on if your employer has decided to have this special subset of fertility care for its employees.

Carrie Bedient MD (20:40)

And with that care, there's variation in it in the same way that there's variation in any insurance company. There will be some that have very limited coverage and there will be others that have nearly unlimited coverage. And again, totally dependent on what the employer has signed up for. That's not something most of the time that we have a whole lot of control of.

Abby Eblen MD (21:01)

But as a general rule, if you can choose one of those third party payers, you're going to be better off than traditional insurance. They are loads better. When I first started my career out, there was no one in our state that covered IVF. And I never thought I would see the day when about 40 % of our IVF cycles were covered by one of those third party payers. it will be really advantageous if you can get that coverage, even if it's not great. Still better than typical coverage.

Carrie Bedient MD (21:26)

Once we know that someone does or does not have coverage, and we've gotten into the diagnostic phase of testing, if someone doesn't have any coverage for their diagnostic tests, think the general blood work that we do, the physical exam and the cultures, the tube tests, the ultrasounds, the sperm test, what's one way that a patient can approach that situation?

Abby Eblen MD (21:51)

Sometimes things can be approached with your primary care doctor. There's some testing that may be able to be covered through them as opposed to being covered by a fertility doctor. So routine testing like blood counts, thyroid testing, things like that might be able to be covered by your primary care doctor and paid for with a regular insurance plan.

Carrie Bedient MD (22:08)

So if you have a doc that you can work with who will help you, if you just say, okay, my fertility center really wants this list, that can be a very useful way to get at least some things covered. But the diagnostic tests that are always associated with fertility, such as an HSG or the dye test, that one doesn't really matter who orders it. A lot of the time, it's going to be written as fertility and it will not be covered for that reason.

Susan Hudson MD (22:32)

And I think some of that has to go state by state. I think in Texas, it has more to do what the diagnosis code is. People sometimes be like, well, if my family medicine doctor ordered this, it's going to get covered. And for us, it really doesn't work that way. It just depends on if it's related to a fertility diagnosis. It doesn't matter who's ordering it. It either is or it isn't going to be covered. But other ways that you could consider paying for things.

Some clinics have cash pricing. So if you pay through your clinic, they may be able to help you get it less expensively than if you go straight to LabCorp or Quest or your local radiology center. That is one option. Another option is to consider looking at special loans that are intended for people who have fertility challenges.

Most clinics have established relationships with reputable loan agencies that specifically deal with people with fertility challenges. So you're not having to go to the bank and be like, I am infertile and I need a loan to pay for my care. That's not a conversation. You fill out a form, you find out in 30 minutes, it's done. It's a very smooth process. And then there's also the option of looking at things like grants.

Now, with that being said, there are not a lot of grants out there. There are some, they take time, they take applications and realize that most grants are going to be based on number one need. So it's going to you and your partner, if you have one, there's going to be a maximum amount that you can bring in as a couple. And it's also going to be based on the situation.

If you are a normal new patient, haven't been through fertility care, haven't been through any treatments, there's nothing extremely unusual about your medical or personal history, it's going to be hard to get a grant in that situation. If you've been through multiple cycles or you've had other health issues or something like that, those tend to be the cases where grants are more likely to be granted.

Abby Eblen MD (24:57)

One other really not common way that people can have coverage for basic tests that we do sometimes would be if you happen to be a blood donor. Blood donors, when you donate blood, you get lots of tests and you can always sign a release and send those labs to your doctor. So that will include like a blood count, that will include infectious disease testing that sometimes we need for different things. That's another way to get testing done for free. Basically, you don't pay for it.

Carrie Bedient MD (25:24)

I don't think I ever have thought about that or knew that that was even a viable option.

Abby Eblen MD (25:29)

I donate blood fairly frequently, so yeah, you can definitely do that.

Carrie Bedient MD (25:33)

So once you've gotten through all of the diagnostic testing and you're now looking at treatment, what are the general ways that fertility insurance treatment plans can work? You've got the straightforward ones where absolutely nothing is covered and that's self-explanatory. And then you've got the other side where absolutely everything is covered, which is also self-explanatory, but about as common as unicorns.

What are the ways in between that we typically see that insurance plans can be structured?

Susan Hudson MD (26:05)

So what we often see is there may be a dollar amount. So it could be $5,000. It could be 10,000, 15,000, 25,000. It can also dictate a certain type of coverage. What I mean by that is maybe IUI only is covered or IVF only is covered.

