Financial Information for Patients

Transcription

1 Financial Information for Patients Introduction Thank you for considering attending Bourn Hall Clinic for your fertility treatment. This information sheet details the fees for the treatments available. In order to make the pricing of your treatment as clear as possible we have organised our prices into Treatment Packages and detailed what is included in each package. The costs detailed are valid from 01 January 2018 however we reserve the right to alter prices in exceptional circumstances. Treatment is subject to our standard terms and conditions (Page 11). Treatment of infertility includes a wide range of possibilities and we hope to have included most of them within our price list. Should you have any queries on the cost implications of your treatment, or any comments on how we can improve this information pack, please contact the Patient Services Finance team as below: Telephone +44 (0) (0) Fax +44 (0) info@bourn-hall.com IS301R28.00 Issued: 09/01/2018 Page 1 of 11

2 Table of Contents 1 Fertility Assessments Consultations Ovulatory Stimulation and Monitoring Treatment Package Intra-Uterine Insemination (IUI) Treatment Package In-vitro Fertilisation (IVF) Treatment Package Frozen Embryo Transfer (FET) Treatment Package Sperm Retrieval Treatment with Donor Gametes and Embryos Egg and Sperm Donor Programmes Egg Share Providers Egg Recipient Sperm Sharers Altruistic Egg / Sperm Donors Egg Freezing and Embryo Transfer Semen, Egg and Embryo Storage Scanning Packages Additional Treatment Costs Tests and Screening Requirements Bacteriology/Virology/Immunology Bacteriology/Virology/Immunology continued Andrology Haematology/Biochemistry Cytogenetic/Cytology Endocrinology/Hormone Tests Drug Costs What if I don t complete treatment? In-vitro Fertilisation (IVF) Cycle Blastocyst Culture Geri+ / Eeva plus Blastocyst Culture Intra Uterine Insemination (IUI) Cycle Frozen Embryo Transfer (FET) Cycle Donor Sperm Egg Share Programme Egg Freezing Embryo Donation Fees and Payment Details Terms & Conditions of Treatment at Bourn Hall Clinic IS301R28.00 Issued: 09/01/2018 Page 2 of 11

3 Package price (Per couple) 1 Fertility Assessments Mini 400 Full 800 Semen Analysis Ovarian Reserve Blood Tests Pelvic Scan Medical consultation (30 minutes) HyCoSy Blood tests (Rubella, Chlamydia and Progesterone; if required) Medical consultation (60 minutes) 2 Consultations Initial or full consultation with Consultant Gynaecologist / IVF Specialist 200 Review consultation with Consultant Gynaecologist / IVF Specialist 200 Consultation with Andrologist 250 Fertility Health and Wellbeing Consultation (30 minutes) with Consultant Gynaecologist 90 Missed consultation 50% of consultation fee is payable unless 24 hour notice of cancellation is received 3 Ovulatory Stimulation and Monitoring Treatment Package 900 Three treatment cycles All trans-vaginal scans Nurse discussion 4 Intra-Uterine Insemination (IUI) Treatment Package 900 All scanning costs Insemination procedure 5 In-vitro Fertilisation (IVF) Treatment Package 3300 All monitoring and scanning costs Cyst aspiration (if required) Local anaesthetic or Intravenous sedation (for egg collection procedure only) First year storage Egg collection Counselling In the event that the treatment cycle is cancelled before egg collection takes place there will be a refund of 2650 IS301R28.00 Issued: 09/01/2018 Page 3 of 11

4 6 Frozen Embryo Transfer (FET) Treatment Package 1400 All scanning costs Thawing of embryo(s) 7 Sperm Retrieval Surgical sperm retrieval PESA or TESE (includes cost of GA if required) 2000 Micro-TESE Treatment with Donor Gametes and Embryos Donor Sperm Family Reservation Fee (per 5 ampoules of donor sperm) 1000 Donor sperm (per vial used) 600 Purchase and administration costs for transfer of reserved donor sperm to another UK licensed centre (per vial) Donor Eggs 2950 Donor Embryos Egg and Sperm Donor Programmes Egg Share Providers Free of Charge Drugs up to pregnancy test All monitoring and scanning costs Cyst aspiration (if required) Local anaesthetic or Intravenous sedation (for egg collection procedure only) Egg collection ICSI Freezing of suitable embryos HFEA registration fee First year storage Counselling Fees are payable for the initial consultation and screening tests that are required to determine eligibility for this free package of IVF treatment. 9.2 Egg Recipient From 6250 All monitoring and scanning costs Donor oocytes Fertilisation with IVF Counselling IS301R28.00 Issued: 09/01/2018 Page 4 of 11

