Clinical Oversight of Fertility Benefits – Driving Efficiency and Effectiveness for Employers and Employees Alike

With 66 percent of employers projected to offer fertility benefits in 2019, more and more of them are trying to determine the best way to offer these benefits.  Do you just increase insurance coverage and set limits on the number of IVF cycles, or impose a lifetime cap?  Or do you get managed benefits with clinical expertise to guide your employees through the process? A managed program, like the program offered by WINFertility, connects employees with fertility experts, helping them to navigate this complicated space and use their fertility benefit dollars efficiently.

Clinical Oversight

One of the advantages of a managed fertility benefit is clinical oversight.  Nurse Care Managers serve as the employees’ advocates and guide them through their fertility journey.  These qualified nurses and other network experts help employees choose the most appropriate doctors, medications and treatments to be successful in building a family. This approach is more efficient because your employees don’t waste time and money on ineffective treatments.  It also insures they are focused on clinically-proven best practices.  For example, genetic testing of embryos may increase success rates in IVF in certain instances by determining that only embryos without chromosomal abnormalities are used.  When used appropriately, genetic testing can significantly improve a patient’s chances of success.  But this testing is not necessary for everyone, and is often recommended only for older women or patients who have experienced multiple miscarriages.  An employee’s Nurse Care Manager will help them determine the best course of treatment to get the baby they want so badly.

Cost Control and Safer Treatment

Offering benefits without management may seem less costly on the surface than managed benefits.  But the long-term costs of “unmanaged” benefits can be significant.  Employees may choose to have IVF with multiple embryos transferred, hoping for a multiple pregnancy in order to avoid the out-of-pocket costs of subsequent IVF cycles.  But most people don’t realize that a twin pregnancy is a high-risk one, and that triplets are extremely high-risk.  More than 20 percent of twins and 80 percent of triplets require care in the neonatal intensive care unit (NICU).  An average NICU admission lasts 20 days and costs from $40,000 to $80,000.  And increased medical costs over time are associated with conditions due to premature birth, such as asthma and cerebral palsy.

Employee Productivity

Another plus of managed benefits is the effect of emotional support and clinical guidance on employees who participate.  Fertility treatment is extremely stressful, both emotionally and financially.  Providing support through this fraught time helps employees make good decisions and feel that they’re not alone in their fertility journey.