Or you must do a certain number of IUIs before doing…

Carrie Bedient MD (26:37)

Or a dollar amount that you can start with anything and it doesn't matter what you start with, doesn't matter what you do, but once the money is gone, it's gone.

Abby Eblen MD (26:47)

For the third party payers, often they sort of treat it as a pie. A pie might cover six cycles of IUI. A pie might cover IVF cycle where you create embryos. And then the other half of the pie would be the transfer. And again, the number of pies that you have, they structure them that way because you can visualize it better. But the number of pies that you get really depends on the plan as well.

Susan Hudson MD (27:08)

Also know that your pharmacy coverage and your other treatment coverage may not or may be altogether. Sometimes your medications come out of that medical benefit, but other times you may have a specific designation for medication and another specific designation for procedures.

Carrie Bedient MD (27:28)

It is well worth knowing that distinction for your plan because I have had cases where the medications were counted towards their total benefit and the amount that the insurance counted towards their medication, let's say they ordered, if they had paid a cash price, it would have been $4,000 worth of medication. The insurance counted it as seven to 10.

And there are certain situations where it makes more sense for you to pay out of pocket and use that benefit towards a different part of your cycle. This is well worth your time in diving deep because a lot of the medications have approximately the same coverage from one pharmacy to the next. You don't need to go diving for the absolute rock bottom prices that will suck up your time, energy, in general you don't get such massive improvements that it's extremely helpful. But it's well worth knowing if you may be better off buying your own meds because that will help your insurance coverage dollars go further.

Abby Eblen MD (28:36)

One other subtle difference with the third party payers, and this is really diving in deep, but for the few people that this has affected, it's a big deal. So for a lot of third party payers, at least here in Tennessee, so like Progyny or Maven, they may pay to create embryos. So if you have a partner, you're trying to create embryos, you're trying to get pregnant, they'll pay for that coverage, but a lot of people don't realize that they don't pay for egg freezing. Generally, clinics will let patients know that before they get the process started to make sure they're aware of that. But where it can really come to bite you is if you're intending, so you and your male partner are intending to create embryos and have a baby together, if something happens and he can't collect on that day, that day it turns into an egg freezing cycle and not creation of embryos. And that means that you may have to pay out of pocket what it would cost for an egg freezing cycle.

That just happened to me a couple weeks ago with a couple that I did IVF with. He couldn't collect and he didn't have a frozen backup specimen. So the one trick around that is just make sure, if that's the case, make sure he has a frozen backup specimen. We can thaw that out, fertilize the eggs, it doesn't put the pressure on him that he has to collect on that day.

Carrie Bedient MD (29:46)

So if you have insurance coverage and you know in general they're going to cover your cycle, does that necessarily mean that that will cover the clinic and the surgery center and the labs and the medications?

Susan Hudson MD (30:02)

No, because those are all different entities. They're not necessarily all different entities everywhere, but some of them are. I mean, where you're buying your medication from is always a different entity from your doctor. Your anesthesiologist is probably not going to be within that doctor system. It's often that you have to pay separate entities and each of those have to be contracted with whatever is happening. There's a lot of cooks in the kitchen when we're doing this. It can get a little confusing.

Abby Eblen MD (30:36)

Sometimes, and this happened a while ago with our office, some of the labs were not contracted, and you have to get the lab, generally, at your fertility doctor's office because we can run estrogen levels and get the results back the same day. There's really not any emergency room or anywhere like that that can do that because they don't need to get estrogen levels back the same day. If you don't have coverage through the lab, you have an issue. Some surgery centers, like Susan said, even though everything else is covered, one of the bigger expenses is the actual retrieval procedure and you have to pay a fee when you go to a surgery center. And so if the surgery center's not contracted, that can be a big deal too. So those are all things that you want to know on the front end before you ever start into your IVF cycle.

Carrie Bedient MD (31:18)

Embryology labs are a big one. You cannot price shop embryology labs. The center that you're going to has the lab that they use and they're locked together. Knowing whether they're covered or not is well worth the time. And the financial surrounding fertility treatment is in many cases very, very frustrating. The third party intermediary groups like the Progynys, the Mavens, the WINs, the Carrots of the world make things a lot easier, but they don't solve absolutely everything because there's always unknowns. And certainly when you're working with the standard insurance companies, they make money by not paying for things. And when you call to talk to them, get names, take notes, get it in writing, and be as detailed as possible because if you need to go back and fight that claim, you need to know because one of the other things that can happen with insurance companies is we may have to get a prior auth. And this is when we put in a request to do something before we do it so that we can have approval and know that the insurance company is going to pay for it. Prior auths do not happen quickly.