5 9.3 Sperm Sharers Medical & nursing care All monitoring and scanning costs Cyst aspiration (if required) Local anaesthetic / Intravenous sedation (for egg collection procedure only) Egg collection Freezing of suitable embryos HFEA registration fee Free of charge First year storage Counselling Fees are payable for the initial consultation and screening tests that are required to determine eligibility for this free package of IVF treatment. 9.4 Altruistic Egg / Sperm Donors Altruistic egg and sperm donors are entitled to claim compensation for visits to the clinic in accordance with HFEA regulations. Alternatively you can nominate a friend or family member, who needs fertility treatment, for a free cycle of IVF. Your nominee will receive the IVF package described in section 5 above, once you have completed your donation. 10 Egg Freezing and Embryo Transfer Stimulation, monitoring, egg collection and egg freezing 3900 Local anaesthetic / Intravenous sedation Egg collection All monitoring and scanning costs Egg freezing (including first year of storage) Cyst aspiration (if required) Counselling Embryology and embryo transfer 2350 Egg thawing Fertilisation with ICSI 11 Semen, Egg and Embryo Storage Semen freezing of three ejaculates up to a maximum of 12 ampoules of sperm, including three semen assessments Storage of semen for second and subsequent years and part thereof (annual fee) 350 Storage of eggs for second and subsequent years or part thereof (annual fee) 350 Initial freezing/administration fee for suitable spare embryos 600 Storage of embryos for second and subsequent years or part thereof (annual fee) 350 Administration charge for preparing frozen gametes or embryos for transfer to another UK clinic 100 Administration charge for preparing frozen gametes or embryos for transfer to an overseas clinic IS301R28.00 Issued: 09/01/2018 Page 5 of 11

6 12 Scanning Packages Pelvic ultrasound scans for Bourn Hall patients outside of treatment 120 Non-treatment pelvic ultrasound scans package (three scans) ovulatory monitoring 300 Early pregnancy / viability scan (6 12 weeks) including report and up to 5 black and white prints 80 Reassurance, Gender and Growth Scan (12 weeks to term) including report, up to 5 black and white prints and a CD of images. Gender scans may be performed from 18 weeks onwards. Singleton Twins 3 & 4D Scan Bonding Experience including report and DVD of 3D images. Singleton Twins 13 Additional Treatment Costs Additional costs HFEA registration fee per cycle of IVF/ICSI 80 HFEA registration fee per donor insemination General anaesthesia 300 Hysteroscopy Local anaesthetic / intravenous sedation 150 Endometrial scratching 350 ICSI 1150 HyCoSy 400 IMSI (including ICSI) 1350 Surrogate consultation 200 Blastocyst culture 800 Geri+ 300 IVF with surrogacy (this includes a 500 non refundable deposit) IVF with surrogacy with donor eggs (this includes a 500 non refundable deposit) Eeva test 550 Blood tests and screening requirements See 14 Assisted hatching 450 Drugs required for treatment See 15 Preimplantation Genetic Screening (PGS) up to 6 samples Preimplantation Genetic Screening (PGS) per additional sample 2500 Intralipid 20% infusion Tests and Screening Requirements Outpatient visit Scan and E2 blood test (non Bourn Hall Clinic patients) Set of copy notes standard or full 35/ 50 The tables below detail the charges for the most frequently required tests and screening requirements. You will be advised at your consultation which tests you will be required to have. Test results from other sources may be acceptable please bring them to your consultation for review. Occasionally additional tests may be required; if this is the case you will be informed of any fee prior to the additional service being carried out Bacteriology/Virology/Immunology HTLV 1 & 2 53 HIV 53 Hepatitis B Surface Antigen 53 Hepatitis B Core antibody 53 Hepatitis C 53 Rubella 40 APCA 40 Toxoplasmosis 45 Semen culture 60 High vaginal culture 60 Cervical swab culture or cytology smear 60 Lupus anticoagulant 85 Phospholipid antibodies 75 Cardiolipin 85 Cytomegalovirus (CMV) 100 IS301R28.00 Issued: 09/01/2018 Page 6 of 11

