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Improve treatment efficiencies and maximize outcomes

Whether for personal or professional reasons, many couples today are delaying starting a family. However, waiting to conceive can lead to fertility issues — for one partner or both.

May 2, 2023 | 5-minute read

Fertility issues are challenging and expensive to resolve:

  • 1 in 8 U.S. couples are affected by infertility1
  • Approximate cost to health care system:2 $5K at-term delivery $50K preterm delivery
  • 17% of U.S. couples are using fertility treatments3
  • 12K—$17K average cost per cycle for in vitro fertilization (IVF)4

Without state-of-the-art, evidence-based medicine, getting pregnant can take longer and the occurrence of multiple births can be higher. When infertility coverage is not available, consumers often turn to lower-cost, less invasive procedures that are ineffective or less advanced clinically. When unmanaged treatments do not work, they can take a toll emotionally.

In addition to the direct cost of treatment and pharmaceuticals, health plans also bear medical costs of unmanaged fertility treatment as a result of more expensive prenatal care and delivery, preterm births or neonatal intensive care utilization.

To address this issue and ensure that patients receive the right treatment at the right time, providers need access to high-quality, real-world data. This creates a major opportunity for payers to step in and support providers by sharing their existing data around individual care needs and overall utilization.

Evidence-based solutions

Optum® Fertility Solutions guides consumers through the fertility landscape with tools and support to help them make complex treatment decisions. We provide education, counseling, fertility management and access to a national Centers of Excellence (COEs) of network of premier infertility treatment clinics.

  • Superior member experience with case management — Experienced, specialized infertility nurses work directly with consumers to guide them along the complex fertility journey. Nurses average 14 years of experience and help consumers understand benefits coverage and treatment options, and answer the inevitable questions that come up along the way.  
  • Reduce unnecessary spend with utilization management — Pre-authorization of treatment plans and fertility medications that conform to benefits and evidence-based guidelines, along with review of submitted claims can reduce spend.  
    • Benefits verification — Fertility staff will verify benefits at the plan level, review accumulators and authorize only covered services. 
    • Medical necessity — Denials are recommended for services that do not meet evidence-based medicine guidelines. 
    • Pharmacy dosage management — Monitoring prescriptions helps ensure preferred drugs are used in appropriate quantities. 
  • Better outcomes at lower rates with network management — Evaluation and contracting with Reproductive Endocrinology Clinics, along with case rate contracts provide better outcomes at lower rates.  
    • Network contracting — Contracts include bundled procedures that reduce cost, risk and complexity while providing a superior experience.  
    • Centers of Excellence qualification — The Optum Clinical Science Institute constantly evaluates fertility clinics and only the very best centers earn our COE designation.  
  • Reduce medical expense variability with our risk-based program — We will work with you to transfer infertility spend risk and increase medical expense predictability for fertility spend. Take advantage of rate favorability within our network of contracted providers. Optum will reprice claims based on our network contracts, and work with you to identify covered medical and pharmacy spend and assume the risk.

By aligning consumers to the right treatment at the right time, Optum Fertility Solutions reduces instances of multiple births and preterm deliveries, improves treatment efficiencies and maximizes outcomes while reducing medical costs overall.

For more information

Please contact your Optum representative:

  1. The National Infertility Association. Facts, diagnosis, and risk factors. 20, 2022.
  2. Centers for Disease Control and Prevention. National Vital Statistics Reports. March 23, 2021. Accessed September 20, 2022.
  3. Centers for Disease Control and Prevention. Key statistics from the National Survey of Family Growth. October 13, 2017. Accessed September 20, 2022.
  4. National Conference of State Legislatures. State laws related to insurance coverage for infertility treatment. March 12, 2021. Accessed September 20, 2022.