Surrogacy insurance is one of those important yet confusing items. You know that you need it and should use it but figuring out the best plan and how to make it work for your surrogacy journey isn’t always easy. The different types of insurance include medical insurance to cover health care, short-term disability, long-term disability, loss of organs, and life insurance. The best practice is to sit down with an insurance expert so that they can advise you on your different options. So I did! I sat down with Sarah Paige of ArtRisk Solutions to ask her your burning questions about surrogacy insurance. Listen in to our virtual coffee date for some pearls of wisdom.
In this insurance series, we are going to go deep into everything you need to know about surrogacy health insurance.
How to find the best surrogacy insurance (part 1)
Watch part 1 of my interview with Sarah Paige
Here is a glance at this interview
>> [4:11] An ART insurance broker understands the language of health insurance policies that cover fertility and surrogacy.
>> [6:48] Health insurance for intended parents, even in mandated fertility coverage states, doesn’t usually cover surrogacy related expenses
>> [8:44] Your surrogate, not you, needs an insurance plan to cover her pregnancy medical care.
>> [10:40] Surrogate friendly insurance is an insurance plan that can be used to pay for medical expenses that come up during a surrogate pregnancy
>> [12:06] Specific billing codes and notes in your surrogate’s medical record let insurance know that this is a surrogate pregnancy, therefore this can’t be hidden
>> [15:55] Medical costs from a pregnancy complication can easily be tens or hundreds of thousand dollars, therefore having insurance coverage is best practice for protecting everyone.
Connect with Sarah Paige here –> ArtRisk Solutions
Surrogacy Insurance conversation – Part 1 Transcript
Alyssa: All right we are here with Sarah page from ArtRisk she is the chief operating officer and she is coming to talk to us all about insurance for surrogacy.
Sarah: Yes, I’m very excited to be here.
Alyssa: So we were talking before we started recording, we it seems like got interested in insurance in a similar way. So having to look at insurance to figure out if it was a suitable insurance or not. So for me being the medical person in my family, I would be tasked with looking at the two or three different employer insurance plans and trying to pick between the HMO and the PPO and the high deductible and the low deductible plan, and then trying to figure out which one would cover fertility services and to what extent. And Sarah you’re saying that you initially did not like insurance for that reason?
Sarah: Yeah I didn’t. I didn’t like it! I – my background is education and every time they came up with, you know, the different plans that you had to choose and the deductibles and I honestly would call my parents and say, “can you can you just pick this for me?” Because I didn’t want to really deal with it. And I, and at the time didn’t really use insurance that much. So I felt, you know, I think like a lot of people unfortunately do; I mean I’m on the flip side now so I see the importance of it, but originally I was like, “what is the purpose of this? I’m not going to need. It’s an expense out of my pocket. Just pick something, it’s going to be okay.” But yeah I didn’t, I felt it an unnecessary evil to have at the time. And I did not like it or want to deal with it in any capacity.
Alyssa: Okay and then at some point in time you fell in love with insurance and said that you want to spend more than a decade of your life focusing on insurance for people going through surrogacy, fertility treatments, and that sort of thing?
Sarah: Yeah so I kind of fell into the job. I took a job at ArtRisk uh working 10 hours a week. I was just reviewing policies at the time calling insurance carriers and there really wasn’t a full-time position. I was in between jobs at the time and it ended up growing; I ended up liking it a lot. We were kind of on the ground floor of creating things uh policies. And the Affordable Care Act was coming up and was in Congress at the time and trying to get passed. This was back in 2009 before it was enacted in 2010. So there was a lot that was going on and shifting and changing.
Sarah: And I have a- the way my brain works, I like to figure out puzzles and put them together and so for me it was an ever-changing ever-evolving field and I really enjoyed that aspect of it. I don’t like to do anything stand still. I’m kind of that person that, you know, if I’m watching something on TV I’m also probably reading something or doing research on something. So for me it was a really nice way to transition just into insurance and then fell in love with the ART realm and not necessarily on the client side – I honestly fell in love with the professional side and the advocacy and the love and the care that the professionals take whether it’s an agency owner, a doctor, an attorney, escrow.
