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The gap between provider care and financial counseling may be costing you patients.
This episode focuses on that gap.
Joining the conversation are Dr. Allison Bloom, practicing REI at Main Line Fertility, and Cheryl Campbell, Director of Operations at BUNDL.
Together they examine:
Where the clinical care and financial counseling should intersect
Why patients fall out of care between the provider visit and financial counseling
What physicians and financial counselors should (and should not) communicate
How misalignment leads to patient drop-off (Even among insured patients)
How better preparation before the provider visit improves conversion and retention
Why “covered” patients often still lack sufficient financial guidance
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Allison Bloom (00:00)
Finances come up very often on the first visit. I think patients are nervous when they come in. I think you sense that and you have to make them comfortable. I very rarely get through a new patient consult without people asking me, well, do I have coverage for that? Or how much is that going to cost? Financial counselors, again, have a huge role to play to educate the patients about their insurance and their coverage.
Griffin Jones (00:33)
If you'd prefer to continue losing and frustrating fertility patients at one of the most pivotal points of their clinic journey, skip this episode. Many of your patients are dropping out in that phase between the provider and the financial counselor because the baton wasn't properly passed. I bring on an expert financial counselor and an REI who have each put a lot of thought into how their roles in the process come together. I scrutinize where those roles converge and diverge so that you providers and managers can build a better patient experience convert more needing patients to treatment and serve them better.
The doctor, Allison Bloom, a practicing REI at Main Line Fertility in Philadelphia, who handles a lot of third party cases, and Cheryl Campbell, director of operations at BUNDL who manages and coaches financial counselors.
How many children do you want to have is the question that builds our bridge between these two roles. But Bloom and Campbell make it clear what doctors and financial counselors should and shouldn't say.
A large percentage of covered patients don't have sufficient coverage and they're not receiving the financial counseling they need to retain and help patients later.
This is a huge missed opportunity that partners and executives should be paying attention to.
Bloom and Campbell share tips for preparing the patient to engage in the follow-up that works.
including meeting with the financial counselor prior to the visit with the provider.
Dr. Bloom shares why her practice keeps using BUNDL so frequently.
If you get this handoff right, you will better serve your patients and you'll improve your practice's top line dramatically. Enjoy.
Allison Bloom (03:03)
that patients are nervous. think...
Patients feel sometimes embarrassed walking into the clinic. They feel like there's something wrong with them and they feel ashamed. They feel alone often in the journey that they have no one to talk to. And I think it's really important that we sort of provide a setting where they don't feel alone and they feel supported and feel like that we're a family for them and yeah, make them feel supported in the journey. I think that's often something that they come in very fearful of.
Griffin Jones (03:32)
Where do you think is the appropriate limit to that? Because I could see hitting a ceiling where you just can't provide all of the support that someone's gonna need. You can't fill in all of the rules for what a partner maybe should be doing, or friends should be doing, or relatives maybe should be doing. Where do you think is this is what we need to do in the practice versus I've taken it as far as I can go?
Allison Bloom (04:00)
Yeah.
I think like you said, think making sure that the partner's on board and I think having the partner at visits is really helpful because often the partner doesn't understand what the other partner is going through and I think explaining things in person is really helpful so that they know it's not their fault and that there's things that can be done to help them. I think not only as the physician but as a practice in terming your staff of being supportive of it and I think if that's on
enough just getting people on the outside and giving support in terms of ⁓ mental health providers and support groups and resources online to support the things we can support within our clinic and within their family structure.
Griffin Jones (04:44)
So do you see it more as like the emotional needs come make themselves more visible first before like the logistical needs that, you know, like people saying, are they bringing up to you issues about money or paying for treatment or coverage or did they leave all that stuff for the financial counselor? Like, are they broaching that with you or is that kind of happening down the hall and you're mostly talking to them about their case?
Allison Bloom (05:11)
No, think finances come up very often on the first visit. I think patients are nervous when they come in. I think you sense that and you have to make them comfortable. And I think that starts at the front door, at the person greeting them in the office. And by the time they reach you and sit down in your office, you hope that some of that nerves and that energy has become more relaxed because of the people around you have set that tone. But by the time they sit down you and you start to talk about care,
I very rarely get through a new patient consult without people asking me, well, do I have coverage for that? Or how much is that going to cost? Or if we start talking about their family size and what I think their best treatment plan is, they often ask, I need to talk to the financial person. Or is there someone I can talk to about that?
Or I need to call my insurance company.
Griffin Jones (06:02)
How do you respond?
Allison Bloom (06:05)
⁓ Well, we're very lucky that we do get, I call them these little cheat sheets, which has been a game changer in our practice. Our team really runs their insurance prior to coming in. you know, as physicians, we don't say that we know everything about their coverage, but we do get sort of a basic overview of what their coverage is. So we can at least reassure them or tell them something that first day as.
