Laying It All Out: The Challenge of Improving Fertility Care with Price Transparency

The cost of in vitro fertilization (IVF) remains one of the greatest barriers to infertility care in the United States. Among patients who do start fertility treatment, financial burden is often cited as one of the most common reasons for discontinuation of treatment. ¹ State infertility insurance mandates offer a solution for expanding access to fertility care in the absence of federal legislation. Jain et al. ² found that in states with mandates, insurance coverage for IVF was associated with a 277% increase in utilization rate of IVF, compared with in states without mandates. Moreover, another study found that IVF insurance mandates were associated with more than double the rate of IVF cycle utilization per patient. ³ When selecting a fertility clinic, many patients will review the clinic’s website to search for prices of fertility treatment, and the cost of treatment is often one of the first questions asked at initial appointments. Increasing price transparency has shown to improve patient-centered health care, helping make the best choices for each individual patient. ⁴

Imbroane and colleagues ⁵ conducted a cross-sectional study to determine whether assisted reproduction technology (ART) clinic website transparency of pricing differed between clinics located in states that do versus do not mandate IVF insurance coverage. The study evaluated whether websites included information such as service prices, accepted insurance plans, and financial assistance. A total of 311 Society for Assisted Reproductive Technology (SART) clinics were included, with 28.6% of clinics in states with mandated IVF coverage and 71.4% of clinics in states without mandated IVF coverage. Although the authors hypothesized that clinics in states without a mandate would have more website transparency, given that it would be beneficial to patients to understand the finances involved in treatment, they found that clinics in states with mandated IVF coverage were actually more likely to list specific prices (p = 0.001) and insurance plans accepted on their websites (p < 0.001) compared with clinics in states without mandated IVF coverage. These clinics were also more likely to mention discount programs (p = 0.002).

This study raises concern about the current state of fertility care and the barriers that a lack of sufficient pricing information regarding IVF on clinic websites creates for patients. Clinic website price transparency allows patients to identify clinics that accept their insurance and makes it possible for patients to know if various IVF procedures are something they are able to afford, contributing to informed decision-making. The study argues that updating the American Society for Reproductive Medicine guidelines to encourage SART member clinics to increase financial transparency on their websites may be beneficial and may lead to improvements.

This important issue, however, remains a challenge. The current state-specific insurance mandates of ART are extremely heterogeneous, with a wide range of covered services, patient eligibility requirements, and restrictions that vary by state. Pricing may vary by patient depending on the cause of infertility (e.g., oncology patients may have access to reduced pricing and other charity care services ⁶ or may have the ability to use a navigator that can aid in steering patients through the financial process). ⁷ Patients may be prohibited from using insurance, even if state-mandated, based on social demographics such as same-sex couples or single women. Furthermore, in some clinics, individual clinicians have varying acceptance of insurance; that is, Dr. Smith may accept Insurance A but Dr. Jones in the same practice does not. ⁸

This lack of uniformity in eligibility and pricing makes transparency difficult, as it becomes challenging to provide patients with accurate price estimates on a website. If inclusion, exclusion, and coverage were universally uniform, clinics would be better equipped to provide patients with correct assessments of out-of-pocket costs tailored to a variety of situations. Ideally, universal federal fertility coverage would remove existing barriers to care for all who need it, but for now, easily accessible, transparent price information is essential to patient care. Exploring possibilities such as creating a website where patients have the ability to enter their information and get a price estimate tailored to them, as exists with sites on car insurance or student loan repayment, may be a consideration for future care. It is important to note that although patients need to know what out-of-pocket costs for fertility services may be, the goal is not for patients to get the lowest price possible. The goal remains to have patients well informed on cost and fertility clinic outcomes in order to achieve the best results in the most accessible way possible.