Patient Relations

Thousands of IVF Payments Frozen After Change Healthcare Cyber Attack

Other clearinghouses, cash-pay patients, insulate reproductive medicine sector from severe financial crunch.

The content and themes expressed within the article are that of the news. The advertiser does not have editorial control over the content of this article, and Inside Reproductive Health maintains full editorial independence. The views and opinions expressed in this article do not represent the views of the Advertiser or of Inside Reproductive Health.

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BY RON SHINKMAN

A ransomware breach of one of the nation’s largest clearinghouses for health insurance claims has likely caused some consternation to reproductive medicine practices, an expert familiar with the situation says.

The breach of Change Healthcare – a subsidiary of UnitedHealth Group, the nation’s largest medical insurer – occurred in late February. Change reportedly paid a $22 million ransom in bitcoin to regain control of its data and networks, but the company said it will not be able to start processing healthcare claims against until at least March 18. Change handles about 15 billion healthcare transactions a year, according to the U.S. Department of Health and Human Services.

“The hack affected not only (our customers), but the entire healthcare industry,” said Nimesh Shah, chief executive officer of eIVF, which provides services to about 140 fertility practices, although not all of them use its billing service. The company relies on Change Healthcare to process and pay claims to its clients. Shah said about 30 to 40% of the claims its processes for clinics are billable to insurance companies, and the company typically handles “thousands” of such claims each day.

The issue has become so serious that last Sunday, Health and Human Services (HHS) issued a letter urging UnitedHealth to “take responsibility to ensure no provider is compromised by their cash flow challenges stemming from this cyberattack” and “ensure expedited delivery of funds to impacted providers.” 

How the breach is impacting individual reproductive medicine clinics and their networks remains unclear. Executives and spokespersons with some of the largest fertility clinics in the U.S. – including Boston IVF, Shady Grove, the Prelude Network, Progyny and the University of California at San Francisco Center for Reproductive Health – have either declined to comment or did not immediately respond to requests seeking comment.

Taylor Stein, co-CEO of EngagedMD, which provides support services to clinics but does not handle their claims, suggested that fertility centers’ finances may not be as crimped as other medical practices, because of the number of self-pay IVF patients.

“Unless they’re operating in states (with mandated insurance coverage for IVF), most clinics have a lot of cash coming in the door,” Stein said.

Workarounds through other clearing houses

Meanwhile, other clearinghouses have been offering workarounds to providers who contract with Change Healthcare. Availity, another claims clearinghouse, is offering to process claims for Change clients, Shah said.

“Once a clinic registers with Availity and creates a relationship, we’re automating that into our (electronic medical records) or billing solution, so that they can do things in an automated fashion as opposed to a manual process (for submitting claims),” Shah said. He added that about half of eIVF’s clients – fewer than 100 in total – have signed onto the program, which is known as Availity Lifeline.

According to Availity spokesperson Matt Schlossberg, the company has "provided free digital connectivity to more than 300,000 providers—and that number continues to grow,” Schlossberg said in an email, adding that about $5 billion worth of claims had been processed through the program as of early this week. He was unable to immediately provide a breakdown on the number of reproductive medicine providers participating in the program.

Remaining concerns

Although Shah observed that his company wants “to create choice whenever possible,” he would not say directly whether eIVF would seek another clearinghouse for its clients.

“When this happens, nobody is claiming victory,” he said. "If you’re Availity or (other clearinghouses), you are not excited by what just happened. Probably their number one reaction is ‘thank God that wasn’t us.’”

However, the likelihood of clearinghouses and other players in the healthcare industry dodging such breaches appears to be diminishing, said Stein, whose expertise is in cybersecurity.

“They’re going to keep on happening,” he said. “It’s the new normal.”

The content and themes expressed within the article are that of the news. The advertiser does not have editorial control over the content of this article, and Inside Reproductive Health maintains full editorial independence. The views and opinions expressed in this article do not represent the views of the Advertiser or of Inside Reproductive Health.

This News Digest Brought to You by

 
 

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All external links active as of 3/14/2024

External links are being provided as a convenience and for informational purposes only; they do not constitute an endorsement or an approval by Fertility Bridge or Inside Reproductive Health of any of the products, services or opinions of the corporation or organization or individual. Neither Fertility Bridge nor Inside Reproductive Health bears responsibility for the accuracy, legality or content of the external site or for that of subsequent links. Contact the external site for answers to questions regarding its content.