Yeah, you coming in for your basic diagnostics. Yes, you have some coverage for that. Or yes, you have some coverage for IUI or IVF. Now we don't say that what that is, but at least we can give them some basics there. We also say that we do have financial counselors available to help. And then I do, I also talk quite a lot about, know, that fertility coverage doesn't often cover everything. And sometimes when people don't have coverage that there are other resources out there like
BUNDL and also some financial programs that can help finance some of these things. Because my goal is to build their family, not just to have that one baby. I always sort of ask the first visit, what do they see their family looking like? And that's my goal. And a lot of times people are so afraid that they just say, well, I just want a baby. And I say, well, what do you see your family looking? And they say, well, I really want two or three babies. I say, well,
Well, that's our goal is two or three babies. Let's see how we can do that.
Griffin Jones (07:25)
I hear some people say that the doctor really shouldn't be talking about finance or insurance stuff at all. And then on the other hand, I see your point of people are going to bring it up anyway. So maybe the cheat sheet is the nice solution in that spectrum. But where do you side in that debate for lack of a better framing? What do you think is the doctor's appropriate role with regard to talking about?
those topics that you just mentioned in your cheat sheet and then where is it time to move them on to somebody else?
Allison Bloom (07:58)
Yeah, I think that depends on what you're comfortable with.
I think every doctor is different. think some physicians may not want to be burdened with understanding the intricacies of coverage. And I don't mean to say that I understand all the intricacies of coverage, but I know that there are some coverages out there that we understand very well and that they're very simplified when it comes to fertility coverage. And we work with them so much that I think that we can guide our patients how to best use that coverage.
Cheryl Campbell (08:07)
Thank
Allison Bloom (08:28)
And I think it's important and I often say to patients, hey listen, from a medical standpoint, I don't know necessarily that you need to do IVF, but from a benefits standpoint, this may be the best way to use your coverage. For example, I see a lot of same sex couples with donor sperm who want multiple children. Doing IUIs with donor sperm for multiple children may not be cost effective.
Cheryl Campbell (08:42)
Thank
Allison Bloom (08:51)
Do they need IVF because they have infertility? No. But should they know how to understand their coverage and make that informed decision? Yes. And I tell them that. I'm not telling you to do IVF. You need to understand your coverage and make an informed decision of how you want to approach this journey. And then you let me know how you want to approach this journey. And then we will approach that together with how you decide.
Cheryl Campbell (09:13)
thing.
Griffin Jones (09:17)
You sound pretty comfortable talking about it. Is it just the cheat sheet that's made you comfortable? Or have you had special training? Or are you more inclined to talk about personal finances in other parts of your life? is there something else that you feel like makes some of your colleagues not as comfortable as you are?
Allison Bloom (09:21)
Yeah.
No, I am not very good at other financial things. I just, I think I just care about...
the patients as a whole and I think the financial burden is real. And I really feel for the patients who can't get to where they want to be because of the finances. And I think I take that into consideration in all my care. I don't just treat everybody the same way. And I don't think every single person needs every test and every single person needs the same treatment. And I try to meet patients to where they're at because not everybody can afford something.
And if they really need a certain treatment, then I try to find a way to get them there either through, you know, again, you know, a financial program or through a BUNDL or sometimes even through a research program if we have it.
Griffin Jones (10:26)
Well, now I'm going to go to my financial counseling guru. There's a handful of financial counseling experts that I go to when I want to ask about this stuff. Cheryl Campbell is at the top of that list. And Cheryl, do you like that idea of doctors talking about finance? I think of it from a client services perspective. Like sometimes there's project managers. They don't want the strategist saying anything about project management. They're like, don't mess up.
Allison Bloom (10:29)
You
Cheryl Campbell (10:30)
No.
Griffin Jones (10:51)
the stuff, you're going to set some wrong expectation. Do you have any of those kind of reservations about doctors talking to patients about the financial process?
Allison Bloom (10:52)
Thank
Cheryl Campbell (11:02)
I think it's great. And in fact, I think when patients come to us to talk about BUNDL and they've had maybe a slice of this type of conversation with their doctor, I think it assures them because I think they're feeling that, you know, they're counting a lot on what the doctor is saying. And so, you know, I think the doctor talking a little bit about, you know, what your coverage might be, what the financial piece might be, it really helps us. We never want doctors to feel, you know,
that they have to go down that road because we're happy to take that piece and kind of go with it and make sense of it against the backdrop of what they're hearing on the clinical side. We ultimately want the docs focused on what the clinical piece is looking like, what the plan looks like, and then let BUNDL kind of fill in. But it's always great when doctors feel that, find their level of comfort with it. Because I think it assures patients that, okay, we're all in this together. We're all partnered up in this. We all want the same goal.
Griffin Jones (11:56)
What about when they don't find that level of comfort and you want them to shut up? I don't think that many, not most, but many or at least some REIs are anywhere near, have the knack that Dr. Bloom does. And so are there times where you're having a patient come to your team with some sort of expectation in mind or some kind of framing in mind that you think,
Cheryl Campbell (12:00)
Hahaha!
Griffin Jones (12:23)
I wouldn't have said it that way.
