The Bill(s)

Update

So I have been terrible about updating the blog, but I swear that being on the Pill makes my head fuzzy and drains my motivation in general.  (I'll explain shortly why I'm on the Pill.)

As it turned out, the 2009 RMA video was outdated and RMA has since entered the new age of vitrification, a huge relief to me!  This goes to show how new vitrification really is.

While I did check out NYU as a backup plan while I anxiously awaited an answer from RMA, I learned that NYU use vitrifications and/or the slow-freezing method depending on what’s called for upon examination of the retrieved eggs.   A nurse told me this, so no idea if this is accurate or not.

In any case, I’m moving forward with having my eggs vitrified at RMA.  My treatment cycle is to be on the Pill for 24 days, then go off of it for four days (to get my period), and then begin ~10 days of hormone injections to stimulate the follicles, and then egg retrieval/freezing.  

Not all women go on the Pill prior to their egg freezing cycle, but because my hormone levels were OK (FSH 8.36, Estradiol 31.2 based on the bloodwork done prior to my consultation; then FSH 7.1 right before I began the Pill), I guess they think that the Pill, which suppresses the ovary function for this month, can actually help the ovaries be more responsive to the hormone stimulation I am about to undergo next month.

I'm on Day 18 of the Pill.  I take my 24th Pill on July 18.  I go in for more bloodwork on July 22nd, and assuming my hormone levels are OK that day, I begin my injections that night.  Egg retrieval should be around the first few days of August, but actual date will depend on how my follicles respond to the hormones.  The progress will be monitored at least every other day during my hormone injection cycle to determine optimal retrieval date.

So all this means that I need to figure out how to actually pay for it since I have some big bills coming up soon.

How Much It Actually Costs

There are so many hidden costs in the egg freezing process.  They’re quick to toss around “$15K” as a number, but it really is closer to $20,000 depending on your treatment cycle.  NYU seems to charge even more (see their fees for services here), and the nurse told me that some of these fees are outdated, meaning that fees have gone up!

These are the initial costs I incurred to determine my eligibility for egg freezing:

• $300 blood tests for FSH, Estradiol (taken prior to consultation in order to evaluate and discuss results at consultation)
• $375 initial consultation fee 
• $200 pelvic ultrasound at time of initial consultation

>Initial Consultation Total: $875

This is the cost summary that RMA gave me once I decided to go ahead with egg freezing:

• $9,000 – Single Egg Retrieval and Freezing Cycle (includes cycle management fee; office visits, blood tests, and ultrasound during cycle; post-operative visit; freezing costs for one year) 
• $300 - Psychological Orientation 
• $750 - Anesthesia
• $4000 to $6000 - Hormone medication for stimulating follicle growth (variance is due to the fact that different women require different cocktails of meds; rule of thumb is that the more meds you need to stimulate the follicles, whether due to declining fertility or lack of hormone response, the higher the cost)

>Egg Freezing Costs: $14,050 to $16,050

The following future costs are not included, which I never expected to be included:

• egg freezing after the first year ($500/six months)
• egg fertilization and embryo transfer services (~$15K to $20K?)

Here’s the fine print:

• The services covered under the egg retrieval/freezing cycle (cost: $9,000) only begin from the start of your first injectable medication until Oocyte Retrieval.  Any services performed prior to the start of your medication is not covered.    This means that if you have any blood tests taken to measure your FSH and Estradiol levels prior to the cycle to determine how your hormones are doing, these are additional fees (for me, $300 each time).  If they check your bloods to see if it’s a good time to start your cycle and the levels are no good, then you have to skip that month and take the blood test again the following month.
• Before you can begin your cycle, they require a battery of blood tests to screen for infectious diseases such as HIV, Hepatitis, gonorrhea, etc.  Because many of these tests aren’t standard, your insurance won’t cover it unless there’s reason to believe you’ve really been exposed to unusual viruses.  This bloodwork cost me $637.
• Another pre-cycle requirement: they require a recent pap and culture results (I think within the last six months).  I was able to transfer these records gratis from my OB/GYN to RMA because they’re both within the Mt. Sinai network, but if that were not the case, I may have had to pay a fee for document transfer. 
• For my particular treatment cycle, I am on the Pill for 24 days prior to hormone stimulation.  So I will need to obtain two months of the Pill (since each pill pack only contains 21 doses).  My insurance will cover this, but if yours won’t (or if there are restrictions on how soon you can refill the second pack), you will go out of pocket.  For me, it’s a $10 copay for me for each pill pack. 
• I will be on antibiotics for a week after the egg retrieval—it is surgery, after all.  Again, insurance should cover it ($10 copay for me).

These are the unexpected expenses I will incur (those marked with * are anticipated costs to come):

• $300 – check for FSH/Estradiol levels before I began the Pill
• $300* – I expect that I will have to pay to check my FSH/Estradiol levels on July 22 before I begin my hormone injections [UPDATE July 22, 2011 - I had bloods/ultrasound this morning to see if I would begin my cycle today, and they did not charge me for any of the tests they ran today, so I guess this is not a charge that is incurred unless the plan is to push the cycle by one month]
• $637 – infectious diseases pre-screening
• $20 – two pill packs (co-pay for insurance)
• $10* – copay for antibiotics

 >Unexpected Costs Total: $1267

So here's my Grand Total:

• Initial Consultation Total: $875
• Egg Retrieval/Freezing Total: $14,000 (my meds seem to be coming in <$4000, fingers crossed)
• Unexpected/Hidden Costs: $1267

>GRAND TOTAL: $16,142

Gulp. 

And this is on the lower end of my estimates because I'd slotted in a $5K estimate for the hormones.

But I have a plan to pay for all this which may be either very stupid or pretty strategic.  Or both.  More on that tomorrow.