In our seventh episode, Circle Surrogacy & Egg Donation Director of Marketing, Kristin Marsoli, sits down with Lissa Kline, SVP, Provider and Member Services at Progyny!
They discuss the services that Progyny provides, the importance of fertility benefits, why folks choose surrogacy & egg donation, and how to address infertility with your employer.
Lissa shares about what makes Progyny special and how to reduce the costs of third party reproduction and have a higher rate of success.
Circle Surrogacy is proud to partner with Progyny and help make surrogacy and egg donation more affordable and accessible.
Interested in learning more about surrogacy and egg donation? Check out our website at https://www.circlesurrogacy.com/
Interested in learning more about Progyny and their incredible fertility benefits? Check out their website: https://progyny.com/
Welcome to the Family Circle, circle, surrogacy and egg donations Podcast. I'm gonna be your host today. This is Kristen, I'm the Marketing Director here at Circle surrogacy and the subject of surrogacy and egg donation costs is one that we are asked about quite a bit. intended parents often wonder if there are ways to make their journey with surrogacy and egg donation a little bit more affordable. Sometimes we get asked if there's benefits that cover third party reproduction. So it is a hot topic for us over in the surrogacy and egg donation world. Today, we have a super special guest, we are hoping to answer all of those questions. So I'd like to welcome Alyssa Klein, who is the Senior Vice President for provider and Member Services at progeny. So welcome, Alyssa. It's wonderful to have you here.
Thank you so much, Kristin. Really nice to be here. And we're I'm really excited about the topic.
So I'd love to start, can you just give us a little bit background about yourself and tell us what you do over a progeny and sort of how you got into that line of work?
Awesome. Yes. So as you said up progeny, I'm SVP of provider and Member Services, which means I oversee, ultimately our member experience. And so what does that mean? That means that progeny is a fertility benefits company, really one of the leading in the space. So we offer fertility benefits to our clients, which means our members are those people covered under those medical plans have access to a really comprehensive fertility benefit through progeny. And one of our key components to our benefit is member support and having a direct contact a point of contact throughout that journey to really provide emotional support, logistical support, help understand what your benefit is, and what you have access to as a covered person. And so I oversee pretty closely that member experience including a few teams, I joined progeny about five years ago, prior to my life at progeny. I worked at Columbia University Medical Center in their division of reproductive endocrinology and infertility what is known as Columbia University Fertility Center, which is an in network clinic for progeny members. And so I'm still connected there, which is great. And I had a number of rolls over my time there, including running at one point, the egg donor program, and so do have a really good experience with an egg donation at the time, surrogacy wasn't legal in New York State, which is where I live and where Columbia University is located. And so we didn't do a ton around surrogacy, but certainly throughout my career, I have worked with surrogacy intended parents, gestational carriers, as well, and lots of egg donors, and so have a pretty good understanding of how that process works on the other side, and now at progeny, how we support members through those really complex journeys.
Wonderful. So you have a lot of knowledge in third party reproduction, it sounds like so as you were talking, you were talking about, there's the employer side of things, and then the members and the client. So does progeny as a whole work directly with let's say, me as an intended parent, or do you work more directly with employers and through the employers, the people who are on those plans?
So both actually, we have a robust client. So our clients are the employers, we have a robust client support through our account management team, and so they are helping them understand what benefit they're offering. And then we have a team, my team who are supporting those intended parents, those covered people intended parents less working with the gestational carriers, it comes up occasionally, but really mostly supporting those intended parents through that journey.
Oh, that's wonderful. Okay, so what are some of the reasons that patients may need an egg donor or a surrogate find themselves talking to your team?