Cheryl Campbell (12:27)
Sure, yes, there might be some points to our program where docs might misspeak or, you know, maybe get it a little wrong. Certainly nothing intentional, but like, for instance, with our refund program, you know, you want to be careful. We have to clinically qualify people for that. We think we do a really good job of getting a lot of people in that program. But, you know, there is a sliding scale of criteria. And I think if a doc is saying, hey, they've got a program, 100 % guarantee you can get in, you know, we want to kind of
pump the brakes on that say, well, let us take a closer look at everything. We try to counsel docs to say, if you have a 28 year old sitting in front of you, you can say they're going to get the refund program because they will. It's really kind of the sort of more advanced maternal age when we're getting into 36, 37 year olds, we want to take a look at more. So sometimes there can be patients coming to us saying, hey, I hear I'm going to get into this refund program. And my doctor said, I'm a good candidate. so we just have to kind of roll it back a little bit, take a deeper look, but
nothing real. mean, we don't see many doctors kind of quoting prices, things like that. So short of that, I think any information is easily, you know, we can redirect it or, you know, kind of work with the patient on it if it's a misspeak.
Griffin Jones (13:39)
How should docs be setting up the conversation with the financial counselors so that the financial counselors are set up for success?
Cheryl Campbell (13:48)
Well, think that, I mean, for BUNDL, right, we're solving for not only trying to help patients on the financial side, but really be a multi-cycle option, right? It's that elephant in the room. We know 60 to 70 % of patients are probably going to need multiple rounds of IVF. So that's really kind of where BUNDL's biggest hurdle is. And so I think for financial counselors, the ideal
back and forth with doctors would be, hey, this is a good candidate, you know, just to know. And again, our doctors are range in terms of what they'll do. Some may not want to speak about multicycle at all, and that's fine. Some patients will bring it up and Dr. Bloom, you correct me if I'm wrong. I mean, some patients are like, I wanna, I'm gonna do this. I wanna go twice. I wanna go, I want three cycles. I'm building a big family. I wanna go back to back on retrieval. So some patients will advocate for that themselves. But I think as far as the financial piece,
piece to the physician, it really is, is this a good candidate for multicycle? Is it a self-pay patient? Is it a patient with spotty or minimal insurance? Because even though BUNDL sits in that kind of self-pay bucket, we really want to talk to patients that are even minimally insured. Because even though patients might have some coverage now, by April, May, I want to make sure those patients come back to me if they've maxed out on any benefits. I think it's just creating that whatever that
connection works between the financial counselor and their physician to sort of say, hey, this is a patient that really could use some exploration with BUNDL. And I think that it's just trying to keep that line there. And some doctors want to feel better about it than others.
Griffin Jones (15:27)
Do you either or do you want to train physicians so they ask the question that Dr. Bloom had mentioned, which is how big do you want your family to be? How many children do you have? Do you train them on that or do you want to be training them on that to start the conversation that way?
Cheryl Campbell (15:43)
Well,
it's funny that it came up because it's exactly what we try to say to docs. You don't have to say much, but you know, and we say it too. What does your family planning look like? What is it? What is your thought? Because we want to make sure from a BUNDL standpoint that we put them in the right program because our programs have different variations to them. So we're psyched if that's the question. Yes, I think rather than, you know, say mention multi-cycle mention BUNDL, it really is that. What is your family plan? What does it look like? What's the plan? What do you want?
Allison Bloom (15:47)
Yeah.
Cheryl Campbell (16:13)
Because I think a lot of patients are, want a baby, I just want a baby. Well, you know, here we are. Do you want three babies? you like, you know, it's kind of and then they kind of have that aha moment, where it's like, yeah, I didn't I thought I could just, I just I just want that baby, because I'm struggling and I'm having such a hard time. And so I think that that is such a soft landing, such a great way to start that conversation. So I guess to answer your question, yes, if I think there was one thing
that we could really talk about is really just that. Because I think it naturally then moves towards, well, here's options, right? We have a program that you can do back to back and save money and get your transfers. Because remember, you need transfers for a baby. And it just kind of creates that entire conversation.
Griffin Jones (16:58)
Allison, when did you start taking that approach? Because I don't think it's immediately obvious that REIs do that or should do that. My PCP doesn't ask me how long do you want to live for? How old do you still want to be able to climb up stairs for? How heavy of a grandchild do you want to be able to lift when you're in your marginal decade of life? My PCP isn't asking me those questions. And maybe they should.
So I don't think it's immediately obvious approach. When did you start?
