How to check health insurance for surrogate friendliness

Sometimes it seems like insurance is purposely confusing, doesn’t it? In the US medical bills are a big contributor to debt and financial struggles. Evaluating insurance for suitability for surrogacy is essential! There are insurance professionals who can help with sifting through this information and finding a policy. In my personal experience, however, having a little knowledge can save you a lot.

When we hired an insurance specialist through a notable company, the agent told us there wasn’t a suitable ACA marketplace plan for our gestational carrier. But prior to speaking with them I did my own research and identified a plan that did not appear to have any exclusions or liens. When I brought it up, the agent confirmed that we could use it, and they had overlooked that policy. Wow! My simple research saved us an incredible amount of money as we would have had to pay medical expenses out of pocket, negotiate an insurance lien or buy an expensive $25,000+ private plan.

Here are the steps you can take to make yourself more knowledge about insurance policies:

Talk to your insurance carrier

The gestational carrier is going to have to contact their own insurance provider
As as a surrogate, make sure they understand that you want to know if your insurance covers your prenatal and maternity care while you are pregnant as a gestational carrier. (Not that you are looking for them to cover someone else through infertility benefits)
You may be asked to provide diagnosis and procedure codes for the customer service agent to look up. Some helpful ones to offer are:

Z33.3 – diagnosis code (ICD10) for a gestational carrier who is pregnant

59400 – procedure code (CPT) for vaginal delivery

59510 – procedure code (CPT) for cesarean delivery

Get it in writing and keep a record

This will be the paper trail and provide a record to support your cause should you need to. You should also keep a log of who you spoke with, their position, the date and the time. Ask for a reference number for the interaction.
You can use the online portal, email, or messenger application for correspondence.
You can request that documentation, pre-authorizations and other information be mailed or emailed to you. Keep it in a safe place until well after your surrogacy journey.

Get the plan Policy Booklet

It goes by various names depending on the insurance carrier. It could be called the “Evidence of Coverage”, “Benefit Booklet”, “Summary of Benefits of Coverage”, “Policy Manual” etc.
This is generally 75-300 pages and very detailed about what conditions and treatments are and are not covered by the insurance plan. You want to search for anything that points to an exclusion or limitation.
Search the booklet for key words such as “surrogate”, “surrogacy”, “gestational carrier” or “host uterus”.
Pay special attention to the sections regarding maternity coverage and exclusions.
If surrogacy is clearly excluded then you can probably forego a professional review as you need to obtain a new policy. If the language concerning surrogacy is vague or confusing, or if surrogacy is not mentioned, then consider a professional review.

Speak with a professional

There are experienced surrogacy lawyers, insurance brokers and specialists who can help with this. They can look at the insurance plan documents, call the health plan and help to decipher whether or not this is a good insurance plan for surrogacy (surrogacy-friendly).
In the event that you do not have surrogacy friendly insurance, professionals can also walk you through the process of finding a policy. They can help with structuring dual coverage from insurance, decipher liens, and even negotiate lower payments with insurance providers.

Hopefully this helps you to determine if an existing policy is surrogacy friendly. At the very least you’ve been able to educate yourself more about the insurance policy and collect the Policy Booklet. When you’re ready to speak with an insurance professional they will need this same Policy Booklet, so you will be ahead of the game. If it is clear that you won’t be able to use this insurance, I’m sorry. Let’s take this opportunity to go over how to find a potential plan through the ACA (Affordable Care Act) Marketplace.