Medications Finally Included with Price of IVF

Program Expands to Remove Variable from Patients and Clinics

This News Digest Is Paid Sponsored Content From
BUNDL

 
 

BY: ERIN FLYNN JAY

Historically, IVF medications have almost never been included with the price of an IVF cycle. That was, until very recently.

The popular fertility financing program BUNDL has launched BUNDL with Medications℠, a new partnership with InspireRx to finally include patient medications with the price of IVF.

Separate Medication Costs Negatively Impact Patients, Providers

When patients can’t plan for medication costs, they may not be able to start their cycle when they’d like…or they may not be able to start their cycle at all. They may need more of a certain drug or a different protocol and they can’t afford it. 

“It puts an extra stressor on patients--maybe they finally have an IVF plan and finally have their treatment scheduled. But then they have to figure out what's going to happen with the meds?,” said Cheryl Campbell, Director of Operations for BUNDL. “It continues to grind at them and halt their process. They’re left alone to research where they’re going to get the best and most inexpensive meds.”

When patients face financial strain because of medication costs, it puts their treatment in jeopardy and may end up canceling their IVF cycle, which negatively impacts the fertility center’s scheduling.

BUNDL with Medications℠ allows fertility clinics and patients to consolidate treatment and medication costs into one plan with the backing of a financial guarantee. 

Campbell said it's hard for fertility physicians to see patients struggle with medication costs.

“As an ex-fertility patient myself, time is of the essence, right? When a patient can’t move forward with their provider’s treatment plan because they are hindered by medication costs, that's very daunting for physicians. They want those patients to move forward.”

How to Reduce Stress of Medication Costs for Patients

BUNDL with Medications℠ is a multi-cycle program. “Patients’ financial barriers are being removed because we are discounting their treatment. We’re going from top to bottom for the patient; all they have to do is focus on their IVF cycle.” Campbell added.

“It works as a layer onto our existing discount program. When a patient buys a two-cycle program from us, for an extra X amount of dollars, they can choose to add the costs of their medications and we'll handle that back and forth with their clinic.”  

BUNDL with Medications℠ covers everything a patient might need. “If a patient needs more but we didn't realize it, they're going to get it,” said Campbell. “If they're a poor responder and they need more, we're going to give it to them. Our patients will get what they need when they need it. The only exception drug is omnitrope, an off-label drug; other than that, patients will be able to access what they need.”

Which Fertility Clinics Can Benefit

BUNDL with Medications℠ is open to any clinic who has partnered with BUNDL.

Karol E. Bonilla, Strategic Account Manager for InspireRx, said there are many patients who don't have any coverage for either treatment or medications. “It's not difficult to actually combine great providers and great pharmacies to provide brand name medications,” she said.

Patients go with the provider of their choice. “Through InspireRx, they have less medication pricing for their fertility drugs since they don't have any coverage,” she said. “You're going to get multiple cycles so there are savings on the treatment and then also savings on the medication. It's a win-win for our patients.”

This News Digest Story is paid featured sponsor content, where the Advertiser has editorial control. They do not reflect the views of Inside Reproductive Health.

How to Finally Streamline Medication Costs for Your Patients

Medication costs are a huge stressor for patients working through IVF and IUI treatments. They can be costly, and the variability of when they’re needed means an even more difficult process. But it doesn’t have to be this way, and that’s why BUNDL has streamlined the process with their new BUNDL with Medications℠ program.

BUNDL with Medications℠ is a multi-cycle offering that includes all the patient’s medications, for one up-front cost. Contact BUNDL today to learn about their exclusive virtual pharmacy program, and how this can optimize treatments for your practice and patients.

 
 

This News Digest Is Paid Sponsored Content From
BUNDL

 
 

All external links active as of 8/10/23.

External links are being provided as a convenience and for informational purposes only; they do not constitute an endorsement or an approval by Fertility Bridge or Inside Reproductive Health of any of the products, services or opinions of the corporation or organization or individual. Neither Fertility Bridge nor Inside Reproductive Health bears responsibility for the accuracy, legality or content of the external site or for that of subsequent links. Contact the external site for answers to questions regarding its content.

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Compared: Progyny, Kindbody, Carrot, and Maven as fertility benefit coverage increases 33% in two years

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BY: RON SHINKMAN

According to a recently released survey by the International Foundation of Employee Benefit Plans, 40% of U.S. employers offered some form of fertility coverage last year. That’s up dramatically from 2020, when only 30% offered fertility benefits – a 33% jump in just two years. More employers now offer fertility benefits than financial assistance or paid leave for an adoption.