7 14.1 Bacteriology/Virology/Immunology continued TORCH screen 135 Syphilis (VDRL/TPHA) 50 Chlamydia (blood test) 100 Chlamydia (urine test) 50 Gonorrhoea (urine test) 50 Zika PCR (urine or blood test) 210 Zika Serology (blood test) Andrology Semen assessment 130 Sperm antibody test 130 Sperm DNA fragmentation test Haematology/Biochemistry Full blood count 40 Blood group 40 Blood cross match 40 Haemoglobin 40 Haemoglobin electrophoresis 150 Sickle-cell screen 70 Glucose 40 Fasting insulin 40 Prothrombotic screening 590 Recurrent miscarriage profile Cytogenetic/Cytology Chromosomes blood 300 Cystic fibrosis screen 200 Karyotyping/cystic fibrosis/y-deletion (together) 600 Y-deletion test 180 Cytology cyst fluid (per sample) Endocrinology/Hormone Tests AMH (anti-mullerian hormone) test 100 FSH (follicle stimulating hormone) 40 LH (luteinising hormone) 40 Prolactin 40 Estradiol (E 2) 40 Progesterone (P4) 40 Beta-HCG 40 Androstenedione 70 Testosterone 60 DHEAS 70 SHBG 60 Thyroxine (T4) 40 TSH (thyroid stimulation hormone) 40 T3 40 Cortisol 40 IS301R28.00 Issued: 09/01/2018 Page 7 of 11

8 15 Drug Costs Please note: the cost of drugs are additional to the treatment cycle costs. We routinely check our prices against those of other suppliers to ensure that our prices remain competitive. Intra-Uterine Insemination (IUI) Drug package 300 All treatment drugs necessary for one IUI cycle up to the pregnancy test (excludes adjuvant drugs) Frozen Embryo Transfer (FET) Drug package 200 All treatment drugs necessary for one FET cycle up to the pregnancy test (excludes adjuvant drugs) IVF Treatment Cycle Drugs From 1200 Patients purchasing drugs from Bourn Hall Clinic are given training in the administration of the drugs, a sharps bin and a drug storage case, free of charge. Drugs may be dispensed / purchased from the Pharmacy at Cambridge or delivered to your home address through a homecare provider; there is a charge per delivery. In-vitro Fertilisation (IVF) Drugs Individually priced Aspirin 75 mg dispersible tablets 1 x 28 1 Cabergoline 0.5mg tablets 1 x 8 35 Cetrotide 0.25mg injection 1 vial 37 Clomifene citrate 50 mg tablets 1 x 10 6 Crinone 8% vaginal gel 1 x Cyclo-Progynova 2 mg tablets 1 x 21 5 Cyclogest 400 mg pessaries 1 x Estraderm 100 mcg MX patches 1 x 8 10 Folic acid 1 x 28 2 Fragmin (2,500iu) 1 x Fragmin (5,000iu) 1 x Gonal F (75 IU) injection 1 vial 32 Gonal F (300 IU) 1 pre-filled pen 128 Gonal F (450 IU) 1 pre-filled pen 192 Gonal F (900 IU) 1 pre-filled pen 384 Intralipid Infusion 1 infusion 350 Lamberts Vitamins (for female) 1 months supply 19 Lamberts Vitamins (for male) 1 months supply 19 Lamberts Vitamins (two packs) 2 months supply 35 Lubion (25mg) injection 1 x 7 vials 140 Luveris (75 IU) 1 vial 58 Metformin 500mg tablets 1 x Microgynon tablets 1 x 63 6 Needles, syringes, sharps bin & disposal* 25 Norethisterone 5 mg tablets 1 x 30 5 Ovitrelle injection 1 pre-filled pen 61 Pergoveris (75 / 150 IU) 1 vial 62 Prednisolone 5 mg tablets 1 x 28 3 Progynova 2 mg tablets 1 x Proxeed female 1 months supply 30 Proxeed male 15 days supply 30 Suprecur (buserelin) sc injection 1 vial 25 Synarel (nafarelin) nasal spray 60 dose 70 Zomacton (4 mg) injection 1 ampoule 120 *All appropriate needles, syringes, sharps bin and sharps bin disposal are provided free of charge with the purchase of medicines. Although the above prices were correct at the time of printing Pharmacy prices are subject to change without notice. If other products are required check with the Pharmacy for prices. IS301R28.00 Issued: 09/01/2018 Page 8 of 11