Allison Bloom (17:28)
something I kind of did from the beginning and I think I got it from some of my mentors ahead of me but I think where it really became transparent is again I think I see a lot of same-sex couples with donor sperm and I think that's another place where you really have to plan ahead how many vials of sperm do you need and in order to know how many vials of sperm you need you need to know how many children you want if you want the same donor and I think
that that is such an integral question in that population. And I think it goes to the insurance piece as well. So I think it was something I learned from mentors. I think it's really important in the donor community. And then it's equally as important when you think about coverage and cycle planning. Like Cheryl said, think patients don't understand that not every IVF cycle is going to result in an embryo. Patients don't understand that not every
IVF cycles are gonna result in enough embryos. But if you don't tell them that, they're not supposed to know that. So it's really important that you educate them about their own body and their own numbers and their own expectations. To me, I'm very transparent with the patients and it's not being negative or positive, it's being realistic. And it's setting expectations so that they're not disappointed, but that they're also planning for
the possibilities of needing more than one cycle. And if they go and they save all their money on this one cycle and they have one embryo.
fails and they're heartbroken, well, we didn't give them what they wanted. And we didn't do a service to them. So I'd rather be honest with them and then prepare and maybe wait six months and get the money or however they need to do it and get them into a program that is going to get them to their end goal than just tell them not the truth or not be honest with them from the get-go.
Griffin Jones (19:19)
So it's an interesting point about third party IVF though, that if they are going to want to have the same donor for subsequent children, that's something that they're going to have to think about now. is it something that, I mean, the need is equal across cases, or maybe not, it's extremely important across all cases, but that it's even more of an obvious sort of nudge with third party?
Allison Bloom (19:43)
Yes, absolutely.
Griffin Jones (19:45)
Jill, is it an important question? Is this a question that only the provider should be asking or should the financial counselor be asking the question, how big do want your family to be? How many children do you want to have regardless of the discussion that has happened with the provider?
Cheryl Campbell (20:01)
think that's a tough one, right? Probably not. That might not be the juncture where that's happening. Look, financial counseling is a quick, mean, for the most part, it's overwhelming. And part of why BUNDL exists is to help being an extension of that. Financial counselors, there's a lot. These are busy. Allison's in a very busy clinic. A lot of our network is very busy clinics. Financial counselors have a lot. And so I think that it's...
It's hard to get granular, right? At that discussion. You wanna hope that they're passing along, you know, a good bucket of information because again, to Allison's point, I think it's information, options, transparency. Like patients don't underestimate how much patients want that, right? They wanna know what they can know. We educate all day long in the best way we can from our standpoint. So I think patients just, want the options, they want the information and understanding.
I think financial counselors just have a shorter window with the patient and not because they don't want to give them all the tools they can give them, but I think it's just a different juncture. So when we are able to, again, be that extension with financial counseling, we can get into more of the weeds on things and kind of really talk through the stuff that maybe had been touched on the surface and then try to sort of you know, kind of meet that out a little bit better.
⁓ But the financial council, it's tough because I think it's just a smaller window.
Griffin Jones (21:26)
Allison, when I asked that question, you had a little bit of a trepidatious look on your face like, I don't like that idea. Tell me about that.
Cheryl Campbell (21:27)
Yeah.
Allison Bloom (21:30)
Yeah.
just think the financial counselors, again, they are busy and they have a huge role to play to educate the patients about their insurance and their coverage.
And they don't have the medical background. So for them to intervene and start to give advice about how to use their coverage in terms of what medical path or what interventions to use, I don't think is the right place.
Now, where I think that we can do better is educating patients how to optimize their coverage, meaning sometimes patients don't have enough coverage. And I don't think we do a good enough job of teaching patients, and not just us, but the insurance companies, of teaching patients of how to optimize that coverage. For example, patients spend a lot of money of their coverage on medications. And if they pay for their medications out of pocket,
then those medications are actually cheaper and they'll have more money to use towards procedures and cycles. But the patients don't understand that unless you tell them that, right? So again, this is me probably overstepping, but I tell the patients, ask these questions, know, find out how much your medications cost through your insurance or if you self-pay, right? If we know we're gonna need to do more than one cycle and you have X number of dollars through your insurance,
then let's see how much we can get from your insurance to pay for your cycles and then you self-pay your medications. But this is something that, why should the patients know this? Someone has to teach them this. So these are the things we need to teach our financial counselors how to educate the patients on. That is a role that is appropriate.
Griffin Jones (23:13)
That particular concept of paying for meds out of pocket because they're cheaper that way. Do either of you or do any of us know yet if that's as true, less true, more true with TrumpRx?
Cheryl Campbell (23:27)
I know, I don't know. Yeah, not sure.
Griffin Jones (23:30)
That will be something that's interesting to pay attention to. wonder if it becomes more true. I really have no idea. Cheryl, you mentioned you want them being the doctors to get good information for the financial counselors so that you have more to work with. What other information would you like them to have uncovered other than the desired
Cheryl Campbell (23:33)
Yeah.
Griffin Jones (23:55)
size of family.
Cheryl Campbell (23:56)
the FCs to get at their first console kind of thing.
Griffin Jones (23:57)
No,
the that you want would have wanted the providers to have have uncovered so that the FCs already have that information by the time they're meeting with them
Cheryl Campbell (24:07)
Right.