Yeah, so it is complex. Obviously, there are many reasons that a person or couple may need or desire prefer an egg donor and or gestational carrier or surrogate one of the largest populations we see under progeny is either single men or men with a same sex partner. So a same sex male couple or a single male individual who typically using male as a as a placeholder for a person who produces sperm. Usually they will need an egg donor and or a gestational carrier to build their families typically if their partner doesn't produce eggs and her uterus right and so we see a lot of single male But more than that, we see a lot of same sex male couples utilizing egg donation and surrogacy. And we also see heterosexual couples where one partner is female assigned at birth and one partner is male assigned at birth, where there is a, maybe a medical indication. So sometimes that means that the female partner has diminished ovarian reserve or is no longer able to produce or make embryos right and so isn't able to use her own eggs or what you would call a Ptolemaeus eggs. And so they need an egg donor that's often age related, but certainly not the only time that a person needs an egg donor. And then sometimes they may also or only need a gestational carrier, because there is a medical reason why a female partner can't carry a pregnancy that can be for a lot of reasons, including maybe there's an issue with her uterus like a Septate uterus or her uterus isn't able to carry a pregnancy, or maybe she has another another medical indication where pregnancy is dangerous, right. And so we see a lot of people coming into needing an egg donor and gestational carrier for really a lot of different reasons.
Right. And we know I know from my personal experience of having gone through surrogacy as an intended parent and working here at Circle, that surrogacy and egg donation and really third party reproduction in general is not cheap. And to have that financial stress on top of physical stress, emotional stress, when you're going through this process and really hoping to build your family, it can be really difficult. Do you find that more employers now are starting to cover third party reproduction, and that is a place where intended parents can really find a little bit of help with those the financial side of things?
Yes, within progeny, we are seeing that employers are covering third party reproduction and I can talk about that specifically. I do think progeny is unique in this space. And so we don't see overwhelmingly outside of progeny that these are covered services. We do see within progeny that members have access to some members have access to coverage for egg donation that looks a little different client to client or or patient to patient member to member but it does exist for gestational carrier or surrogacy coverage, we see that this is typically a post tax reimbursement. So what does that look like? That means that an employer group may say because that gestational carrier or that surrogate is not a covered entity under your plan, your medical plan, we can't cover they're usually hurt, but we can't cover their medical services directly under your medical plan. Medical Plan covered services are pre tax, which gets a little weedy but I'm explaining that for a reason. And so what some clients will do some employers will do is they will give their members $1 benefit post tax that sort of $1 benefit, let's say $20,000 or more that they can use towards those expenses. Egg Donation, when covered is typically covered under a medical benefit, we see that the options for covering egg donation, either covering the purchase of a cohort of previously frozen eggs or a what what some people call it a live donor, which means you are actually choosing a donor either through an agency or through a clinic, that donor is cycling and all retrieved eggs are the input property of the intended parent or intended parents. And that is often covered Certainly not 100% of the time, but is often covered through the progeny benefit.
Got it. Okay. So if there are employers that don't cover these types of services, what do you tell them as a reason why they should be offering that?
What do we tell the employers? Yes, I will first say when it's not covered, it is often because of a tax policy or a tax decision, which is under ERISA. And so it's not typically covered because employers don't see the value of it. Their counsel is telling them that it's not a covered benefit, right. It can't be a covered benefit. And there's been some guidance under IRS who oversees a lot of these benefits. There's been some guidance over IRS policy that says that these shouldn't be covered. And so that's often the reason that clients are choosing not to cover but when we are talking to people about why this should be covered. We at progeny have worked really founded on a Diversity Equity and Inclusion and that a fertility benefit should be equitable across a diverse population of employees. So what does that mean? That means that if I work at progeny, which of course I do, and I have access to the progeny benefit that I should have the same coverage as my colleague next to me. So me as a straight woman who may have a male partner should have the same benefit as my colleague who maybe identifies as male and has a male partner so that coverage should be equitable. And so we talk about that as in terms of egg donation and surrogacy because different people need different pathways to parenthood, and many need egg donation and surrogacy to build their families, as we talked about before. And so all of these things should be covered equally. And that's really what we talk to clients about. And I will say, overwhelmingly, clients agree when it's not covered, it's typically again, as I said, more of a decision around insurance policy and not because they don't see the value.
