Shared Risk Q & A

What is the “Shared Risk” IVF Refund Program?

Many couples do not have insurance benefits to pay for In Vitro Fertilization (IVF). Because of this, the financial implications, should you need multiple treatment, cycles can be overwhelming. Our Shared Risk IVF Refund Program insures you financially against the risk of not being successful. It does this because our fee is earned only when you take home a baby.

In the Shared Risk Program, you elect to pay a flat fee, which covers the cost of up to six completed IVF cycles. (Also included is the cost of cryopreservation of embryos from those six cycles and their later transfer). Should you not take home a baby as a result of those six cycles (and the transfers of cryopreserved embryos), 100% of the fee is refunded, thus preserving your resources for other family building options. This program, therefore, reduces the amount of money you have ‘at risk’ for six cycles and fixes your costs. Sharing the risk with you also establishes a trust in our success rates and our reasonable confidence in the outcome.

Many of the very important details you will want to know about the costs, cost comparisons, eligibility, inclusions exclusions, screening tests, withdrawal, among others, concerning our Shared Risk Program can be found in the answers to the questions below and in an available Shared Risk agreement document.

How does the Shared Risk Program work?

Once a decision is made to utilize IVF as infertility therapy, and the medical screening process is underway, investigation into means of financing the IVF cycle is initiated. Our Financial Coordinators, working directly with you and your physician, help investigate applicable insurance benefits. If you do not have insurance coverage for IVF, then you may elect to pay our ‘global IVF fee”, which is a traditional fee-for-service or you may request consideration for our Shared Risk Program. (See below for the current fees and cost comparisons.)

If you elect to apply for the Shared Risk Program, a committee of physicians reviews your medical records and IVF prescreening tests. If you meet the Shared Risk criteria discussed below, as over 70% of all patients in our practice do, the Shared Risk payment is made by the initiation of your first cycle. With this single fee, you have up to six completed IVF cycles to have a baby. Then, if you deliver a baby, we have earned our fee.

The fee that you pay for Shared Risk is greater than you would pay for a single fee-for-service IVF cycle. Therefore, if you have a baby after the first IVF cycle of therapy, you will have paid more for that single cycle than you would have had you elected fee-for-service. That is the part of the financial “risk” that you are sharing.

We define ‘success’ in IVF the same way you do – with the delivery of a baby. Neither a cancelled cycle, nor a ‘biochemical’ pregnancy, nor a clinical miscarriage, nor a second trimester pregnancy loss, nor even a very late pregnancy loss following any of your IVF cycles qualifies us to earn our fee.

If you do not have a baby after the first completed IVF cycle, you can then withdraw from the Program and receive a 100% refund for covered services, or you can proceed onto a second cycle.

If you have a baby after your second cycle, we then earn our fee. The amount you have paid through Shared Risk for two IVF cycles is nearly equivalent to the sum paid for two separate fee-for-service cycles, especially if you include the cost of cryopreservation, an included benefit with Shared Risk, but an additional charge when using fee-for-service. If you do not have a baby, you can withdraw, receive the 100% refund, or try again.

If you have a baby as a result of the third thru sixth IVF cycle, or as a result of subsequent transfer of embryos cryopreserved during the six cycles, we then earn our fee. But you will have paid far less for those cycles than the total you would have spent using the full fee for each cycle of service. This is where our part in the “sharing of the risk” comes clearly into effect.

And if you should not have a baby as a result of these six IVF cycles of therapy, then you are guaranteed a full refund of your original investment. This then serves as insurance against treatment failure for you to use for future family building options, or in any way you should chose.

Can we be considered for Shared Risk using Donor Eggs?

Yes. The use of donor oocytes may qualify a couple for Shared Risk in lieu of the above criteria regarding day 3 hormone levels or age.

Using ICSI?

Yes. The use of ICSI for male factor infertility using the male partner’s sperm if medically indicated may qualify a couple for Shared Risk.

Using a gestational carrier?

Yes. The use of a gestational carrier, if medically indicated for an abnormal or absent uterus, may qualify a couple for Shared Risk in lieu of the above criteria regarding the uterus or ‘mock’ embryo transfer.

Using Preimplantation Genetic Diagnosis (PGD)?

PGD entails two components in an IVF cycle: an embryo biopsy and then laboratory genetic analysis of the biopsied cells. If using PGD, a Shared Risk PGD/Embryo Biopsy includes the costs of embryo biopsy drugs, Shared Risk IVF cycles for $24,000. The laboratory genetic analysis is performed by and fees are passed to Shady Grove Fertility Center, LLC is not included. For further information about PGD see our section on PGD.

