Health Insurance Reviews and Coverage Opinions for Surrogates and Carriers
What is a Health Insurance Coverage review?
At the Adoption and Surrogacy Law Center it is our policy to review the entire health insurance policy of a gestational carrier or surrogate before we begin drafting a contract. Insurance reviews are a crucial step in the legal process when contracting with a gestational carrier. A thorough and competent insurance review protects both the carrier and the intended parents. Most gestational carrier agreements provide that the intended parents will reimburse the carrier for her copays and deductibles for healthcare expenses related to the pregnancy, but it is expected that the bulk of the carrier’s healthcare expenses for her maternity care, delivery and post-delivery care, as well as any complications that might arise, will be covered by her insurance. If her policy has a clear exclusion that excludes coverage for her serving as a gestational carrier or surrogate then the parties might have significant unexpected medical expenses.
In order to conduct an insurance review, our office requires the full up-to-date policy from the gestational carrier – not just a summary – along with proof of coverage. When reviewing such health insurance policies, coverage issues can exist not just in the “Exclusions” part of a policy but in other areas, including but not limited to, in “Covered Services” and the “Subrogation/Coordination of Benefits” sections.
Oftentimes there also are important coverage issues in the health insurance policy that should be incorporated into the contract. For example, if the carrier or surrogate receives an allowance or credit towards her medical costs, then a determination must be made as to whether she should be reimbursed by the Intended Parents for using her allocation (that might otherwise go towards other medical bills including for members of her family). Moreover, sometimes there are certain programs that the carrier or surrogate should know about in which to enroll. These are just a few examples of why a detailed coverage review is important. Sometimes certain procedures may not be covered such as abortions or the use of a mid-wife.
What is a Coverage Opinion Letter?
Once our office completes an insurance review, we can issue a legal opinion letter summarizing our findings and stating whether or not maternity coverage will be available, or whether there is a clear exclusion, or whether the language is so vague that further inquiry is needed. In addition, the coverage letter will include any recommendations to the parties about other aspects of coverage such as: whether the carrier should enroll in a special program or whether she should be reimbursed for any allowance she is provided. This process gives security to the carrier and the intended parents, safeguards all parties for the duration of the gestational carrier arrangement, and ensures that all relevant aspects of coverage are incorporated into the negotiations between the parties as well as the gestational carrier or surrogacy agreement.
What if There is an Issue with Coverage?
It is critical that the insurance review occurs prior to contract drafting is to identify issues when they can still be addressed. If the health insurance policy of the surrogate or carrier contains a clear exclusion, then it may be best for the carrier or surrogate to obtain other coverage. If coverage cannot be changed or supplemented and the carrier denies maternity benefits, then an appeal may be necessary. Our office represents clients in appealing coverage denials.
Insurance Reviews for Non-Clients
We perform health insurance coverage reviews throughout the United States whether or not we are engaged to represent any of the parties in the process or not. While insurance reviews typically are included as part of our services when drafting gestational carrier contracts, we perform them as an independent service as well. In addition, we provide legal assistance and litigation services when coverage has been denied in assisted reproductive technology matters.
Please contact our office with any further inquiries about our insurance review and opinion of coverage services.