IVF Centers Face Slashed Reimbursement, Lenders Cover Gaps In Self Pay
Federal IVF Benefit Clarification Reframes Employer Options
Recent federal guidance clarified how fertility benefits may qualify as excepted benefits, widening the structural options available to employers offering IVF coverage. As reported by Healthcare Dive, the Departments of Labor, Health and Human Services, and Treasury indicated that fertility benefits may be offered outside traditional group health plans — structured similarly to dental or vision coverage — without triggering the full set of Affordable Care Act requirements. This interpretation allows employers to add fertility benefits without redesigning their primary health plans or assuming the compliance burden of major medical coverage.
The clarification does not mandate IVF coverage and does not alter how fertility care is priced or reimbursed. Instead, it expands how benefits may be delivered, including through standalone arrangements and reimbursement-based models. The guidance lowers regulatory barriers for employers while leaving affordability, utilization, and financial risk allocation unresolved.
Meanwhile, fertility centers often absorb the consequences of partial coverage.
Reimbursement Rates Slash Fertility Centers’ Margins
Employer benefits managers and insurance companies often reimburse fertility clinics at a fraction of billed rates — in some cases around 50%.
“Not much has changed as far as reimbursement with insurance companies,” Stern told IRH in December 2025. Stern suggested that many IVF centers may have reached the limit of what cash pay patients are able to pay, which often subsidizes the low rates reimbursed by insurance and carve-outs. Stern said fertility centers will likely take this into account when negotiating with those companies. “In most cases, the contracts can be [two to four years] with a small annual increase, typically two to four percent, which doesn't really off-set the annual increase in the cost of labor at the IVF center.”
Payor-covered IVF continues to increase in market share, not only because of employer demand, but also because of new state laws. California’s law mandating certain insurance policies to cover fertility treatment went active on July 1. Stern mentioned that many states have already proven that fertility centers can successfully adapt to insurance-paid IVF, but they had to make operational adaptations. Stern said these adaptations include not only utilizing REI physicians at the top of their license, but leveraging technologies including but not limited to ALife and Cycle Clarity to vastly improve efficiencies.
“At Kindbdody, we’re looking at ways to use more AI and automation to take busy work away from our practitioners and help our Financial Navigators with RCM (Revenue Cycle Management) . [We believe bots will be able to perform] manual processes like VOB (verification of benefits) and help patients to understand what is covered and what isn't, even using their individual plan for deductibles and copays”.
As employers continue to add fertility coverage for their employees, the tension between benefit expansion and fertility clinic sustainability increases. While clinics find a way to make the economics work, Progyny’s stock hit its highest price of the year in late December, On December 17 Trading View reported that Progyny will not name a successor to President, Michael Stummer, after his last day on December 31.
Some Lenders Less Active in Fertility, Some Much More
Because self-pay remains a vital component of IVF in most countries, including those with broad coverage, fertility patients rely on lending programs to help them afford their treatment, and on their centers to direct them to the best program for them.
Clinics increasingly rely on alternative financial structures to stabilize cash flow and reduce volatility — frequently even when patients technically “have coverage.” These financial models operate alongside employer benefits rather than replacing them, absorbing uncertainty created by partial reimbursement.
Clinics often see treatment delays when patients cannot cover required deposits or medication costs, particularly in self-pay or partially covered benefit designs. CapexMD addresses that constraint by providing fertility-specific patient financing that clinics can offer as part of the care pathway. They enable patients to move forward with treatment when they would otherwise be stopped by large upfront costs for IVF, egg freezing, and related services.
While other lending institutions are paying less attention to the fertility space in favor of other verticals in their portfolio, CapexMD maintains the fertility field as their exclusive specialty area and Patient Fi has increased their footprint in the fertility sector. Patient Fi was named the 54th fastest growing company in North America on the 2024 Deloitte Technology Fast 500 list.