“We’ve been seeing family-friendly benefits like fertility coverage continue to grow as part of the larger trend of expanding work-life integration policies to be more inclusive of all employees,” said IFEBP Vice President of Content Julie Stich.  “Fertility benefits hold a high value by talent no matter their gender identity or relationship status. Providing these benefits helps nurture overall happiness and well-being.”

However, coverage can differ dramatically between employers. For example, among companies that offer fertility benefits, less than 35% cover egg harvesting or freezing services, and less than 45% cover fertility services that are not related to in vitro fertilization (IVF). There are numerous other variations along those lines.

Larger employers – those with more than a few hundred workers – often self-fund their employee medical costs and use a third-party administrator to handle claims (typically a subsidiary of a large health insurer). They may also outsource their benefits to major fertility platforms such as Progyny, Carrot or others in what are known as benefit “carveouts.” In those cases, the fertility firms usually act as a one-stop shop, offering benefits in line with the limits of coverage set by the employer, managing claims and collecting payments. Here is a breakdown of the four largest platforms:

Kindbody
Founded: 2018
Headquarters: New York City
Valuation: $1.8 billion
Locations: 27 Clinics in 21 cities in 15 states and the District of Columbia, Including New York City, Los Angeles, Atlanta and Houston
Senior Management: Gina Bartasi, Founder and Chairwoman; Angeline Beltsos, M.D., CEO, clinical operations; Annbeth Eschbach, CEO, corporate operations; Greg Poulos, President; Taryn Branca, Chief Revenue Officer
Major Employer Clients: Walmart, Lyft, Activision

Walmart, the nation’s largest company with more than 2.3 million employees, entered into a fertility benefits carveout with Kindbody last September.

“Our partnership with Walmart signals that fertility benefits have joined medical, dental, and vision as standard workplace benefits for leading employers,” said Bartasi when the deal was announced.

The pact with Walmart is an indication of how all-in-one fertility companies have grown in just a few years. Kindbody was founded only five years ago. That it was able to raise more than $281 million, according to Crunchbase, helped turbocharge its growth.

Although Kindbody does not post specifics regarding its benefits packages for employers, a recent webinar conducted by its senior management indicated that companies should curate a benefit that takes into account projected utilization by employees, medical and drug costs per cycle, and sources of direct and indirect savings.

Progyny
Founded: 2008
Headquarters: New York City
Enterprise Value: $2.7 billion
Coverage: It networks with 650 clinics and 950 physicians and clinicians
Leadership: David Schlanger, Executive Chairman; Peter Anevski, CEO; Michael Sturmer, President; Mark Livingston, Chief Financial Officer; Jennifer Bealer, General Counsel
Major Employer Clients: Detroit Pistons (NBA Team and its employees); Children’s Hospital Association

Progyny is the elder statesman of the group with its founding in 2008. Its 2022 revenue of nearly $787 million was 57% higher than 2021’s. It works with 370 corporate clients nationwide representing some 5.4 million employees, although the company has been mostly tight-lipped about its clientele. Unlike the other companies, it does not post the names and logos of its major corporate clients on its website. And the employer pacts it has announced – with an NBA team and a healthcare trade association – likely only cover a few hundred employees apiece.

Progyny and Maven were the only companies to respond to a request seeking comment for this article prior to publication. According to Progyny spokesperson Alexis Ford, the company assigns each patient an advocate “to better understand their Progyny benefit, their deductible, co-insurance, etc., since this is dependent on each employer’s health plan. The patient care advocate also provides unlimited education and is the patient’s go-to resource during the entire journey.”

Ford provided a single detail regarding Progyny’s carveouts: 90% of employers working with the company also offer their workers ProgynyRX, which includes medication coverage, next-day deliveries and access to support from pharmacists and other medication clinicians.

According to Holly Hutchison, co-owner of Reproductive Health Center in Tucson, Ariz, a carveout firm such as Progyny offers a “smart cycle.” That is specifically an egg retrieval and transfer along with anesthesia, laboratory and monitoring services. “Employers choose how many cycles they want to include in coverage, from one to five cycles,” she said.

According to Progyny’s website, an IVF procedure where one embryo is implanted and rest are tested and/or frozen represents three-quarters of a cycle. An intrauterine insemination represents one-quarter of a cycle. Egg freezing is half a cycle. A reciprocal IVF procedure involving a same-sex couple is 1.25 cycles, while a surrogacy IVF is 1.5 cycles.