So as an employee, if I work for a company, in your opinion, that might not offer something like this, do I have the power to change that? Are there steps I could take to advocate for people and have my employer offered these types of benefits?
Yes, so the short answer is yes, you do. I think we see that employers or clients choose the progeny benefit, often because their membership their employees has come to them and said, This is important to me, for this reason, and this is important to my colleagues for this reason, right? And so having that really humanizing the the experience and explaining to your HR team, your benefits team, why this is such a valuable and necessary benefit does often change. I do think in my experience working at progeny, that employer group are increasingly seeing the need for fertility benefits, and specifically seeing the need for comprehensive and equitable employer fertility benefits specifically, really as a recruitment and retaining, right, so really seeing that people want these benefits. And it's important to them, particularly as folks age and delay childbearing. And also, as LGBTQ folks are looking to build their families, this is increasingly becoming a really necessary and vital benefit for employers to offer.
You mentioned comprehensive benefits. So as someone looking into this, what are some key things that I should look at when I'm looking for fertility benefits? What should it include?
So if you are joining a company or talking to your company about adding a fertility benefit, I would say that really important things to include are what does the access look like for everyone. So in other models, there are often restrictions where you have to have been actively trying to conceive for a certain amount of time to have access to any fertility benefit. What happens there is that excludes large populations of people who aren't able to actively try to conceive either because of their sexual orientation, their relationship status, or you know, their family dynamic, right. So if I have a female partner, as a female person, we are not able to, in quotes, actively try to conceive right for certain number of time. So I think it is important to know how that benefit can be accessed and what those criteria are likewise, looking at what are the covered services. So once I can access that benefit, right, you want to know the breadth of services that are covered. So we're talking today about egg donation, and third party surrogacy? And so those are really important questions to ask. I would also ask if that plan covers IVF as an example, in addition to egg donation, does it cover fertility preservation? Does it cover sort of like all of these things that may be necessary along a journey for family building?
I think when you start on this journey, and you're faced with an alternative path to parenthood, you just mentioned like, Hey, you should check if it covers IVF, which I think sometimes people might think great, I need egg donation and not even consider that IVF is a completely separate piece of the puzzle that also costs money. So I think that idea of knowing exactly what you might require in order to move forward to creating or building a family is super important. Talk to your doctor, what is it I need? And then you're armed with the knowledge when you're asking questions of your employer, right.
Totally. Yeah, it's a really good way to think about a comprehensive benefit and when we talk to our same sex male couples, even if they don't have egg donation covered, you can still get coverage through progeny and and maybe other solutions for the portion of creating the embryos. So once an A donor has their eggs retrieved, or once you've purchased that those eggs those Oh sites, there is still services to create embryos, right sperm prep, the embryo development, the biopsy and and testing Have those embryos PGT. A, which is a test, of course that you can do on embryos to check for chromosomal abnormality or are these healthy embryos. And so those services may be covered under your plan. And that is another way to save your out of pocket cost and utilize and sort of optimize that benefit. So you're right, thinking about all of these different aspects is really so important. You touched
on this a little bit when you were talking about employers and employee retention, and what but what are some other benefits to an employer to be able to offer this type of coverage for its employees?
Really good question. So I think it shows the investment in the whole person of your employee group, right. So I think this shows as an employer that you really value their life outside of them being an employee, if that makes sense, right. So you value their family building, you value their priorities. And so I think that's important. I also think that when you have a benefit in place, like progeny, which I mentioned, the support that we offer, and that's really important, but we also cover a benefit in a really specific way that allows people to get to the first treatment they need the first time. And so what does that mean for the employee, that means they're getting to their dream of a family more quickly, and with more success, right. And for the employer, that means they are covering a fewer futile treatments, right? So they're not covering treatments that aren't going to work. And that also means the employee is at work more, right? Does that make sense? Right? If if you do, let's say I UI as an example multiple times, you're out of work, because these treatments take time away from work, right. And so you're out of work more often, because you're going through these treatments that aren't necessarily going to be successful. And so I think that matters to employers. I also think we cover specific services that ensure that are hopefully always achieving a healthy singleton pregnancy, which means that the gestational carrier or the mom, if there's a mom carrying are having a healthier pregnancy, with fewer risks of those sorts of preterm birth and things like that, which again, is is helpful to the employer, I think, for obvious reasons.