Do you accept patients from outside the Washington, DC area?

Yes. We have many patients from that travel from all 50 states and 35 countries around the world, many of whom come to us initially because we offer the Shared Risk IVF Refund Program. We have staff members designated to help you with any logistical arrangements, and we are experienced with working with your local physicians to minimize inconvenience to you without compromising your medical care. The National Capital Washington area is also convenient and an accommodating environment for medical care.

Do I have to complete all the cycles?

No. You can stop therapy at any time. You are under no obligation to complete any number of cycles.

What are the penalties for early withdrawal before six cycles are completed?

There are none. You receive a full refund regardless of how many of the six IVF cycles you complete – unless you deliver a live born child.
Just as you have the right to withdraw, we must share the right to withdraw you from the Shared Risk Program, for instance if you have an unexpectedly poor ovarian response to stimulation. In this rare event, the same 100% refund is paid back to you as if you withdrew on your own.

Really?

Yes. And it is spelled out in the Shared Risk Agreeement.

How can you just let us drop out without completing the six cycles?

First, we know that many of you will have a baby after only one cycle, so even if it your intention to drop out after one unsuccessful cycle, often enough you will be incorrect. Happy, but incorrect! Second, we do not believe that it is appropriate to hold you hostage to do an IVF cycle by holding your money beyond a time that you want us to. Third, many couples continue on to a second cycle even having planned to discontinue after just one because they know that the cycles that follow an unsuccessful first try are more and more being financed with our share of the money. That is reassuring – as it is meant to be.

Is Shared Risk a guarantee?

Yes. While a successful pregnancy is not guaranteed, a full refund is if treatment fails to help you have a baby. This may be viewed in contrast to what is guaranteed in traditional fee-for-service payment: you are guaranteed to pay the fee irrespective of the IVF cycle outcome.

What do others say about Shared Risk?

Our Shared Risk Program has been widely evaluated and has become the model for such programs in national discussions and for other IVF clinics considering a program of their own.

What does the ASRM say about Shared Risk?

The Ethics Committee of the American Society of Reproductive Medicine (ASRM) thoroughly reviewed ” Shared Risk or Refund Programs in Assisted Reproduction” and published their Committee Report in September 1998. (Fertil Steril 70:414-416, Sept 1998). We were humbled to have them adopt our name for such programs, and support many of our long held contentions about it. They found “that shared risk programs may be viewed as a form of insurance against the risk of failure that might appeal to some couples seeking IVF. The appeal arises from the general absence of health insurance coverage for IVF.” In evaluating the concerns inherent in offering a shared risk program, the Committee found ” the plans it examined [including ours at Shady Grove] provided sufficient information to enable patients to make an informed choice about whether to chose this option” In addition, they state that “whereas it is unethical to create unrealistic expectations or make false promises, shared risk plans do not appear to have that intent or effect…Whereas the provider’s willingness to assume some of the risk of failure may convey a message of confidence in its services, no patient is likely to interpret the arrangement as a guarantee of success. On the contrary…what is guaranteed is obviously not success, but a refund if treatment fails.” Precisely.
Before and after its recommendations were published, we have always complied fully with the Ethics Committee’s recommendations that, with full disclosure, informed consent and identical treatment for patients using shared risk plans versus fee-for-service, Shared Risk is a valid and ethical option to offer.

What do patients say about Shared Risk?

Patients love the idea of Shared Risk and laud our Program’s attributes once they have gone through – regardless of whether they have had a baby or not. Nearly every day we hear comments that patients are secure because the medical team is fully dedicated to their success – medically and financially; that they are secure because we at Shady Grove are confident in our ability to be successful; they are secure because they have insurance against the risk of failure of therapy; and that they dismiss critiques of ‘outcome based fees’ as coming from those who aren’t risking their own money trying to get pregnant.

One typical comment written on our Shared Risk Patient Satisfaction Surveys – surveys which attest to the near universal support from patients – states: “The Shared Risk Program gave us peace of mind while we were going through IVF because we knew the costs were fixed, no surprises. Once pregnant we were comforted to know that even if anything happened to the pregnancy, we could try IVF again or later adopt.”

What’s the “catch”?

There really isn’t any. As long as you know the way the Program works and you understand that this is a voluntary option to finance IVF as an alternative to fee-for-service; and that we each have some money ‘at risk’; and that you can drop out at any time; and that this is a form of insurance against the possibility of failure and not a guarantee of success, then you pretty much understand the major components of it. And we urge you to investigate every detail.

If you have additional questions about Shared Risk, please contact our International Patient Liaisons at 001-301-545-1390.

Comments are closed.