Well, again, I think what anything that points to the clinical plan, right? I think that anything that the docs can uncover and then, and again, every clinic is different, I think, with when that financial counseling piece comes in, it could be, you know, post conversation with the doc, maybe it's pre, although I'm guessing most of the time it's kind of, you know, they go to the doc and then there's literally sitting down with the FC to talk about, you know,
that financial piece, but I think that at that juncture, it's great if they can know anything about the plan. Again, for us, is it a multi cycle?
Griffin Jones (24:41)
Is that to say
that you're seeing a lot of notes that have very little reference to a clinical plan or none?
Cheryl Campbell (24:48)
Sometimes,
yeah, sometimes I think sometimes when we get a patient cut over to us, they're not, the FC may not be 100 % sure fully what the plan is or how that's computing to what the financial, and again, I think this kind of piggybacks on what Allison is saying, which is it's just building a little more education at that level. That is a frustrating level for a patient when,
Okay, they're feeling good now about what they heard in the clinical side. Okay, I need these diagnostics. I might need meds. I can maybe understand. They get to the financial counseling piece and they're hearing a little bit of what you might have coverage. We think you have coverage. We have this plan, which is multi-cycle. We've got this plan, which is a grant. It's a little overwhelming. And I think that...
it's that's the moment to kind of tie all these pieces together and really help the patient. And I think that we're not always getting the full picture when we get a patient. And I think that it's just the financial counselors. Again, it does come back to education and what we'd like them to kind of feel comfortable. We're not asking them to kind of get an AMH necessarily, but you know, just some idea of, is this an IUI patient? Is this potentially a donor patient? Is this the same sex couple? Is this, just like,
That really helps us when we're trying to counsel, when we take the patient over and say, okay, BUNDL's got this program for you. And so we stumble and stutter a bit at that juncture where we're counting on that clinical refer. We're counting on wanting those patients to know about BUNDL. The worst conversation is when somebody didn't know about BUNDL. So first and foremost, just let patients know there is this option.
It may be out of the realm of anything they can do, but we certainly don't want them to never know that there isn't an option for them. So that's the main thing. But I think that it's something cohesive, a little bit more understanding of what that journey is going to look like for the patient at that moment. And I think sometimes it's a little spotty with the information that comes over.
Griffin Jones (26:46)
Allison, when FCs have spotty information or a lack of indication on what the treatment plan might be, is that from poor note taking? Is it something else? What does that come from?
Allison Bloom (26:59)
yeah, well, I mean, sometimes at your first visit with a patient, they don't know the plan, which means we don't know the plan, right? So if you have a patient that comes in with primary infertility or secondary infertility, you're laying out a diagnostic cycle for them, right? And then you're laying out really two treatment options generally. You're laying out a medicated IUI path and an IVF path.
And honestly, sometimes it comes down to what's covered and what they can afford. And part of that financial counseling visit is for the patient to understand their coverage and to understand what they can afford. And unfortunately, a lot of patients are forced into less effective treatments.
because they're cheaper or that's what they can afford. And sometimes for some patients that might not be the right treatment. That treatment might actually pose higher risk, like higher risk on multiples. But that visit may not, they may not go into that financial counseling visit with a set plan. That financial counseling visit is the visit for them to figure out what they can do financially. And I think that's very common in way that they approach that visit.
Griffin Jones (28:14)
this would be an entirely different topic. So I don't want to take us too far down this rabbit hole, but I do want to explore it to see where the edge of our conversation goes, which is some people increasingly are talking about as the field grows and as we hopefully become a field of medicine that serves population health, that you need a tier of the system or an adjacent system that triages patients, that sees patients before they need IVF and that
REIs are really seeing patients that are IVF ready. Would that system help this theoretically? there other challenges that might come from that?
Allison Bloom (28:52)
I think that's such a gray area to say that there's patients that are non-IVF and IVF patients. I think that's such an informed decision making process with the patient and the provider. I just don't think there's many patients that fit in that box.
for many reasons. know, there's differences in ease, there's differences in egg reserve, there's differences in diagnoses, there's differences in desire for family size. So I think that would be really hard.
If you're talking about our EPPs seeing our ovulation induction cycles within our clinics, yeah, that happens. My EPP does most of that. But I don't think that could be divided outside of this clinic because if you talk about three to four cycles of medicated IUIs, if they want to start that, they're very quickly coming back and doing IVF. People are not sitting in that category anymore for long periods of time. I think that's few and far between.
especially the way we're sort of helping people financially getting into IVF if they truly need it.
Griffin Jones (29:56)
That is the limit that I wanted to explore with that. And it is its own topic because I do know that people want to pursue that. And you've given me a little bit of ammo for how I can press them with those questions. Cheryl, you talked about maxing on benefits. And I think oftentimes we would think of a program like BUNDL as something that's exclusively for self-pay patients, but it's very much not. And so talk to me more about that.
Cheryl Campbell (30:07)
Yeah.