That makes total sense. Is there a difference? If I work for a really small company, or I work for a company that has, let's say, like 10,000 employees? Are the same types of benefits available to all size companies? Or am I at a disadvantage? If I work for a smaller company? How does that work?
So I think the short answer is probably no difference. The more complicated answer is that a smaller company may have a different bottom line and may not be able to provide as rich of a benefit based on their budget. I don't know that to be true, but just guessing that that may be a thing. Another distinction is a fully insured company versus a self insured company. I don't think that really places employees at a disadvantage progeny as an example is a fairly small company, we have just over 300 employees. And the I would consider that small in terms of the number of people versus Columbia University where I used to work right that had 1000s and 1000s. And progeny, like Colombia, where I used to work has very rich and very robust benefits for its members, including chosen fertility benefits, obviously, because we live our mission and our values. And so I don't think it really matters. I think it may be case to case it could but I really do think small companies can provide just as rich benefits as large companies are able to.
Well, that leads me to my next question of, I feel like I got this too. So shame on me, but a common myth when employers actually add more benefits or add a fertility benefit that it will increase their overall health care costs. Is that a myth? Is that true? Am I wrong?
I think it really depends on the benefit that you put in place. Right. And so I think it's kind of a myth. I wouldn't call you wrong. But I think it's kind of a myth in that if you put a smart like progeny benefit in place that is working with your members, and a provider network of doctors to achieve a healthy singleton pregnancy that you can actually save what are what we call downstream NICU costs. What does that mean? So if you put a benefit in place that is not very efficient, and is not very effective, and maybe incentivizes people to make poor decisions about their health, right and their the outcome of those cycles, those fertility cycles, you may be incentivizing people to for example, transfer multiple embryos, which could lead to a multiple gestation we love twins. They're adorable and I know many healthy twins who are who have grown into adults and And or adults who have twins wonderful. And we know that those are higher risk pregnancies and they often mean preterm birth. And so that means babies and in some cases the mom or the person carrying is at risk for more health issues stays in the NICU are very, very expensive, because as you can imagine, there are a lot of things that need to happen in the NICU and constant surveillance. And so you can be putting a benefit in place that is actually going to increase those downstream costs. When you put a benefit like progeny in place, you are hopefully ensuring or as much as possible, ensuring that your members are able to efficiently and effectively use the benefit with the best treatment option available to them from the beginning, which will lead to everyone's goal which is healthy singleton pregnancies,
we see the same thing. Circle surrogacy when talking about births of multiples and why singleton pregnancy is you know, the safest not only for the baby, but for the gestational carrier as well for for all of the reasons that you stated. So one question I have for you, family building is a very personal decision choice. And you know, a lot of times employees or you know, people in general, even with family and friends, they're not only sharing what's going on behind closed doors, right? So if I'm an employee, and I'm not quite ready to share my plans with my employer, is there a way for me to advocate for a benefit without spilling the beans that this is something that I'm trying? I'm trying
to do? Personally, I really love that question. And it's one that I get asked a lot. I think that so at progeny, I can speak from our experience, we do, of course, have a very robust fertility benefit. But let's pretend for a second that we don't for this analogy, we do have very regular what we call town halls. So we all come together as a company, we talk about a number of topics. And as part of those town halls, we are able to anonymously ask questions, and I love it because our executive team gets in and they answer questions. And you in this way could say, if you have this ability at your office to say, Hey, I'm not really comfortable coming out about how I need to form my family, whatever that means, right? And we don't have this benefit. Here's why it is important to me as an individual and as an employee. And so I think that's a not an example of an opportunity to sort of anonymously provide feedback to your employer, I would also say go to your HR team, and maybe ask for it to be kept anonymous. I think generally speaking, HR teams benefit teams understand why that's important. And explain what it means to you and say that you're really not ready to disclose this publicly to your manager, but that it's important. I as a people, manager, myself, of course, having worked in this space for a long time, I understand and certainly talk to my other contemporaries here, my other colleagues here about why this is important, but even to people outside of progeny, I am have an open door policy, I really want everyone on my team, whether they report directly into me or not to be able to come to me with any questions, maybe because it's my background as an LCSW. I also understand the value of anonymity in some cases, especially these really sensitive and intimate conversations. And so if you feel like maybe your manager or a manager in your company, if you feel that they would respect that anonymity and advocate for you, on your behalf, I think that's another opportunity to do that.
