Paying through the no$e for a baby

Somewhere back in our recent IVF past, I think it was after Cycle Two and before Cycle Three. Oh my, how these things become a blur when they begin to multiply! Anyway, we had been in the city for an appointment with our fertility specialist, and somehow it happened that the nurse could see us shortly after our appointment was over, so off we went across this large city hospital to where the action end of the clinic is located. Could we be so fortunate after making five or so of these 8 hour (round trip) travels to the clinic all in a short span of nine or ten days, get away with having to make yet another journey back for what they term the ‘nurse appointment’?

In the nurse’s office we were signing papers, how many embryos did we want transferred, 1 or 2 (the standard for our chain of clinics). As if I was thinking. Only days earlier we had made the long hike to the city, staying in a nearby motel the night before, we had travelled to the clinic’s private hospital that morning having made it with any of those pesky early morning calls to suggest that things had gone awry.

After one cancelled cycle and a long IVF lay off due to the mishandling of the resulting ovarian cyst, we were finally heading for our first embryo transfer. One lovely three day embryo, all of our own making. Long story short, as we gleefully joked about in the waiting room, someone called my mobile phone from upstairs and told us our embryo had arrested.

So there we were back with the nurse at our second clinic, the third clinic – the location of our cancelled transfer – had only come about due to the unavailability of egg pick up on a public holiday. We had managed to wangle an appointment with our second fertility specialist for two days after the transfer had not taken place. It was the ideal chance to pick ourselves up and get some idea of Dr Dream’s take on things. As we left the appointment, the good doctor told us of his upcoming and sudden retirement. Health issues meant he would only be practising long enough to see our next cycle to the end.

Communications with Dr. Dream’s nurse had proven to be difficult in the past. Unsure of something, I’d send an email asking her “Do I need to do X or Y?” Nurse would reply with a vague; “yes, do that!” which would lead to more emails as I tried to sort out what she had meant. Yet, as this was only our second dealing with an ART nurse, this experience was a vast improvement over the short-tempered and non-phone call returning manner of Nurse Doofus. We really had little to draw on.

Somewhere in our discussion with Nurse Dream it became apparent that we were signing up for Cycle 3 immediately. That meant paying there and then. My panic rose, and Wobbles looked like he might be about to have a stroke. The costs for Cycle Two where sitting at around $6000, including additional testing and extra medications. That cycle had taken its final bow only two days earlier. Only five days earlier we had also paid for the hospital costs of $650 on the day of the egg pick up. The anaesthetic bill of $270 would arrive eventually. We were yet to receive the speed-camera traffic fine in the mail, a special souvenir of our trip home the day the embryo transfer was cancelled. Well, at least we were spared the $250 embryo transfer fee!

The way our clinic works it, the costs are payable upfront. While Australia’s fabulous compulsory government back health insurance system, Medicare, means a great whack of the cost are eventually paid back to the patient. Trouble is how many people have enough cash to have the costs for two or three IVF cycles paid up to the clinic at the one time?

Wobbles eventually summonsed the courage to direct “Do we have to pay today?” to our nurse.

“Yes, or you will have to just come all the way back here again!” she snapped.

Now, I have never gone along with any of the conspiracy theories that clinic staff might be working on some commission arrangement, but her approach would surely be enough to raise suspicion. As usual with our stumbling IVF experience we would later find that her statement was not accurate. We could have signed the papers then, paid the funds later and had the medications posted to us before the cycle began.

On arriving at the accounts department we asked a basic question about the refund we would eventually receive on the recently failed second cycle. Again, we were novices. Six months earlier we had paid upfront for our first cancelled cycle. That money had kindly been held in ‘credit’ by the clinic. We had no clues as to how the Medicare refund system worked. Nor did we know how much of a refund to expect.

The accounts woman felt the need to give us a mini lecture on how inexpensive treatments are; “IVF really doesn’t cost much!”

Outside, I feared that I might have to revive Wobbles should he collapse soon after. The funds now benevolently being cared for by the clinic was now totalling something like $11,000. That would not be the end total of two cycles, but that was how much of our funds the clinic was currently ‘minding’ for us. The next cycle was weeks away from starting, and the refund from the previous cycle even further away.

Please understand I am eternally grateful that the Australian government subsidises health care. Ongoing ART treatment and its related medical expenses means that we qualify for Medicare’s Safety Net, a system that means once out-of-pocket medical expenses total more than $1058.70 in one calendar year, the refund on out-of-pocket costs for out-of-hospital services grows to a healthy 80% benefit. The day hospital procedure for egg pick up or embryo transfer can only be claimed via private medical insurance. Additional IVF medications must also be claimed privately, with the cost of the standard FSH included in the upfront cost of a cycle.

We are fortunate in this country. Some clinics charge slightly less. Others charge more. My only complaint in this area is the very long and drawn out process my clinic drags clients through.

The funds are paid upfront. Back in June we paid the clinic $4210 for a basic IVF cycle with ICSI. The cycle ended in the early days of August. Only today did we receive the invoice that allows us to begin the somewhat shorter claim process with Medicare.

Our group of clinics is known to worth hundreds of millions of dollars. A 50 per cent of its ownership was floated on the stock exchange only a year or so ago. Medicare also offers a system where in many cases patients can directly pay only the ‘gap’ cost of what is not refundable by the government’s system. It is not an inflexible and difficult system however our large fertility clinic is able to drag its heels in this process by weeks or even months.

We physically would have been able to have started another short IVF cycle days after the collapse of our most recent failure. If a successive cycle had not worked we could now be in the midst of our sixth cycle. That would have meant having made upfront payments for three cycles on the trot, with no sign of a refund of any of those.

Other reasons for have come into play for our current hiatus from continuous IVF cycles, the clinic’s added stress through their handling of payments has contributed in many ways.