Carrot Fertility
Founded: 2016
Headquarters: Menlo, Park, Calif.
Valuation: $500 million (estimated)
Locations: NA
Leadership: Tammy Sun, Founder and CEO; Ashima Ahmad, M.D., Co-Founder and Chief Medical Officer; Tim Kelly, Chief Commercial Officer; Brooke Quinn, Chief Customer Officer
Major Employer Clients: Zoom; Clif Bar; Lucid Motors (luxury electric automaker)

Carrot Fertility has raised more than $114 million since its founding, according to Crunchbase. Its $500 million valuation is an estimate made by Inside Reproductive Health based on available revenue data and multipliers for the healthcare industry.

Carrot Fertility did not respond to a request seeking comment about their company’s differentiation in the fertility space.

Maven Clinic
Headquarters: New York City
Founded: 2014
Valuation: $1.35 billion
Locations: NA
Leadership: Katherine Ryder, Founder and CEO; Kalliope White, Chief of Staff
Major Employer Clients: Snap, Bumble, Sanofi, Booz Allen Hamilton

A Maven spokesperson said the company offers “typical” carveouts, but did not provide specifics. 

Maven has raised more than $292 million since its founding, according to Crunchbase.


Carveouts Provide More Guidance Than Traditional Insurance Companies

Despite the dramatic increase in fertility benefits from employers, there are still no standardized guidelines mandated by nationwide governmental bodies such as the U.S. Department of Health and Human Services. As a result, fertility benefits and carveout structures vary from company to company.

“The coverage will vary depending on the employer and which fertility benefit management group they choose,” said Hutchison. State mandates on fertility benefits also play a role, she added. Hutchison estimated that about 45% of its patients currently have some form of insurance coverage. “They all have co-payments and deductibles and out of pocket amounts that apply prior to the coverage kicking in,” she added.

David Stern, the chief executive officer of Boston IVF – which operates 18 fertility clinics in six states – observed that most employees receive minimal guidance regarding their fertility benefits.

“You might have fertility coverage and IVF coverage, but the employee is told by their insurer ‘you’ve got to figure out yourself,’” he said. That puts enrollees at risk of using up their benefits on unneeded testing and procedures before they even start IVF, Stern added.

By contrast, carveouts can provide direction to health plan enrollees. According to Stern, one of the most important parts of a carveout is that fertility platform companies can provide care managers “who will talk to you about what the process is and what it looks like.” Boston IVF is a network provider for several major fertility benefits companies , including Progyny, Maven, Carrot and Stork Club Fertility, according to Stern.
 

Controlling Unexpected Costs

Stern noted that many platforms also emphasize “centers of excellence” models where they only refer patients to clinics with the highest standards and outcomes. This not only helps with success rates, but can also protect the employer, which may rely on rigorous standards to avoid multiple births. A triplet birth, even if all are healthy, can cost a self-insured company more than seven times the cost of a single birth, Stern said. As a result, he observed that many carveout arrangements specify only one embryo transfer at a time may be attempted for an IVF or similar procedure. Currently, about 95% of Boston IVF’s procedures are comprised of only a single transfer, according to Stern.

Whether employers offer carveouts or not, most coverage Stern sees from companies is minimal.

“You can go to a doctor and you can be seen by a specialist, but they don’t pay for medication or treatment,” he said.

The themes reported in this publication are those of the news. They do not reflect the views of Inside Reproductive Health, nor of the Advertiser

 
 

All external links active as of 4/20/23.

External links are being provided as a convenience and for informational purposes only; they do not constitute an endorsement or an approval by Fertility Bridge or Inside Reproductive Health of any of the products, services or opinions of the corporation or organization or individual. Neither Fertility Bridge nor Inside Reproductive Health bears responsibility for the accuracy, legality or content of the external site or for that of subsequent links. Contact the external site for answers to questions regarding its content.

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Fight for Families: RESOLVE’s 2023 Initiatives in a post Roe world

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This News Digest Is Donated Sponsored Content From RESOLVE

 
 
 

BY: MELANIE KALMAR

When the Supreme Court overturned Roe v. Wade last year, one organization renewed its focus on access to care for patients battling infertility.

Since 1974, RESOLVE: The National Infertility Association  has provided education, advocacy and emotional support to people nationwide who are trying to build families. The 501c3 is funded by individuals, corporations, fertility clinics, and individual professionals/experts in the field. 

A majority of the work RESOLVE does involves ensuring patients have access to emotional support and all family building options, no matter their zip code. This work includes, —support groups, federal and state advocacy, a program to encourage employers to include IVF coverage in benefits packages, public awareness campaigns and patient education, explained Barbara Collura, CEO of RESOLVE.