There's no emergency stat code for fertility. I've had many people been told that there is, and then my billing staff, when they put it on, they get laughed at of, that doesn't exist. We'll get to it when we get to it. And they do try and get to it reasonably quickly, but not necessarily in the, my period starts tomorrow, let's go, kind of quickly. The other thing is that, sometimes a prior auth or sometimes a benefit will be denied. Maybe we've got a protocol that doesn't match the exact protocol that the insurance company is going by. And we will do what's called a doc to doc call. Usually our billers will submit a bunch of paperwork first, that'll get turned down and we'll have to do a doc to doc where your doc gets on the phone with the insurance company's doc. And that doctor may or may not know anything about fertility. There are some companies that are really good where I'm talking to another fertility physician. There are others recently where I was talking to a pediatric ICU specialist.

Abby Eblen MD (33:28)

Yeah, usually not, I would say, in my experience. Usually, I don't think I've ever talked to a reproductive endocrinologist.

Carrie Bedient MD (33:33)

Yeah, there's one program where thankfully I at least get to talk to another REI. But most of the time we're trying to explain it and they don't know our specialty. I have sent them paper articles from journals that we have published with our success rates, and they still deny it. And sometimes they'll do it over what seems like really silly things like they'll pay for the retrieval and the thousands and thousands of dollars, but they won't pay for the monitoring estrogen levels because they think we're ordering too many. And other things like that. If you hit resistance, sometimes your doctor's office can challenge it. There's nothing like a squeaky wheel to get grease. It takes an awful lot of time, but that may be one route you have to go if you think you've got benefits that you're not being given.

Abby Eblen MD (34:21)

Although one thing I will say about the squeaky wheel, our billing department is really good at, like for example, Susan had mentioned, some people have to do a certain number of IUI cycles before they can do IVF. If that's written in your contract, that is non-negotiable. It doesn't matter if I get on the phone call and talk to a doctor, another doctor about it, it is not gonna change. Sometimes patients will, out of frustration, will be like, when Dr. Eblen get on the phone and talk to this other person at the insurance company, I always try and help patients out, but if my billing staff says, look, it's written in our contract, they're not going to change that for, no matter what I say, then I would just know that, your doctor wants to help you, but we can't make them do something if they already have specific guidelines written in the contract. It won't work.

Susan Hudson MD (35:06)

Another thing to keep in mind is that if you have had a permanent sterilization procedure, either you or your partner, meaning you've had your tubes tied or there's been a vasectomy, that a lot, not all, and it's fewer and fewer, but there are quite a few insurances with fertility coverage that exclude the situation of voluntary sterilization.

Just be aware if you've had your tubes tied or partner's had a vasectomy, you need to find out even if you're like, I have IVF coverage, you need to find out if your IVF coverage is still in place with the fact that you've had voluntary sterilization.

Carrie Bedient MD (35:49)

Will your IVF doc code something differently? Because if they do, it gets covered.

Abby Eblen MD (35:54)

We have to follow the Yeah, if it's true, we'll do it.

Susan Hudson MD (35:54)

If it's true, we will do it. We are not going to code something incorrectly that is not true because that's a felony and none of us look good in orange.

Abby Eblen MD (36:10)

We don't want to lose our license.

Carrie Bedient MD (36:12)

We worked a long time for those. We'll keep those.

Does insurance coverage usually cover third party reproduction, meaning a donor egg, a sperm donor or gestational carrier?

Abby Eblen MD (36:24)

Generally, no. Those are things that are not usually covered by third-party payers.

Susan Hudson MD (36:30)

There are some payers that may have some coverage, but I would say most likely donor sperm, then probably donor egg. And if you have gestational carrier coverage, I actually just had this this last week. I had a patient who was so excited. She's like, I have gestational carrier coverage. And I was like, that is great. Before we get into all the details, because it was kind of a gray zone of whether it was truly needed. I was like, how much coverage do you have? And she's like, I have $20,000. And I was like, that is great. I want you to know that if you're using a gestational carrier through an agency, you're probably going to have least $150,000 bill minus that $20,000. And she's like, we're going to use my uterus.

Abby Eblen MD (37:25)

I was gonna say I have never seen anybody with coverage for a gestational carrier. That's a new one.

Susan Hudson MD (37:31)

There's, there's a few that I've seen recently, but it's not it's not full coverage. I've never seen any company foot 150,000 gestational carrier bill. Have y'all? Yeah.