Sarah: How much everyone gave and cared about building these families and it was so inspiring and so that’s – I mean, it was a it was a love that evolved. I can tell you that it wasn’t like, “oh! I love this!” right off the bat. It was something that definitely evolved over time. It’s so funny when I talk about it everyone’s like you’re you’re actually you have a lot of passion around this. I’m like, “I do!” I never thought I would but I honestly I really do. So yeah so that’s how I found I guess fell in love with it slowly. That I definitely the long lasting love which is good.
Alyssa: Interesting. So it it you can hear the passion that you have for ART insurance. But I wonder, is it something that one needs to specialize in or can any insurance broker sell plans for people looking to do like egg donation or surrogacy?
Sarah: yeah, I you know, kind of like with an attorney or a doctor, such as yourself, you want someone that’s specialized in it. You want someone that understands the policy language; that understands how different carriers react to gestational carriers coming in the door even if language is good sometimes the carriers aren’t friendly. So yes, I think specializing in it definitely helps. There’s also very specific policies that only people who are specialized in it will be able to sell to kind of anyone going through the Journey, whether it’s a donor, gestational carrier, intended parent. So you always want to hook up with someone who has that ART background and understands the journey aspect to be able to cover the risks and then also offer the correct policies that you’re going to need um throughout the journey. Again, from kind of the donor aspect through the inception through delivery and even into the newborn aspect.
Alyssa: okay. So it sounds like they are different types of insurance that one can use around a surrogacy journey.
Sarah: yeah, there’s a lot of different types um and we kind of break it down by stages. So we have it where we originally start with the donor. We get donor insurance, which is to technically cycle insurance to cover any complications on that side. We have recipient insurance, which will cover the transfer procedure. We of course have maternity, that’s the big one. We want to make sure everyone has that maternity insurance. There’s life insurance because every contract is going to require that gestational carrier to carry life insurance on herself should anything happen. You’ll have loss of reproductive organs, because that is a legitimate thing that can happen and we’ve had to pay out on policies. I would say you know it’s it’s low but it’s at least six percent that you know of Journeys throughout the year we’ll probably pay some form of a loss of reproductive organ fee out. There’s permanent and total disability. There are legitimate risks that come with being pregnant and going through this journey and so we have we’re going to have insurance that covers those risk.
Sarah: Then we also look at the contract side of things to make sure that we’re covering what the intended parent is contractually required to cover. From there then we then we’ll look at the newborn side, which of course the intended parent is fully responsible for, but we always touch upon it because we want to make sure that they’re setting themselves up for the best possible outcome as well because newborn and NICU build can be devastating if you don’t have the right Insurance in play.
Alyssa: Absolutely. Okay, so given all the different types of insurance that one actually could use and should use regarding a surrogacy journey, let’s focus primarily on the health insurance for the surrogate, for the gestational career. Now, some of us have really really good insurance coverage for fertility. So I lived in two different states which have fertility mandates that cover IVF. So let’s say I’m living in Maryland and I have fertility coverage that is mandated by the state should I expect my insurance to cover my gestational carrier’s health expenses?
Sarah: yeah, I love this question because I think a lot of people do. There’s a little bit of an expectation on that. Like, “well if I can’t and I have fertility coverage and this is part of the fertility process then I should be able to cover her,”
Alyssa: “If I can’t get pregnancy and that’s my disease, which is infertility, then it should be covered.
Sarah: Exactly
Alyssa: But why is it not covered?
Sarah: I know it should be! It should be. There’s only a couple (insurance) carriers that do and they’re usually on self-funded plans through very specific companies. It’s not because she’s not your dependent. And so if you look at insurance law and who you can add to a policy, it will typically go back to the state tax code. So in order to add someone to your policy you have to basically be able to file that they are part of your household; which is why they’re not typically added into insurance policies unless they unless they want to. But then again, those are the self-funded plans that don’t necessarily have to follow all of your tax code laws or insurance laws within the state. They only have to follow federal law. So it’s a little different. That’s why we don’t see gestational carriers being able to get insurance through that and it really has to go again back to how the department of insurance is set up in conjunction with the tax code and tax law within that state.