PatientFi scaled point-of-sale lending to address this friction point, enabling patients to spread fertility treatment costs into monthly payments at the moment they decide whether to proceed. The platform has supported financing for more than 320,000 patients across healthcare, reflecting how installment lending became a critical access mechanism as self-pay exposure expanded. PatientFi’s growth culminated in its ranking as the 54th fastest-growing company on the Deloitte Technology Fast 500, underscoring the scale of demand for financing solutions in care categories where coverage gaps persist.
During periods of operational disruption, including pandemic-era shutdowns and pauses in bank lending, fertility practices struggled with patient drop-off when financing options were limited or delayed. PatientFi’s leadership, including CEO Todd Watts, described these moments as forcing the company to rethink how financing could be offered more reliably at the point of care.
Shared Risk Takes On New Life
As IVF outcomes have improved, the financial structure surrounding treatment has struggled to keep pace. Clinical success increasingly requires multiple cycles, while insurance coverage often remains limited to one attempt or reimburses only part of the cost. According to the Society for Assisted Reproductive Technology, more than 70% of fertility patients require more than one treatment cycle to achieve success, a reality that exposes patients to escalating out-of-pocket costs and leaves clinics navigating uncertainty around patient follow-through.
BUNDL emerged in response to this mismatch between advancing clinical capability and financial accessibility. As TJ Farnsworth, Founder and CEO of Inception Fertility™, the parent company to BUNDL has said, while science and technology in reproductive medicine have advanced significantly over the past 30 years, financial access has remained a barrier for many patients. BUNDL addressed this by packaging multiple treatment cycles into a single bundled price and pairing that structure with refund guarantees if defined outcomes were not achieved.
By consolidating cycles — and later medications — into one financial commitment, the program provided patients with clearer expectations while allowing clinics to receive upfront payment. Outcome risk was redistributed across patients, clinics, and financial partners rather than remaining concentrated with the patient alone.
Still, fertility centers struggle with how to present IVF pricing to patients. Sunfish focused on reducing patient hesitation driven by opaque and fragmented costs rather than clinical uncertainty. Through its partnerships, including one with Illume Fertility, Sunfish introduced flat-fee IVF bundles paired with partial refund protections, simplifying how costs are communicated at the start of treatment. The approach allowed patients to enter care with more predictable financial expectations while supporting clinic revenue stability under reimbursement constraints.
Sunfish evolved out of similar cost and predictability challenges but focused on simplifying how patients experience IVF pricing from the outset. Clinics operating in environments with limited insurance reimbursement faced pressure to explain variable, multi-step costs while managing patient anxiety around financial uncertainty.
Over time, Sunfish expanded its approach to include partial refund protections and structured financial guidance layered onto bundled care. Sunfish founder and CEO, Angela Rastegar, who shared some of her background story on Dr. Lora Shahine’s Brave and Curious podcast in May, is considered one of the rising stars of IVF patient finance.
Future Family addressed outcome risk by introducing IVF insurance that refunds treatment costs if defined cycles do not result in a live birth. By adding $400 million to in financing capacity, the model moved financial downside into an insurance framework supported by actuarial modeling and reinsurance capacity. This approach aligned with employer reimbursement strategies that avoid assuming clinical risk while offering patients protection against repeated unsuccessful cycles.
In September, CEO Claire Tomkins transitioned to Board Chair while Future Family tapped sector veteran, Alden Romney, as its new CEO.
Rather than replacing insurance or employer benefits, these models have developed alongside them, absorbing financial volatility that traditional coverage has not resolved.
Implications for Employers, Insurers, and Benefits Leaders
Recent federal guidance expanded flexibility in how fertility benefits may be offered, but it did not change the underlying economics that shape access. Clinics continue to operate within discounted reimbursement structures, patients remain exposed to out-of-pocket costs, and employers balance competitiveness with cost control.
The growth of lending platforms, bundled pricing, shared-risk programs, and outcome-based insurance reflects how financial responsibility is increasingly distributed across multiple actors rather than absorbed by a single payer.
Expect California’s new IVF mandate and the consolidation of large fertility networks to influence how payors respond.
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