Insurance – 101 – The Health Insurance Question

Medical Building Blocks

We’ve decided to do a blog post series on navigating insurance in gestational surrogacy because it’s a recurring source of stress for many of our clients. Although (for most of us), learning the ins and outs of insurance products is not high on our list of desirable ways to spend time, obtaining even a moderate level of understanding about the way that insurance works (and helps) in a surrogacy journey can ultimately save you a lot of money, and a lot of anxiety. So this will be our first post of several. In this post, we are going to orient you to the basics of the most important insurance issue in surrogacy: health insurance. Let’s look at it like a “Choose Your Own Adventure.” Here goes! 

  1. Can my surrogate’s pregnancy care be covered by my health insurance policy? 
    1. Answer: No, never. Get that out of your head now. You cannot add her as a dependent or otherwise substitute her for yourself or your spouse in order to have your policy cover her medical care. 
  2. OK, so now that we’ve dispensed with that idea, ask: Does my surrogate have a valid and active health insurance policy at all?
    1. If no, go to number 4
    2. If yes, go to number 3
  3. If my surrogate has a health insurance policy, it should be professionally reviewed for whether or not it has a surrogacy exclusion. 
    1. Fun tip: Insurance policies that do not exclude coverage for surrogacy are called “surro-friendly.” Insurance policies that cover maternity care generally but will not cover that same care if the insured is acting as a gestational surrogate are NOT “surro-friendly.” 
    2. Why should I pay for a professional review if I can just read the policy documents or call the company myself
      1. Answer: The reason is that most people are not adept at reading lengthy health insurance policy documents and accurately detecting coverage criteria, billing codes, etc. Additionally, often, when intended parents or prospective surrogates call the insurance companies, they are told erroneous information by representatives who don’t understand the questions being asked. A professional company has the staff and the resources to do a deep dive into the black hole of each specific insurance policy. 
      2. My surrogate has a “great” insurance plan (state employee, military service member, etc), so why should I worry about it covering her pregnancy? 
        1. Even “great” comprehensive insurance plans can still contain an exclusion for surrogacy. The military plan (Tricare), for example, is actually never surro-friendly, and cannot be used for any journey. 
      3. So now that you’ve had the plan professionally reviewed, read your opinion letter.
        1. If it says that your surrogate’s policy can likely be used for the pregnancy, GREAT! You’ve solved one of the big challenges in this stage of your journey.
        2. If it says that your surrogate’s policy contains a surrogacy-exclusion, then go to number 4
  4. OK, so either your surrogate does not have insurance at all OR her current policy is not surro-friendly. What does that mean?
    1. Answer – She’s going to need a new policy, and you’re going to pay for it.
    2. Where do you find such a policy? 
      1. Answer – the same company that did the insurance review above can assist you with researching and selecting a surro-friendly replacement policy and/or
      2. The Affordable Care Act marketplace can be an option depending on the time of year (Open enrollment is usually November 1-December 15) 

Overall conclusion: whether you’re on an agency or an independent journey, you’re going to need assistance with navigating the insurance elements of your journey. The sooner you get started, the more options you will have. The right solution to the insurance question could literally make tens of thousands of dollars in difference in your overall journey cost. Reach out to your Village today so we can help get you started. 

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