9 16 What if I don t complete treatment? It is sometimes necessary to discontinue treatment for medical reasons. Under these circumstances we may refund/partially refund your treatment costs or discount your next treatment cycle. Here are the most common examples of our refund or discount rates. Please note that we do not refund any of the costs relating to the pre-treatment procedures or drugs In-vitro Fertilisation (IVF) Cycle If an IVF cycle is discontinued on the advice of a Bourn Hall consultant, for medical reasons after stimulation has commenced but before the egg collection procedure we will refund you the full cost of the IVF Treatment Package less 650. This is to cover the cost of administration and nursing care up to this point. Once the egg collection procedure has commenced no refund will be made. If your IVF treatment is halted on the advice of a Bourn Hall consultant, for medical reasons prior to transfer of your embryos, necessitating the freezing of the embryos created in the treatment cycle, the cost of the first frozen embryo transfer will be reduced by 50% Blastocyst Culture In the event that the blastocyst culture fails prior to the transfer of the embryos we will refund you the blastocyst fee Geri+ / Eeva plus Blastocyst Culture In the event that a day 2 or day 3 embryo transfer is recommended we will refund you the blastocyst fee Intra Uterine Insemination (IUI) Cycle In the event that insemination does not take place, on the advice of a Bourn Hall consultant due to a medical reason, we will refund you the cost of the IUI Treatment Package. In the event that insemination does not take place due to a non-medical reason we will refund you 50% of the cost of the IUI Treatment Package Frozen Embryo Transfer (FET) Cycle If an FET cycle is discontinued on the advice of a Bourn Hall consultant for medical reasons, before thawing, we will refund you the full cost of the FET Treatment Package. If embryos fail to thaw or cleave, there will be a 50% refund of the Treatment Package fee Donor Sperm Sperm donors are permitted to create a maximum of 10 families. In order to help you achieve your family we reserve a maximum of 5 (five) ampoules of sperm for you from your chosen donor. We recommend that same gender couples who both wish to have treatment using the same donor consider paying two reservation fees to reserve 10 ampoules of sperm. If your treatment using donor sperm is unsuccessful, either after IUI or after all frozen embryos created from the use of donor sperm are used, the sperm reservation charge will be refunded Egg Share Programme A minimum of 8 eggs are required to enable egg sharing to take place. Should the monitoring scans indicate it is likely that less than 8 eggs will be collected the egg share provider has the option to transfer to a self funded treatment cycle. If egg collection proceeds with the expectation of sufficient eggs being obtained but subsequently there are insufficient eggs obtained to enable sharing to occur then the treatment fees paid by the egg share recipient will be refunded and Bourn Hall Clinic will bear the cost of the egg share providers treatment cycle Egg Freezing If eggs are collected, but none are successfully frozen, we will refund the full treatment package fee. If there is no subsequent embryo transfer, we will refund the full embryo transfer package fee Embryo Donation If you are not accepted onto the embryo donation programme or decide not to proceed with treatment the donated embryo reservation fee will be refunded in full. If your treatment with donated embryos is discontinued for medical reasons, or if the embryos fail to thaw or cleave, the treatment fee will be refunded in full. We do not refund any of the costs relating to the pre-treatment procedures or drugs. IS301R28.00 Issued: 09/01/2018 Page 9 of 11