In FY 2022, RESOLVE helped 1.4 million people gain new or improved family building benefits through its access to care initiatives. According to Collura, the non-profit’s three big initiatives for 2023 include: protecting access to IVF services, opening access to it in California, Minnesota, Oregon and Washington State (four states that don’t have IVF insurance mandates) and increasing emotional support by returning to in-person support groups. RESOLVE offers peer-led support groups in 30 states and Washington, D.C. (42 in-person; 78 virtual; and 31 professionally led).

Protecting access

In response to the Supreme Court overturning Roe v. Wade, a move that could restrict access to IVF and people’s rights over their embryos, RESOLVE launched a new campaign: Fight for Families. Its goal is to amplify the non-profit’s existing state advocacy work and protect access to care.  

“What’s different now is the stakes are so much higher,” Collura said. “We felt we needed a louder voice and brought in PR support.” RESOLVE recently hired New York-based Fenton Communications to work with IVF patients on how to succinctly tell their stories to the media, to change minds and influence public policy.

Increasing access

Sharing stories of people who face barriers to building their family is so important in RESOLVE’s work, especially the Fight For Families campaign and when it comes to increasing access to IVF insurance through state laws,, Collura said. RESOLVE sees even more of an opportunity to increase access to care in California, Minnesota, Oregon and Washington State because after Roe v. Wade was overturned, legislators from those four states announced reproductive rights of women are protected in their regions, yet  those states don’t have an insurance mandate for IVF to back it up, Collura explained. She went on to say that this state advocacy work largely happens because of a strong coalition of other non-profits and corporate partners that work together. 

She said a robust insurance mandate would include coverage of at least two cycles of IVF, medication, unlimited frozen embryo transfers and fertility preservations (insurance coverage to preserve sperm, egg or embryo of patients experiencing Iatrogenic Infertility; infertility caused by medical interventions like chemotherapy, surgery or other medications someone facing Cancer treatments may undergo).

It’s critically important for people in those states to know what’s going on and speak with legislators,” Collura explained. “RESOLVE can show up and advocate but if constituents, the people that vote these lawmakers into office, don’t show up it doesn’t move our issues forward. “If legislators are hearing from their constituents about how important it is, it changes their mind and gets them to support our issues.”

She said RESOLVE has put coalitions to work made up of doctors, patient advocates, attorneys, grassroots influencers and bill sponsors and hired a team of paid lobbyists to help advance legislation they introduced in those state capitols.

Mental health matters

The third initiative is restarting and reinvigorating in-person support groups across the country that were virtual during the pandemic. “We believe your mental health and ability to take care of yourself enhances and directly correlates to your ability to stay in medical treatment,” Collura said. “Connecting with others, finding a sense of community and taking care of yourself is vitally important to everyone as they go through this journey.”

Introducing federal legislation

With the overturning of Roe v. Wade, access to IVF was not federally protected. RESOLVE is hopeful that the Right to Build Families act that was introduced at the end of last year will be reintroduced this year. It aims to reintroduce to Congress the Right to Build Families Act that was introduced at the end of last year. “It would create a new law at the federal level that says people have a right to access IVF, medical professionals have a right to offer that service and people have a right over their embryos,” Collura said. “We’d love to see it in federal law, then states wouldn’t need to pass their own laws restricting access.”

On April 25, RESOLVE and the American Society for Reproductive Medicine (ASRM) will host a federal advocacy day, an opportunity for people to join RESOLVE and ASRM to advocate on a federal level. Participation is free.

“We provide training and an opportunity to tell you what to say, what the issues are, why these issues are important,” Collure explained. “We help people develop their own story and make it very bite size and succinct so that it will hit on the really important points members of congress need to hear.”

Meetings between participants, senators and state representatives are virtual and last 15 to 20 minutes. Most conversations actually take place with legislators’ staff who relay the messages.

“So many members of congress don’t know about all these issues,” Collura said. “This is our chance to tell them what’s important to us.”

This News Digest Story is donated featured sponsor content, where the Advertiser has editorial control. They do not reflect the views of Inside Reproductive Health.

 
 

All external links active as of 3/30/23.

External links are being provided as a convenience and for informational purposes only; they do not constitute an endorsement or an approval by Fertility Bridge or Inside Reproductive Health of any of the products, services or opinions of the corporation or organization or individual. Neither Fertility Bridge nor Inside Reproductive Health bears responsibility for the accuracy, legality or content of the external site or for that of subsequent links. Contact the external site for answers to questions regarding its content.