Carrie Bedient MD (37:45)

No, no, never. Sometimes I'll have patients who are gestational carriers who are trying to, like they're doing it for a friend, a family member, and they're trying to use their insurance to cover the pregnancy costs. But as a GC pregnancy, that's not always permissible. That's another thing. If you are using a gestational carrier, particularly if it's a friend or someone you know, that...specific question needs to be asked because just because they have insurance doesn't necessarily mean they can use that insurance for a baby that is not theirs.

Susan Hudson MD (38:17)

Also ask if you're getting PGT or pre-implantation genetic testing. Find out if your coverage includes that. There's a lot of insurances that will cover PGT-M, which is for if we're looking for a specific gene like spina muscular atrophy or cystic fibrosis. There are...Quite a few now that are covering PGT-A for aneuploidy, the abnormal chromosomes, but there's still quite a few of them that do not cover the PGT-A. So that's also something to be aware of.

Carrie Bedient MD (38:50)

I've also had patients where their insurance will cover the PGT-M for their specific condition, but they won't cover the IVF cycle.

Abby Eblen MD (39:06)

One last thing, this is a little bit related as well, if you're somebody who's interested in egg freezing, if you've had cancer, one resource, and it's not a lot, but it's better than nothing, is Livestrong Foundation, and usually fertility centers know about this and they'll let you know about it when you come, but Livestrong Foundation will pay for coverage for your medications. Usually if you have two or three days before you're get started, we have time to get all the paperwork filled out so that you can get coverage for medication for your...egg freezing cycle.

Susan Hudson MD (39:34)

But that coverage is only available before you do any chemotherapy. So if you've had any chemotherapy, then you don't qualify.

Abby Eblen MD (39:42)

And it's also need-based too, I should say. Everybody does not qualify. It depends on what your insurance is, and it's also based on how much money you make too.

Carrie Bedient MD (39:51)

Sometimes the government will give some additional support to fertility patients in the form of if you live in what's considered a mandated state, meaning a state that requires fertility coverage to be a part of insurance. So this is Illinois and Massachusetts among several others, that can be really helpful. So if you're looking at two jobs and you need fertility treatment and one of them is in one of those states, that may be real helpful for you.

Susan Hudson MD (40:16)

And your employer could be based in one of those states. You may be in one state, but your employer is actually based somewhere else. Your Blue Cross Blue Shield may be Blue Cross Blue Shield of Illinois, but you may live in Texas. So.

Abby Eblen MD (40:22)

Right. Yeah, I just had a patient this past week who works at Crate and Barrel and they're based out of Illinois and she has Illinois coverage, which is great.

Carrie Bedient MD (40:37)

Yes. The other way that they may help, and we're really still waiting to see how this evolves, is there's some thought that it may be helpful with medication pricing. That is so early in evolution, we haven't seen how that's going to play out. It's certainly not going to make IVF free for everybody. It's not going to make the medications free for everybody, but every little bit helps. keep your eyes out if you're listening to this at some later date. Go back and look and see if there's any government coverage for medications because who knows how that one's going to turn out.

Abby Eblen MD (41:08)

I believe the cost as of recently, we just had a rep in our office Thursday or Friday and the cost has already dropped down. So I think it's in fact for certain, through certain pharmacies.

Carrie Bedient MD (41:17)

Awesome.

All right. Well, any other tips, tricks, tidbits about insurance that you ladies can think about for people to navigate this system and whatever adjectives you choose to apply to it.

Abby Eblen MD (41:31)

I think we've covered lots of great things and I think it's really important that you make sure that going into your doctor's office, if you can find out some things before you even go, that's gonna be even better. You'll know a little bit more and understand a little bit more about your insurance, but also your fertility clinic also is usually, most fertility clinics are willing to help you out with that, but the more you know when you go in the better.

Susan Hudson MD (41:54)

Absolutely.

Carrie Bedient MD (41:55)

All right, well, to our audience, thank you so much for listening. Please subscribe to Apple Podcasts to have next Tuesday's episode pop up automatically for you. Be sure to subscribe to YouTube. That really helps us spread reliable information and help as many people as possible.

Susan Hudson MD (42:08)

Visit Fertilitydocsuncensored.com to submit questions and sign up for our email list. Pick up your copy of the IVF Blueprint today at Amazon, Barnes & Noble, or your favorite bookstore. Check out our Instagram and TikTok for quick hits of fertility tips between weekly episodes.

Abby Eblen MD (42:25)

As always, this podcast is intended for entertainment and is not a substitute for medical advice from your own physician. Subscribe, sign up for emails, and we'll talk to you soon.

Bye!

Susan Hudson MD (42:36)

Bye!