10 17 Fees and Payment Details Comprehensive financial information is provided at your first consultation. A general guide to when payments are due is shown below: Activity Consultation; any tests carried out in the Clinic (e.g. semen analysis or blood test) Treatment package + HFEA Registration Fee Screening tests and/or investigations additional to the treatment package Additional treatments during the treatment cycle (e.g. ICSI or Blastocyst culture) Collection of drugs from Pharmacy Arranging drug delivery by a homecare provider When payment is due Some consultations and tests are payable at time of booking; all others are due on the day of the consultation or test Before or on the commencement of the treatment cycle Before or on the commencement of the treatment cycle or on the day the test is advised and agreed On the day the decision is made to include the additional treatment At the time of collection On placing the order All assisted conception treatment cycles are required to be registered with the Human Fertilisation & Embryology Authority (HFEA). The HFEA charge a registration fee that becomes due at the start of a treatment cycle. Payment may be made in full by debit or credit card, or bank transfer. Credit card payments are accepted over the telephone prior to treatment. We accept most major credit or debit cards and bank transfers. For bank transfers please contact the Patient Services team at your local Bourn Hall Clinic. Please see the Terms & Conditions of Treatment at Bourn Hall Clinic (Page 11) Refunds Any refunds due will be paid once the Patient Services team has received confirmation of the change of treatment from the medical staff. Refunds will be made by card (but only to the card used for the initial payment), bank transfer or cheque. IS301R28.00 Issued: 09/01/2018 Page 10 of 11

11 Terms & Conditions of Treatment at Bourn Hall Clinic Version 6 valid from April Place and Time of Payment Payment must be received by Bourn Hall Clinic on or before the first day of any treatment cycle. Payment should be in sterling, we accept most major credit or debit cards and bank transfers. 2. Place of Treatment Unless otherwise agreed between the parties, treatment shall take place at Bourn Hall Clinic. Bourn Hall Clinic will not give advice, assistance or treatment outside the United Kingdom except by prior agreement. Where patients attend Bourn Hall Clinic having begun treatment, or taken advice elsewhere, Bourn Hall Clinic accepts no liability whatsoever for the consequences of that treatment or advice and gives no warranty that such treatment or advice was properly given. 3. Duration The Terms & Conditions shall apply for so long as the patient(s) are undertaking any treatment which is recommended by and directly under the supervision of the staff of Bourn Hall Clinic. 4. Jurisdiction The proper law for the construction of this agreement is the law of England and Wales and the parties hereby irrevocably agree that all disputes, claims, complaints, issues and proceedings arising out of treatment, assistance and advice given at or by Bourn Hall Clinic shall be subject to the exclusive jurisdiction of the Courts of England and Wales. The Parties hereby agree that all claims for injury, loss or damage connected with or arising out of the advice, assistance and/or treatment given at or by Bourn Hall Clinic shall be subject to the laws of England and Wales and the exclusive jurisdiction of the Courts of England and Wales, howsoever that injury, loss or damage shall be said to have been caused and whatsoever the cause of action raised. 5. Frustration In the event that it shall be impossible or unlawful to embark on, continue or complete an agreed course of treatment or provide a service substantially the same as that agreed, neither party shall, after the event giving rise to the impossibility or illegality of performance, be liable for further performance of the agreement, always provided that the impossibility or illegality does not result from a breach of the terms of this agreement by either party. 6. Withdrawal In the event that the patient shall unreasonably refuse to accept or follow advice given by any employee or agent of Bourn Hall Clinic, either party may withdraw from the terms of the agreement to provide advice, assistance and treatment and treat itself as discharged from its terms, provided always that the withdrawal be communicated in writing and that reasons for that withdrawal be given. 7. Definitions Bourn Hall Clinic shall mean any Company that is a wholly owned subsidiary of Bourn Bioscience Limited, including, but not restricted to Bourn Hall Limited. the patient(s) shall mean the person or couple seeking advice, assistance and/or treatment from Bourn Hall Clinic. Advice, assistance and/or treatment shall have the meaning necessary for their context and shall be defined by reference to the services from time to time offered by Bourn Hall Clinic. IS301R28.00 Issued: 09/01/2018 Page 11 of 11