Alyssa: Okay, so then who needs the insurance?
Sarah: I mean the gestational carrier at that point in time, she’s gonna need the insurance. So what we would do is wherever she is domiciled is the state where we need to procure the insurance, where we have to get it, and we will go through that state where she lives.
Alyssa: Where she is domiciled is where she lives.
Sarah: Yes, so wherever she is residing for more than 180 days of the year that’s where we’re going to have to get her insurance.
Sarah: And so when we do that we have to look at all the different language within all the different policies that are out there and different insurance carriers. We vet them ahead of time and then we enroll her in a plan that of course what we call “surrogate friendly”, and we know the language is good, the carriers are friendly towards gestational carriers, there’s a good network involved with it.
Sarah: So we really try and kind of break it down and say what kind of coverage and access is she going to need during that Journey, during that pregnancy. Let’s find carriers that are going to be able to cover and be again kind of the easiest to work with during that journey. Then we’ll get her insurance. The insurance is in her name so we always will have them on the phone with us, they ask us questions.
Sarah: The intended parent typically manages the bills on that end and makes sure that everything is paid for. That’s typically a contractual responsibility on really intended parent. And the gestational carrier will use the insurance and it should be fine and dandy! Not that there won’t be bumps in the road because it’s insurance and it will happen, it will happen. But then we’ll, you know, on our side will always be the person, the advocate, you know the company that’s going to if there is a bump in the road be there to sort the bump out, get it all cleared away, and that way you can continue on and not be stressed out.
Alyssa: So you mentioned surrogate friendly insurance. So that is a type of insurance that one is allowed to use for surrogacy.
Sarah: Yes and they don’t have to be surrogate specific, so it doesn’t it can be an Affordable Care Act plan. There are some plans on the Affordable Care Act, kind of your insurance on the individual market that will work and they’re very friendly, and then there’s also surrogate specific insurance on the open market or the ACA Market. That’s why we vet it because not every plan is and language will vary between plans.
Sarah: Some may be what we call ambiguous meaning that there’s not a clear definition on surrogacy. Some will be very clear that they love it and they’re and it’s fantastic and don’t worry about it. Some will be very clear that they don’t want it and that it’s excluded from the policy. Others will carry what we call a lien, which may ask the intended parent to reimburse the insurance company for any expenses that they paid on behalf of the gestational carrier. So it’s all over the board.
Sarah: So this is why we’re kind of going back to one of the questions you asked earlier which was, “why do you need an ART specific you know insurance agent,” This is why, because it’s not cookie cutter in any capacity and it doesn’t remain cookie cutter year to year either. So every year we have to revet every single insurance plan to make sure it’s going to be safe that following year.
Alyssa: Okay well I saw I saw a question online I’d love to get your take on it so I’ll read it to you. “My gestational carriers insurance is going to end next month and her new employer plan has a surrogacy exclusion. She should be pregnant by then though and I’m wondering how would her insurance even know it’s a surrogate pregnancy?” Basically, “what could go wrong if we just continue on using the same insurance?”
Sarah: yeah so what ends up… There’s codes there’s CPT codes and z30 and which is basically how the insurance company knows what to cover or not cover. It’s a bill that comes in from the doctor’s office and it says, “hey this is the service,” and it gets submitted. And there’s CPT codes and ICD-9 and ICD-10 codes and again that’s going to financially say this is what the service is, this is how much it is. On the insurance side it goes covered or uncovered and it’s one of the two. There is a specific code for surrogacy and it’s z33.3 and it’s a surrogate pregnancy! For that any doctor, any facility can put that code into the medical bill that’s submitted to the insurance company. And then the insurance company would know that that’s a surrogate pregnancy.