It is very much not. And I think that as we grow and expand, we're seeing more and more that there isn't the bucket of self-pay insurance, right? I think years ago, maybe that was the case, right? It was like, you were designated insurance, that was it. You were done or self-pay, that was it. But I think now coverage is spotty. still is. Listen, we have patients that we call it BUNDL their unicorn coverage, right? That means they've got it all and we're thrilled for them. And that's great. But that is
definitely not the large percent of patients. And I think we're now able to help counsel patients through, know, maybe they're covering in their meds, maybe they're getting a cycle of monitoring, maybe they're getting a cycle. And so again, like I said, that one cycle for a fertility patient, you know, is going to, they're done. They're coming and talking to me now, March, April, right? They're ready to go. They're 36, they're 37. They're not waiting until they can figure out, you know, more coverage. So,
It's great that we're now expanding and able to help people, because again, it's just not the one size fits all. It's taking a look at everything for them. And we think we're helping a lot more patients that felt that they were just done if they did their insurance and then that was it, or paid one self-pay and that was it. So I think we're just trying to kind of expand what that box is now and help more more patients.
Griffin Jones (31:41)
Do you have any idea of what the percentages might be? Even just like really rough ballparks of what percentage of covered patients you think are not sufficiently covered to reach their goal of family building? I even if it's like, is it 20 % or is it 80 %? Like, do you have any idea if it's a small sliver, if it's the majority?
Cheryl Campbell (31:58)
I know that's a hard one.
Well, you know, when we look at practices that have let's say they're I don't know what would mainline be Dr. Bloom like a 6040 insurance cash 7030 that 70 bucket of insurance. You know, half of that is probably probably more, you know, probably more is just like maybe that one cycle covered or a $10,000 max or Yeah. Yeah.
Allison Bloom (32:15)
7030.
least.
I mean, a lot of people have a $10,000 max. mean, that's
not coverage.
Cheryl Campbell (32:38)
That's not coverage at all. And the thing is, is that we're working closely to try to say, hey, listen, this patient that had the 10,000 max maybe did something. Maybe they did something in January, February. Just make sure we don't lose them. That's another avenue of us is that let's not just ding them as insurance. Let's make sure that they can bubble back up and talk to BUNDL or talk to BUNDL back in January. Let them max out. We do this all the time. We'll say to patients, use what you can with what you've got and then
Here's BUNDL, here's what your quote is, here's what we would look like. So maybe in two months down the road, you come back to us if you're not successful with where you're headed and we can help you. So we're trying to make sure that maybe an insurance patient is now that becomes cash pay. And again, this is another financial counseling piece is kind of keeping people like that on the radar to say, hey, let's make sure that at least they know their options with BUNDL because now they're.
Now they're feeling like I'm out of luck. I'm at, I don't know what I'm doing. I've got this great plan from Dr. Bloom, know what I want to do, but now like I can't get started. And we are program that can kind of help them continue on and, at least can, you know, get started again.
Griffin Jones (33:48)
You mentioned that there can be a tendency to just drop them and they're in the covered bucket. Do many or even most practice financial counselors tend to do that? Do they tend to take those under covered folks and just put them in that insured bucket and not have these conversations with them early enough?
Cheryl Campbell (33:53)
Hmm.
They can, they can do and that's just purely based on the way their workflow is and what their job is and that's understandable. They see them as a covered.
Griffin Jones (34:16)
But is
it a mistake with regard to preparing the patient for what they're ultimately going to need?
Cheryl Campbell (34:22)
Maybe a little, maybe it's a missed opportunity to be honest. Again, we struggle with it a little bit because we want to make sure that patients have the full, again, as a ⁓ fertility patient myself many years ago, I remember just, you want options, you just want options. You don't want to be told that you're out of options or information. And I think that's what this is. This is set it all up now, let patients have all these options upfront so that for every eventuality,
they understand, wait, okay, I'm done with that cycle. That didn't work. I had coverage for a medicated IUI, whatever. Now I'm in the IVF bucket. I remember BUNDL. It's just trying to keep that continuity. So yes, to answer your question, I think there's sometimes a disconnect there where they will not reengage and reemerge them as a self-pay patient. And that's a struggle. I think that that's something that we could kind of do better with. But understandably,
I think for an FC, they might be thinking, well, this is an insured patient. And listen, I will tell you, I have insured patients that will use BUNDL anyway. They don't want to go down the road of trying to tackle, what does this 10, 15, I think I have meds, I think I have monitoring. You know, they may just say, maybe I will put that to use down the road if I'm in a fertility journey, but right here upfront, BUNDL is what I want to do. It's easier. I'm going to be able to work with the BUNDL team. I'm going to be able to get this done upfront. I'm going to be able to get the loan that I need.
right now because I can't dip back and get a loan for a single cycle maybe down the road. I've got to get it here now. So it's just all those variables when we educate patients, they've got it all up front and I think they it's just giving them the opportunity to make an informed decision.
Griffin Jones (36:03)
You mentioned a couple of times how short the window between the financial counselor and the patient can be. Is that just a function of it's at the end of a long visit in the office, you want to get them home or are there other reasons why that window is so short?
