Does Health Insurance Cover Surrogacy?

Introduction

Many couples want to experience parenthood but may not be able to due to multiple problems, such as fertility. Surrogacy is one way out, especially if couples have explored all other options and haven’t tasted success. Nearly one in five married women in the US face such problems, prompting them to seek options such as a surrogate, a study by the Centers for Disease Control and Prevention shows.

Does health insurance cover surrogacy? This question assumes importance as surrogacy can be an expensive procedure, as well as emotionally draining. In this blog, we will discuss what determines the levels of insurance coverage for surrogacy, the average costs incurred in the process, and possible ways of reducing them.

Benefits of Using a Surrogate Mother

Surrogacy offers many benefits. This path to parenthood aids couples with infertility or other challenges. It also supports women with a history of miscarriages or health issues that complicate pregnancy. Additionally, surrogacy can also bring joy to the surrogate mother.

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Overview of Health Insurance Coverage

Surrogacy health insurance varies by plan and state. The Affordable Care Act doesn’t require surrogacy coverage. Insurance companies decide on this matter. Several insurance providers view surrogacy as ‘an option’ and not as a case of ill health. Due to this, it becomes unlikely that their policies will cover surrogacy issues. Still, under some circumstances, some surrogacy expenses will be barred by the insurance company.

Does Health Insurance Cover Surrogacy?

Let’s examine a summary of some of those factors:

Medically Necessary vs. Elective Procedures

Surrogacy insurance often depends on medical necessity. Many plans cover it if the parents can’t carry a pregnancy due to a medical issue. However, coverage for surrogacy chosen for convenience or personal reasons is rare. So, it’s crucial to talk to your insurance provider. They can tell you if your situation qualifies as medically necessary.

Coverage for Different Types of Surrogacy

Insurance coverage for surrogacy varies by type. Some plans may cover traditional surrogacy, where the surrogate is the biological mother. However, coverage for gestational surrogacy, where she isn’t, is rare and may have extra requirements. So, it’s vital to check with your insurer about their policies for each surrogacy type.

Factors Affecting Surrogacy Coverage

Most times, the following factors affect an insurer’s ability to ensure surrogacy:

In-Network vs. Out-of-Network Providers

Surrogacy costs vary depending on insurance network providers. In-network providers are cheaper due to agreements with insurers, which lowers patients’ costs. On the other hand, out-of-network providers charge more, increasing expenses.

Copayments, Deductibles, and Coinsurance

Copayments are fixed fees paid at the service. Deductibles are annual amounts needed before coverage starts. Coinsurance is the percentage of costs you pay after meeting the deductible. The specific amounts vary by your insurance plan. So, it’s crucial to check your policy. This helps you understand how these terms affect surrogacy costs.

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Typical Costs of Surrogacy

Surrogacy may be quite costly in total, and the range in which the costs may fall is extensive. Below is a summary breakdown:

Average Costs with Insurance

The amount mentioned covers part of the total surrogacy costs, but not all. Surrogacy can cost anywhere from $150,000 to $200,000. This investment reflects the comprehensive support and care involved in the process.

Out-of-Pocket Expenses

Most intended mothers still face extra costs, even with insurance support. These include agency, legal, and surrogate fees, plus medical expenses not covered by insurance.

How to Verify Your Coverage

There are a few things that must be done to verify the insurance policy before progressing to the surrogacy journey. This is how:

Checking Your Insurance Policy

Before starting surrogacy, carefully read your health insurance policy. Look for sections on fertility treatments, surrogacy, and maternity coverage. Some policies exclude surrogacy costs, while others cover part of it. Knowing your coverage helps avoid unexpected costs.

Contacting Your Insurance Provider

If an insurance policy mentions surrogacy but is unclear, contact your insurer immediately. Ask them to clarify coverage, exclusions, and the need for pre-authorization. Also, inquire about limits. This is crucial for resolving future disputes.

Steps to Get Surrogacy Approved

To get approved for surrogacy by the insurance provider, there are various steps that one has to take:

Pre-Authorization Requirements

Some insurance plans need pre-approval for surrogacy costs. This means getting approval before any medical work starts. Pre-approval is helpful. It shows parents-to-be what costs to expect, avoiding surprises.

Filing Claims Successfully

Filing insurance claims for surrogacy is often complicated. First, keep detailed records of medical procedures, payments, and insurance communications. Then, submit claims quickly and correctly.

Tips for Reducing Surrogacy Costs

Surrogacy can be expensive. But, there are ways to cut costs:

Using In-Network Providers

Using only in-network providers can reduce surrogacy costs. These providers have a contract with the insurance company and will provide services at cheaper costs, so savings on out-of-pocket expenses will be high.

Exploring Financial Assistance Options

Options exist to reduce the high costs of surrogacy. Some employers offer health coverage that includes surrogacy. Additionally, intended parents can seek outside help, such as grants, loans, or fundraising.

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Conclusion

Surrogacy can change lives, but it’s costly. First, understand your health insurance and explore options. This helps manage costs. Health insurance typically doesn’t cover surrogacy for intended parents. Most plans won’t pay for surrogate-related medical costs or fertility treatments. Some insurance may cover the surrogate’s pregnancy if her policy doesn’t exclude surrogacy. In many cases, special surrogacy insurance or employer benefits are needed to cover costs. Coverage varies by insurance provider, plan, and state.

The insurance marketplace Beem lets you compare health plans from various companies at lower costs. Users can review coverage for preventive, basic, and comprehensive care. Choose from a variety of plans so you can find coverage that fits your lifestyle and budget. Download the app here.

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