That's great advice. Yeah, I think knowing that you have someone where you work that is might not even be in your department, but somebody who could advocate on your, on your behalf, or maybe guide you in the right direction on how to do that that's really helpful. Is there anything we didn't touch on that you feel everybody listening to this podcast needs to know about progeny,
I obviously could talk about progeny all day because I really am passionate about the work that we do. I think it's really important. And I think we said it, but it doesn't hurt to say it again, I think it's really important to have a supported comprehensive benefit. One thing we didn't talk about that much is our provider network so that in network physicians who are helping with egg donation with IVF, with surrogacy in many cases, and the provider that you choose is so so important. We unlike a lot of other people in this space have very close collaborative relationships with our providers. We choose really only the best providers to be giving people the best chance at forming their family and so I think that is a really important thing to say. And then I think also partners like circle surrogacy we partner very closely with you as I think you know, I personally have spoken to many folks who work at circle and we know that your mission is aligned very close. With hours, which is individualized, dedicated, really best in class care for people going through these journeys is so important. And so I think that really talks about who we are, in terms of progeny is a company that we partner very closely with our providers, and with partners like circle surrogacy to really offer the best option for people going through these really, as I said before, complex, expensive and complicated journeys.
So if I'm listening, and I'm ready to chat with someone, like what is a good first step for me, like, what is the first thing that I should do? I'm not going to call you directly, but what should I do? You mean,
if you have access to the progeny benefit?
If I have access to the progeny? Or if I don't? Or if I don't know if I do, how do I even get started? Good question.
So I would say, be a really smart and good consumer of the benefits you have available to you. So as an example, in your open enrollment, look and see what benefits you have access to, if it's not open enrollment time, like right now is not we're coming up to it, but it's not for most people right now look on your HR intranet, or whatever that benefits hub or benefit site is and look specifically at the benefits. So type in fertility, what are my fertility benefits type in words like IVF, and egg donation and things like that and see what's popping up, set up time and talk to your benefits team about what benefits you have that are that are available to you. I've seen in some cases, while you may not have a fertility benefit, some companies will have a small bucket of money to help people with medical expenses. And so maybe that's another option for you. And so I think just starting to talk about it starting to do some of your own self service and looking if you know that gestational surrogacy is going to be your pathway, and you don't have access to the fertility benefit, starting reaching out to a company like circle to just understand the landscape and just understand sort of what the timing will be and what the cost will be. And getting those questions answered, I think is a really good place to start. And then if you do have access to progeny, congratulations, that's amazing. Your first step would be to reach out to your patient care advocate. And you can always find your specific phone number to call into progeny, usually on your HR benefits site, or whatever that hub is where you find those numbers. And then you reach out to your individual point of contact your patient care advocate, and they'll help guide you through that process.
Oh, that's all great advice. So thank you. And hopefully that will will help some folks out there who are hoping to learn more about this. Alyssa, I want to thank you so much for joining us today. I know, I'm super appreciative of all of the work and in the partnerships between circle and progeny. And I can't thank you enough for coming and sharing all of this with us today.
Thank you, I think it's so important to have these conversations and let people understand the process. And we're really so grateful for our relationship with circle. You guys are such good partners. And so really, really happy to be here. And like I said, I could talk about this stuff all day. So thank you for giving me the opportunity. Oh, you're welcome. Thanks for joining us. Thank you