Cheryl Campbell (36:18)
I just think it's a, it's a, they're busy. I think it's just, I think it's just the nature of what that function is within. Well, the clinic, you know, it's all, it's all domino effect, right? It's a, it's a busy clinic. It's a, it's a busy doctor. We see a lot of FCs we sort of in like pod situations. I think they do it at mainline. Dr. Broomworth and FC will be assigned out to a group of docs. So they're managing their entire group of patients.
Griffin Jones (36:26)
they being the financial counselor they being the patient
Cheryl Campbell (36:45)
I just think it's, it is a tough role and it's a important crucial role. And I think that it's just a little, can be overwhelming. And I think to, and to Allison's point too, you know, these are, these are, you know, they want the same thing as, we all do, right? They want the good patient experience. They want the patient to be successful, but there isn't, you know, we, but the education is important and they need to kind of understand a little, you know,
just about clinical stuff in general possibly, just helping them to understand how does it all come together because they're really just working numbers all day long and you know, that's, it gets rote. I think it just gets, it can get very staid, you know.
Griffin Jones (37:27)
Allison,
you're nodding. It seemed like you had an opinion of why that's such a short window.
Allison Bloom (37:35)
Well, first of all, our financial counselors are not in the office, so they're not seeing them the same day. So most of these are telehealth or phone calls. But yeah, think they're just.
they're pulled in a lot of directions. We do have our own financial counselor, so I have my own financial counselor for my patients, which is nice so we can interact with them at least. But it is, it's a tough thing to counsel those patients, and I think that's a very stressful call for a lot of patients is the money piece. But I will sort of take this back to the role of the physician as well. So I think this is a place where the physician can also help. So after every IVF cycle, I meet with all my patients about a week
leader and in most of the time they're telehealth calls. But part of that next cycle planning step and especially when we know that they need to do another cycle, I always talk about three things. Where are they mentally, physically, and financially? And what can they do in those three realms? Are they mentally prepared to do another cycle? How did they handle the cycle physically in terms of timeline? And I always talk about where they are financially.
And that has to do with, know, do they have coverage left? You know, and if they don't, how are we going to do this and can they do this? Right? And I take that approach and I think that's not that I need to figure it all out for them, but I think that it's important that we sort of, you know, understand that this is something that they're dealing with. And I think just acknowledging it, you know, shows the patients that
this is real, right? Like this is a burden and we understand it and like anything that we can do to help or respect that I think is important, you know, and sometimes it's okay. Let's talk about BUNDL. Let's talk about, you know, a loan company. Let's talk about ways I can, you know, make your cycle meds more affordable. You know, let's change protocols. So these are things that I think where the physicians can come in to make a big difference and make sure that these patients don't get lost as well.
Griffin Jones (39:40)
So Dr. Bloom answered it from the provider side of the question, the question being what can practices do to expand that window? And she answered it of what providers can do. What can practices do or managers do to expand that short window? Is the answer scheduling more time or different times? I've heard of some practices that will actually have the financial counselor meet with the patient even before.
They meet with the REI and then again, and they'll just have a very brief meeting before just to say, hey, here's what you might talk about that. And then you're going to come back and see me. Maybe it's just five or 10 minutes even, but just to sort of get the patient acquainted with that process and with the financial counseling team so that when they come back, they're more engaged. What can managers be doing to expand that window, if anything?
Cheryl Campbell (40:31)
think that equates to one of the best practices for sure is that you can maybe do a pre meet and then, you know, have your regular financial session. And then I think the best thing to do is kind of teach a cadence of follow up, right? One thing that we, will say my team is very good at is just knowing that follow up cadence with a patient. When was our last conversation? And it sounded like they were struggling with making decision about X. So, you know, just
note-taking, look, simple note-taking, right? And again, understanding that these FCs have a lot of patients on their plate, so to speak, but I think one thing that would go a really long way is really that follow-up. Hey, did that patient cut over to BUNDL? Hey, BUNDL, did you talk to these five patients? So, you know, how did that go? Do I need to intervene in any way? And just not just kind of do the handoff and be done in a perfect world, but because I know that it's tough because they have a lot going on, but
I think follow-up is always key. I think patients knowing that you are taking care of, that you are on their radar, that you're not just being handed over, you're not just, you know, give us 15,000 and then you're done with me and I can move you on. I think anything that can really just sort of give that patient the understanding like, hey, I'm with you, I'm your person, I'm advocating for you, maybe you don't need me anymore, but you know, I'm here. I think it's...
It's simple stuff like that, really.
Griffin Jones (42:00)
You said that prior meeting is one of the most effective things you can do. it just because it teaches them to participate in that cadence of follow-up or is it something else too?
Cheryl Campbell (42:10)
Well, I just think it makes the patient like, wow, I'm, they got me, I'm being seen and being heard. I think when Allison started the entire conversation about how, you know, patients come in feeling broken, they don't feel heard, they feel like they failed, they're embarrassed. Is it me? Is it my partner? Is it like everyone else has a child? I don't. I think so anything you can do, I think at any point along this journey,
to sort of make the patient understand that they're sort of a part. They're now going to enter into a difficult, yes, likely a difficult time, but with a practice and a subset of clinicians and admin teams and FCs, we're all here with you and we're gonna give you the best possible information, opportunities. And if you need me, I'm here for you. you need five minutes, if you need 10 minutes, at any time, it just gives them that feeling like, okay.