Sarah: The other reason too, and the other way that they can know, is that if there are claims or there’s a complication or something happens they will typically request medical records to review to make sure they’re paying for everything they should be paying for on the insurance side. When they get those medical records it very clearly states, and I have not seen a medical record file that doesn’t state, that they are a gestational carrier. Because the facilities need to know, ultimately again, who’s financially responsible, whose baby it’s going to be, there’s birth orders involved… So it’s very clearly stated within that. So those are the different ways that they would know.
Sarah: There’s always concern about not telling an insurance company and just trying to what we call “ride it out” and see what happens. I’m not, I’m not a good “ride it out” person. Obviously I’m an insurance so I mean I’m like, “no let’s cover every single risk, you know!” I’m the person with like the crazy Insurance on their home even though I probably don’t need it.
Sarah: But ultimately it’s it’s really just to make sure that you are protected as the intended parent. Because whatever happens to the gestational carrier you have a contract that says, “I’m going to cover everything and it does not go back to her,” so it’s to ensure that there are no surprises. It’s to ensure that you’re you have a cap on your financial exposure.
Sarah: So when we look at things and people ask, “well should or can I just keep it and then we’ll see what happens?” or, “we’ll wait a couple months and get new insurance later,” and “we’ll just have a this period and we’ll see what kind of bills they cover,” that always makes me nervous. Because again you don’t know what’s going to happen during a pregnancy. Nobody can predict it at all. We know that they’re screened, which is wonderful, and that the gestational carriers are of great shape and health. We understand that that doesn’t mean that a complication could not occur. There’s less risk right? We’re trying to set up for every risk possible, but it’s life and people and bodies and medicine. It all, there’s no guarantees, so we want to make sure everyone’s set up in case of anything.
Alyssa: So it can be found out because of the different codes that are used so like ICD-10 code, and then when they’re reviewing like progress notes, H&Ps, C-section note, medical student, resident, anybody could have noted that this was a surrogate or just a gestational carrier.
Alyssa: And then to speak on the amount that you could pay in terms of health bills. It could be really high right? So for me, I had a catastrophic delivery. It was a cesarean hysterectomy. I was in the ICU, I was in the hospital for 14 days entirely. The actual bill that went from my hospital to my insurance was about three hundred thousand dollars. Just from that one you know pregnancy complication. Just imagine receiving a bill like that after a surrogacy pregnancy.
Sarah: yes and that is that’s where, that’s what’s scary. Right? because we do see those bills. We place around 3000 policies a year, we do claims management on things. So we do see these bills come in and I try and tell everyone if you know when you’re healthy it’s not expensive and that’s typically with everything right? You can go into the doctor’s office. You could get cash rates for three thousand for the OB. You could get a delivery for 10,000. You could be all in a 13,000 and call it a day. And it’s beautiful and fantastic right? That’s not what happens when there’s a complication.
Sarah: As soon, and it can be a tiny one, it doesn’t need to be large, it could be that after delivering she’s lost a little too much blood and they need to do a couple blood transfusions. It could be that she was you know she’s gestational diabetes and so she has to be monitored extra closely and have a couple extra fetal echocardiograms. There could be all over the board as soon as you start to add that in there your pregnancy, which would normally range usually between 18 to 22 mark, that’s a pretty average standard cost of a pregnancy with no complications, vaginal delivery that’s going to go well, into that 60, 70, $80000 range.
Sarah: And then like you said, if there’s anything having to do with hysterectomy, ICU oh my goodness, specialists involved, like as you said 300 000. And honestly, Alyssa, I was shocked that you said 300. I thought you were going to say like 500 or 700 000 you know! It’s expensive and so it’s gets a little terrifying when you hear things like, “oh I’m just gonna cash pay. I have great rates from the doctor. I have great rates from the hospital.” We all have great rates until something happens, right? And again we don’t hope for anything to happen, that’s why they’re screened heavily, that’s why there’s guidelines from ASRM, which is American Society of Reproductive Medicine. I get it. But that doesn’t guarantee and so the purpose of insurance is for what you don’t know. It’s all the unknowns that you don’t, that you don’t have foresight for, that you just want to make sure you’re secure and okay.