I've got a team behind me.
Griffin Jones (43:06)
Allison, you seem to have a slight preference for BUNDL and Cheryl. I promise this is not a jerk comment. I'm just asking, why would a doctor care?
Allison Bloom (43:12)
Yeah.
Griffin Jones (43:15)
Why would a doctor care which financial program the practice ends up using?
Allison Bloom (43:20)
I mean, I think as long as they serve the purpose, you know, and that...
That's the point, right? So, you know, one, think that, you know, we work closely with BUNDL, so this is what I know, but they're very good to our patients. They counsel our patients very well. They're respectful to the patients. They're, you know, reliable. They meet with patients almost the same day or within a day. You know, they're providing the service that they say that they're preserved, that they're, you know...
that they're promising, right? So I feel like that is why we continue to go back to them. And I continue to tell my patients to use them. I think also, when you think about multi-cycle, you tell these patients that they're going to get lower cost per cycle. I think also it's like, it just reduces that pressure. That it's like, if that first cycle doesn't succeed, it's not like everything was in on that cycle and we're done and it's all gone.
takes off that financial pressure is a big piece of it. And I think the other thing is that patients really like the option for that guard, right? Like that protection program. And it's not for everybody. And if they want a bigger family, I talk to them about like, do not do the BUNDL guard, because they're going to make you use all your embryos, right? Which is great if you want one child and you know, like, hey, listen, I've been at this forever and I need to leave here with a baby.
do the BUNDL guard, right, if you qualify. But if you want two or three kids and we end up with one embryo or two embryos and you're 37 years old, that is not the right program for you. So, you know, come back and talk to me. And I think they're really honest with patients about that.
and the patients will come back and ask my advice and I think there's open communication. So I think that it's a great service. I've been very pleased I haven't had any complaints from patients. The patients are very happy after their consults. And I usually tell my patients or my new patients that I'm talking to, I think a large majority of cash pay patients that don't have insurance who need IVF will use BUNDL.
you know, if I tell them that they're going to need more than one cycle.
Griffin Jones (45:29)
Cheryl, what's one thing you want either providers or financial counselors to start or stop doing?
Cheryl Campbell (45:37)
look, I think that we want patients. I've said, I say this all the time and, and, and Dr. Bloom kind of just nailed it right now. It's just like, start just having that conversation about options, about, you know, this looks like this.
So here's what I can give you. Here's what I can tell you that we offer. But you know what? It doesn't have to be about BUNDL either. We want people to have all the options. I can just say that from a BUNDL standpoint, it's important for us to kind of stay true to what we do. We're a multi-cycle program. We partner with lenders. We can try to give you, we will work with you. I have patients I've been working with for a year to get them started. They're not financially there yet, but we can take your patients and help you. I think it's just stay connected, stay connected with.
programs like BUNDL to kind of look at that full experience for the patient. Let us share ideas. Again, doctors are very busy. They're not going to necessarily dip back. But Dr. Bloom knows that she's got a line to me to reach out about a patient at any moment to say, hey, listen, I'm not sure she qualifies for guard, but her reserve is really good. Can we get her it? Whatever. think it's just continuing to have it. Let's not all be siloed. Let's just try to
give options, educate, be upfront, be transparent, share ideas. I know that's very maybe kumbaya, but I just think that's the patient experience. When patients feel left off to the side, if a patient ever said to me, gosh, I felt like BUNDL really just kind of like took my money and ran and wasn't like, it's just like a knife to the heart. Like I can't.
Allison Bloom (46:56)
Yeah
Cheryl Campbell (47:13)
I can't say enough about how much we don't want patients to ever feel this is just either a money grab or or a, you know, or something where we don't have the patients best interest at heart. Like I said, my whole team are fertility patients and it doesn't matter that we experienced it a year ago or 20 years ago, it still hits that, you know, we had to go through this. And so we want patients to understand that when we counsel them and that we're there with them and we really understand what they're going through.
Griffin Jones (47:39)
I gave your team a little bit of a shout out, Cheryl, by name. You, yourself, two others, Courtney and Kerry, and I don't know how many, I don't think I did that for anybody else's admin team in a overview that I did of the patient finance and payer category. I think it's because you can tell that that's who you are. You are a person that will not sleep if somebody even feels like they got the short end of the stick.
Cheryl Campbell (47:42)
You do.
Wow. Thank you.
Griffin Jones (48:07)
And so, and I think that's who people want to do business with. So I look forward to having you back on a fourth time, Shail. Also, both of you busted silos today. You'll get a silo. You should get a silo busting award that because I think we pointed out the exact places where the provider's role ends and the financial counselors begin so we can have a proper handoff of that baton. Thank you so much for joining me today.
